What does an MRI tell an MD?
 

I've now had two appointments with a concussion specialist - by all accounts an outstanding doctor (former neurosurgeon). He said that MRIs typically don't reveal anything in relation to a concussion, but he said it might be worth doing one just to cover all my bases. He said I didn't need to decide one way or the other right away.

Has anyone had an MRI following a "mild" concussion? What sorts of things might it tell a competent doctor? I would prefer to avoid being stuck in that tube for half an hour if I can help it...

He actually gave you a choice? Wow. I'm impressed by this doctor already.

My doctor had an MRI of my brain recently specifically to look for damage to the vestibular region of the brain. I think typically they are done to look for bleeding or more serious damage. They almost always come up negative for concussion. Actually, this is by definition I think -- concussions have negative scans. If something turned up, you have more than a concussion at the very least.

MRI's and CT scans after a concussion are done to look for and rule out an more serious injuries. Bleeds will show up on the 3rd day but usually not sooner. If they spontaneously stopped, they will be resorbed starting the 3rd day.

MRI's will not show the minute injuries from a concussion unless the MRI coil is a 6 Tesla or greater. The normal 1 to 2 Tesla coil MRI equipment does not have fine enough of a resolution. They will show a BB side item and sometimes down to the size of a grain of salt but nothing smaller. The diffuse axonal injuries common to concussion are much smaller. More like the size of a hair strand.

Doctors often use them to cover their own malpractice liability issues. The option is wise as it allows the patient to consider the financial cost. Insurance can also baulk at paying for an MRI that they deem is not medically necessary.

Getting stuck in that tube can be made much easier if you are prepared. I am claustrophobic but have successfully had many MRI's. The trick is to close your eyes before they roll you into the tube. Also, hold your elbows in tight so that you do not feel the sides of the tube. Now, think of something pleasant and spacious. They will give you ear plugs to help with the pounding noise. Use them.

But, as chitown said, a concussion without complications will result in a negative finding.

CT scan
 

My husband has been getting a CT scan every month since his m/c accident 3/9/2011. It is possible, like in his case, to develop CSF (Cereobral Spinal Fluid) in the frontal lobe where there was an injury to the brain or shift (my understanding). A month later, the CSF was absorbed by the body but because there was still a small empty space a vessel ruptured and left a small bleed. His neurosurgeon decided to monitor it ...

His next appointment is June 24, 2011 with a more recent CT scan on the 23rd.

milesa7,

Your husband's CT's sound like they have good reason to be repeated. You husband suffered a severe Traumatic Brain Injury. Most of the questions about MRI's and CT's are in regards to mild TBI's, concussions, subtle brain injuries and such traumas that had limited LOC (loss of consciousness) if any LOC at all and rarely any hospitalization.

It sounds like you husband's doctor is being very thorough. You are both very fortunate to have a good doctor. As he progresses, you will likely hit the recovery wall where he will have Post Concussion Syndrome like symptoms. The recovery process will likely slow down as he starts to deal with the diffuse axonal injuries that tend to become more chronic than acute and life-threatening.

Remember the good times you had just before his accident. You can tell him about these times and build from them, especially if he is left with a flat emotional affect like many of us are.

There can be a big difference between someone who is behaving poorly due to their own choices and those who have behavioral struggles due to physiological problems. We can choose to reject the negative behaviors when we acknowledge that our damaged brain leaves us prone to poor behavior.

I struggle to understand this myself. Before my most recent injury, I would defend my poor behavior. Now, I accept that I behaved poorly, especially when it is a symptom of my PCS and ask forgiveness then try to avoid the behavior the next time. The triggers for poor behavior are usually the same as the triggers for the head aches and cognitive struggles. Now that I know how to recognize the PCS triggers, I can be more proactive at avoiding them and the poor behaviors that may result.

I hope this is making sense. If not, maybe someone else has this same experience and can explain it better.

My best to you all,

When I had my TBI my symptoms are all concussion symptoms but when my PCP did the imaging (3 days later) it showed brain contusion (literally bruising on the brain). After that several MRIs and no more bleeding but showed minimal brain softening (encephalomalacia) and will show that rest of my life. Not that anything can be done for that but is just an evidence there was a mild TBI.

They can look at your vestibular system, sinuses and so many other things just to rule out and give you peace of mind. Sometime subtle CSF leaks can cause headaches etc., which may be able to fixed. Anyway the chances of all these are very less if it is a mild concussion. I didn't know I was claustrophobic until I got into the MRI. So next time my doctor gave me Xanax and sure I tolerated pretty well. By the way that is how I found out Xanax helped me with Dizziness too. As Mark mentioned close your eyes before you they slide you into the machine and never open until you get out. It is not that bad after that. They also talk to you during the whole process explaining what is going on.

When I had my TBI my symptoms are all concussion symptoms but when my PCP did the imaging (3 days later) it showed brain contusion (literally bruising on the brain). After that several MRIs and no more bleeding but showed minimal brain softening (encephalomalacia) and will show that rest of my life. Not that anything can be done for that but is just an evidence there was a mild TBI.

They can look at your vestibular system, sinuses and so many other things just to rule out and give you peace of mind. Sometime subtle CSF leaks can cause headaches etc., which may be able to fixed. Anyway the chances of all these are very less if it is a mild concussion. I didn't know I was claustrophobic until I got into the MRI. So next time my doctor gave me Xanax and sure I tolerated pretty well. By the way that is how I found out Xanax helped me with Dizziness too. As Mark mentioned close your eyes before you they slide you into the machine and never open until you get out. It is not that bad after that. They also talk to you during the whole process explaining what is going on.

When you say "flat emotional effect" what do you mean. If your wife was to up and leave, would it not bother you? If you were to watch a compelling movie which made everyone cry, would you not cry? Are you not emotionally attached to people, places, or things?

Sorry, I am just trying to understand why my husband is the way he is...he came home from work one day and walked right passed the bathroom without saying a word to me while I was getting ready. Seems like I'm living with a completely different person, who doesn't see me the way he used to.

I have the flat emotional effect that I assume he is talking about and I'm not sure if I can explain it to you. If I sit and think about my situation, I expect to feel something come over me that is saddness... I almost brace msyelf for it mentally but it never happens. It's as if that chemical I once had for feeling poorly about a situation i'm in, is simply not there. I haven't once felt bad about my mtbi. It's bizzare. You would think this situation would be depressing. In fact that's one of the first things each of my friends have said. "Wow, you must be so depressed and crazy that you can't workout!" Nope, not really! I simply do not care. Which is weird weird weird for me and they just don't know what to make of it. I live for my workouts and tHis is really a bad thing that happened to me, but I can't feel it. It's almost creepy.

This effect has been great in business. I find myself cutting to the chase better with people who work for me instead of worrying about their feelings... which is a fine balance of keeping them happy, I know that, but hopefully you get my point.

WHen it comes to family, however. If something were to happen to a family member. I think I would not experience it in exactly the same way but yes it would hurt deeply just as it should. I assume. I think something like that would likely just bring on a flood of PCS symptoms and stress.

My MRI didn't show anything concerning my concussion, but it did show a severe sinus infection.

I knew that I had had a cold, but my PCS had masked the other symptoms of what turned out to be a very severe sinus infection. My neurologist told me the bacteria in my sinuses was close to penetrating the skull and affecting my brain.

An MRI is nice just to rule out the other possibilities. It gives you less to worry about. :)

Honestly, after my post-concussion experience, I'm more afraid of side effects of the MRI than anything else. This may be irrational, but I feel as though being in a tube surrounded by powerful magnetic forces for 30-40 mins probably isn't the best thing for your brain + body. Plus, there are websites where people have posted about various side effects of MRIs (although the medical community says that there are no known side effects). On the other hand, getting one done makes sense insofar as it would rule out other problems.

I guess I'll sleep on it for now.

MRI-My First One
 

I actually had my first MRI a couple weeks ago and it really wasn't that bad. I got to listen to music while it was going on and my opinion is that it really more reassuring for me to rule out all other negative possibilities. My only problem is that I got an itch an I got yelled at for moving... opps! LOL Other than that I am glad to know about what is going on in that head of mine. :D

I too am impressed by the technology of the MRI, but am confused by it's capabilities, or lack of.. I was recently diagnosed with TLE, and informed my doctor that I was highly suspicious that I had suffered one or more concussions in my youth while playing football. He then ordered an MRI, although in my own personal research I find that there's no way to tell so many years later that I had a concussion! I am now 62. If anyone can shed some light on this perplexing situation, I would very much appreciate it.

JohnGee,

I am confused. And that is not hard to do. What is your perplexing question?

Well, I've pretty much decided to get an MRI done. The specialist who is helping me thinks it's a good idea (presumably to rule out any other issues). So:

- Use earplugs
- Close eyes before entering tube
- Keep arms close to sides to avoid touching the tube
- Visualize a spacious and peaceful scene

Any other suggestions?

Think Happy Thoughts
 

:o

When I had my MRI done, there was like a little window in the top of the machine which I could see some trees outside upside down. That was nice. I had access to headphones but I had to keep asking the MRI tech to turn the music up because the noises of the brain scan over-powered the music. I don't know if you like music but I can use music as a great coping mechanism. They let me pick my own radio station and everything! One important thing to remember is that it is absolutely painless and to stay still no matter what because they won't be able to get a clear picture if you're moving. I actually went to get mine done during my lunch break and I almost fell asleep. When it was over, I didn't want to get up...a nap seemed pretty appealing because they make the thing you lay on pretty comfortable. ;)

Open Bore or Wide Bore MRI
 

I've been getting MRIs and Contrast Cat Scans since 2010 for my TBI (auto accident in 09). I called around to the hospitals in my area and found several that had Open Bore and Wide Bore MRI scanners. Claustrophobia kept me away from a regular MRI. I used the Wide Bore with no problem. It's very wide and roomy and I wore virtual goggles that took me on a virtual tour of Ireland. I could still hear the noise of the machine, but it was tolerable. I also had a "trigger" that at any point I needed to stop, I could just hit the button and we could pause~Never needed to use it. It cost no more than a regular MRI to use and I didn't need any thing other than a regular rx for an MRI. The Wide Bore is is open at both ends, the Open Bore is in the shape of a big "U" and isn't completely closed in. Both are much shorter than the traditional MRIs. My MRIs are useful to my Neuro and my family (They actually got to watch the MRI scan with the Tech and saw my injuries). I'm one of the rare people that the impact lesions actually showed up clearly on the MRI. Unfortunatley, it's common for MRIs not to show injuries to the brain.

As far as TBIs go, one thing I've learned is that they can be as individual as our own finger-prints. There are somethings that are similar, but we each have a unique set of TBI issues. I finally got fed-up with jumping through hoops for everyone and told my Neuro that I was taking charge of my own TBI and that I would be making some of the decisions that he may not agree with. I'm fortunate that my Neuro is sensitive to the patient and promotes being proactive in my own treatment.

There will be many people that won't agree with this, but please give it some thought...I was very much a "naturalist" before my TBI. Didn't like meds and pills. I struggled with that for quite a bit after my TBI. Now, I whole-heartedly believe in better living through GOOD chemistry. A good Neuro will "teach" responsible use of pain-killers (narcotic and non-narcotic) for pain management. If you don't have a Neuro that specializes in TBIs, please consider seeking one out. If your insurance requires a refferal, insist on one from your physician.

@ Milesa7...Wish I could explain the emotional flatness. It really isn't about not having emotions, but rather that part of the brain that just shuts down at times. We like to romantically think our emotions are all from the heart and soul, but they're really dictated by our brain. I was only married 4 months when I acquired my TBI...Not only did it change my life, but my husband's as well...Neither of us had a clue this was what we were signing up for. It's difficult at times to think outside of our own "TBI box", but it's necessary for us to do so and be sensitive to the needs of those around us. TBI therapy helps immensely with that, for both the TBI survivor and the survivors loved ones.

Long live spell-check~Jinxicat9

First I did an MRI at the hospital and it doesn't have an open end (all closed) and towards the end of procedure I freaked out. But after that I did many open bore MRIs (thanks to Jinxicat9 for technical term) (1.5 T magnet - heard 3T is better but can't find one) . Doctor prescribed 0.5 mg Xanax but I took only .25 mg and it sure helped a lot to relax. But open bore MRIs as Jinxicat9 mentioned doesn't give me the intense claustrophobic feeling.

Staying still is a must or they have to go over some procedures again to get a clear picture.

Jinxicat9 : I also had brain contusions in temporal and frontal lobes. You mentioned going natural way helps. If you don't mind can you tell us where did you had the lesions and what symptoms you struggled/struggling and what natural ways helped you?

Thx.

There were two impact contusions. The first on the initial impact, slamming the right frontal/forehead area and a second impact when the car spun around and slammed the other car again...That impact contusion hit the right side also, but more to the back of my head. All my scans show lesions on the left frontal lobe and left temporal. There are spiny barbs in the interior of the skull and it's been explained to me that when my brain slammed against the left side of my skull, those spiny barbs hooked the brain and tore off small, but essential parts of the left-side.
I also have bone fragments between C5, 6 and 7. I have extreme short-term memory loss, word retrieval, loss of balance/vertigo, visualizing numbers, migraines and as a result of the TBI I developed epilepsy~Petit Mals/Absences seizures and Partial Complex Nocturnal seizures. My "day" seizures are subtle, like daydreaming.
Because my other bodily injuries were so severe, the TBI wasn't the priority at the time, so precious time was lost and things will progress much slower in therapy. My Neuro also encourages me to get monthly B injections, take 500 mg of Magnesium daily, 300mg of DHA fish free Algae based Omega3 and Vitamin D...All of these for aiding in higher brain function and memory. I also take (w/Neuro's approval) Resveratol 500mg and 4500 mg of Glucosamine for my neck. I take additional natural supplements depending on what I feel I need, but not without my Neuro's approval to avoid any drug adverse reactions with my anti-seizure meds.
I also have absolutely no aversion to the hard-stuff when I needed it-Vicodin for migraines and Xanax for stress works miracles when I need one.
I try to avoid MSGs, Tofu and processed soy as there are now concerns that these may change or slow brain function. I'm an ex-vegitarian as I have added organic grain fed free range chicken, wild caught salmon and albacore tuna to my diet since my TBI. I eat nothing that may have growth hormones in it. I'm new at this TBI stuff, but trying to learn as much as I can about it. If not curing it, at least keeping it from getting worse. However, I do enjoy :wink: a nice glass of wine or a cold brew for my own cathartic therapy too.
~Jinxicat9

Jinxicat9 : Thanks much for the explanation and other information. You sure went through a lot and going through a lot and seems like you are facing it strong. I was strong in the beginning but after 2 years still suffering with lot of symptoms and thinking positive getting tough when I cannot find any workarounds or progress.

Mine happened after a fall and got hit in the back of head and my brain bounced and scratched by bony edges of skull as you mentioned and so the bleeding in left temporal lobe and bilateral frontal lobes.

We have few common symptoms. My terrible symptoms mostly are dizziness/imbalance, fatigue, facial pain, dull headaches etc., No meds helping with these symptoms and some of them made it worse I think. Xanax helped me for dizziness/dull headaches but later on there is no effect. If I drink a glass of wine it sure helps me to numb the symptoms but the next day morning becomes a disaster. I was on Xanax and then to Klonopin and then to Xanax before quitting. Klonopin was worse and I switched to Xanax before quitting. When my symptoms are terrible even Xanax doesn't do a thing.

I only take Elavil 10mg at night and it keeps my stomach calm and helps to sleep and nothing else. My new Neuro wants me to stop it if I can and wants me to try low dosage Topomax for headaches etc., My EEG doesn't showed ay seizure activity and Neuro also doesn't think I have any. I do day dream and stare blank at T.V/computer at times and not sure I am having any seizure activity.

Learning about mTBI/PCS seems like never ending journey. Ofcourse each TBI is unique and I am still trying to find something which gives some relief and no luck yet.

Again thanks for sharing all the information and learnt some more.

jinx,

Are you aware that some anti-seizure meds are counter acted by magnesium? I know that Neurontin (gabapentin) is. You may want to check this out. I take my magnesium in the morning so i can take the Neurontin before bed.

Thanks for the heads-up Mark...I'll take a look into that

@pcslife~ I'm having a stretch of negative days too. Sometimes I feel like I take two steps forward and three steps back.

I'm having issues with my ego and pride too. I've always been quick-witted, "fast smart" and more than capable to take on multiple challenges. Not anymore. Sometimes now, I feel like I have to push myself too hard to prove I'm not "stupid" just because I have TBI.

Lately, I've noticed that it's becoming more difficult to spell correctly, even with practice. Some words, even easy ones to spell, completely escape me. Today got me down because I couldn't remember how to spell the word "suit" without looking it up.

I'm trying to accept this as part of the journey, but the slips backwards are still difficult for me.

Off the Wall Question...
 

I am in the Winter Haven, Florida Area......Does anyone know of a good Neurologist in this Area? http://www.brookslawgroup.com

Is there some way to get rid of posts containing advertising (for example, links to law firm websites) - like the above post?

Jinxicat9 : I know what you saying about ego and pride. I still have some of it and most of it is gone.

So far my memory is ok (I think). What TBI can do is so frustrating.

I accepted some of the defects but most of it not sure what I can do. That is where therapies and meds has to help me and still searching...........

I had an MRI on my knee a few years ago and they played 'War of the Worlds' on my headphones. That was one of the weirdest things ever.

Got one on my head tomorrow morning, hopefully I'll get a more appropriate choice of music! Will also follow the advice in this thread, thanks all

MRI: check
 

Well, I got the MRI done. It wasn't too bad (about 25 mins), although the 2.5-hour trip there and back (in the wee hours) left me a bit rough around the edges. The technician let me see the images afterwards - not that they mean anything to me. I will be interested to see the CD and report in a week or two - definitely going to order a copy.

Hopefully I won't have any side effects from the MRI. Glad it's over, anyway. Now, back to rest + healing...

Well, my MRI appears to have been normal, or "unremarkable" in the technical language of the radiologist (I requested a copy of the report). The various findings:

- Susceptibility weighted sequences unremarkable
- No evidence for recent or remote hemorrhage or hemorrhagic contusions
- No evidence for diffuse axonal injury
- On FLAIR weighted sequences no evidence for focal area of encephalomalacia or gliosis
- No evidence for cortical scarring
- No significant brain atrophy
- Remainder of exam unremarkable:
- No mass lesion and no midline shift
- Normal size of ventricles and sulci
- No evidence for recent or remote hemorrhage or ischemia on diffusion weighted and susceptibility weighted scans

Overall impression: "Unremarkable MR of the brain, in particular no evidence for trauma sequelae."

Of course, as we all know, evidence of concussions typically doesn't show up on an MR. So I guess this just rules out some other concerning possibilities, which is at least somewhat reassuring...

the good thing is that you now have peace of mind that it wasn't something more serious than a concussion. i don't have that comfort as i'm still waiting for my ct scan. after that my doc wants to do an mri but its a 6 month wait in canada for that!

Yes, I know, I'm glad nothing more serious showed up on the MR.

You may not have to wait that long, depending where you are in Canada (I live in Toronto). At least in my city, MRI exam openings frequently come up, as long as you're willing to be flexible as to timing. The machines run 24/7 and openings seem to come up late at night and early in the morning. You just have to keep calling the MRI booking office to see if anything has opened up. I think that head MRIs may get some priority when openings become available.

i'm in mississauga. i asked for an mri but the doctor said to do a ct scan first. how long did it take for u to get an mri greenfrog?

My initial appointment was about two months off, but I was able to get an appointment within a couple of weeks once I followed up with the booking office to see if they'd had any cancellations. Every time I called them, they had at least one opening within the next few days.

confuused905 - If you are doing scan several weeks after your head injury it is better to do MRI than CT scan. With CT scan you also expose yourself to radiation. I did several MRIs after my mTBI (with/without contrast, blood flow in arteries, cervical spine etc.,). No one even suggested CT scan.

thats exactly what i thought. but my first neuro appointment isn't until November 25th. however, a spot should come up before then (so i've been told). i think my doctor wants me to do ct first and then by the time i see the neuro if i'm still having symptoms he'll recommend an mri. here's the thing. my family doctor doesn't even know what a "mild traumatic brain injury" is. he asked me what it is! i responded "its like a concussion".

Statistically, a CT is best when done at about 72 hours post concussion. Statistically speaking, before 72 hours, bleeds are too small. After that and they tend to be absorbed. If there are no specific symptoms that indicate serious neural deficit, any imaging at a later date will be negative. The microscopic damage common to concussion does not show up on CT nor MRI. It you have access to a high Tesla (5 and up) MRI that may be in a research hospital, it may be able to show fine damage.

Except for those bleeds that will likely show up with severe symptoms, there is rarely anything that can be done based on imaging. Their value is as a way to rule out more serious damage.

My brain has been imaged with CT, MRI, MRI/MRA, SPECT, EEG, VEP, AEP and qEEP. Most of these imaging studies were done without insurance coverage so the doctor did not prescribe them without serious concerns first. Only the VEP, AEP and qEEP have shown any deficits. In some people, qEEP can be used to direct volitional neuro-feedback to reduce some poor waveforms. In my case, my neuro combined my 40 year concussion history with the severity of my qEEG abnormalities to suggest that neuro-feedback would be of little help. He was surprised at my high level of functioning considering the severity of my qEEG results.

btw, If the MRI is an open MRI, it is not designed for any fine resolution. It is more oriented at diagnosing damaged organs and tumors and larger issues such as knee injuries.