Cognitive impairment and depression post-tbi/ cause?
 

Hello people,
I want to share my story and ask some questions about it subsequently.
When I was 16 and a half years old (12 years ago) I was assaulted on the street by a guy who was trained in Kickboxing. This sob knocked me out and kept on kicking on my head while I was unconscious on the ground. I was unconscious and had retrograde amnesia for a very short period of time like below 10 minutes (possibly below 5 minutes), but my nose and the ethmoid bone behind it was broken. Not much and I would have had an open head injury. Well I didn't feel any other symptoms like dizziness or confusion immediately after the concussion, but could indeed stand up and call the emergency by myself.
However I had a partially torn ethmoid artery which tore apart fully a week after the incident and because my doc ****ed up and tried to stanch the bleeding first with balloons I had three consecutive days of the most intense pain in my life until I got the surgery which solved the problem. The incident however had deep psychological impact on me, because other than that incident I had a very troublesome environment with abusive parents and no other social support.
Ever since that incident my personality has profoundly changed. I became depressive and lethargic and I feel like my cognitive functions were impaired.
This impairment becomes most apparent when I try myself at math. I was really strong at math before the incident. Afterwards I had troubles at solving even easy problems. I was ahead of a couple of guys before the incident who became better than me afterwards. I feel that my short time memory, my attention and my focus got damaged. Furthermore I develop fatigue very easily.
However Im nonetheless unsure wether the depression and the cognitive impairment as described above could really be the result of the incident or rather the result of a psycho-reactive misadaption after the concussion. They say that the duration of unconsciousness and amnesia correlate with the brain damage. If so, I shouldn't have these problems right now since I was only unconscious for a very brief period of time, should I? Is it possible to display resp. exclude structural damage in the brain through medical imaging?

LTagard,

Welcome to NeuroTalk.

Everything you are struggling with could be directly related to physiological damage to your brain. Many can have similar problems without ever losing consciousness or having any amnesia. Those are just 'ball park' indicators. They are not very reliable.

Have you ever had a Neuro Psychological Assessment ? That would be a good way of defining your capabilities. They are expensive but insurance usually pays a good portion of the cost.

Imaging may show so problems but at this point, I don't think it would change any treatment. The above NPA would be more useful. You said "Is it possible to display resp. exclude structural damage in the brain through medical imaging?" I don't understand fully what you were trying to say.

Regarding your math skills. If you need to use math regularly, it is likely you can retrain yourself. The brain is very adaptable. "my short time memory, my attention and my focus got damaged. Furthermore I develop fatigue very easily." These are common struggles many of us have. Fatigue is often due to over-stimulation. Too much sound, visual and other stimulation can cause fatigue. We tend to need to live quieter, moderated lives. We can help you understand how to do that.

It is not uncommon to struggle with depression after a brain injury. Plus, PTSD would be common in a situation like yours. Are you getting help with that ? The personality changes are also common. I went through a serious personality change after a severe concussion at 10 years old.

You have found a good place were many of us understand your struggles. Please feel free to tell us about any struggles you are having. It would help to introduce yourself. What do you do for a living ? What part of the country are you in ? Anything you can tell us can help us understand how your life and environment may be impacting your struggles.

My best to you.

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Hey man,
thanks for your reply.

Yes, I think they did that in form of a medical opinion in the course of the legal process that followed the incident. But the methods these docs employed were only suitable to detect major differences in cognitive abilities before the incident and after like in case of real retardation. By definition they cannot find out whether your IQ took damage since they didn't have an IQ - estimate pre-incident.

For example I heard they could detect "scars" in the nerve tissue by measuring fluid movement in the brain through special MRT or PET scans. I had hoped that maybe some guys in here could have further knowledge on that.

Yeah this is what I mean. I was an introvert anyway before the incident but since then I get sensory overload on a regular basis. I don't need math on a regular basis. I just feel disappointed if I cant solve a mathematical problem and other than that I see it as an indicator for the lack of problem-solving skills. I do experience a lot of difficulties with my current job though and had a lot of difficulties during my studies.

[QUOTE]It is not uncommon to struggle with depression after a brain injury. Plus, PTSD would be common in a situation like yours. Are you getting help with that ? The personality changes are also common. I went through a serious personality change after a severe concussion at 10 years old.[/QUOTE}

The first time I went to a psychologist was 3 years post-incident. Ever since then I received psychological and psychiatric treatment by various psychologists and psychiatrists. Before the incident I didn't have any psychological issues.
This is part of the reason why I asked about medical imaging. The assailant got away with a ridiculous punishment of 1000 Euro (thanks to our social laws that take care of the assailants integration into society first and spit on the victims integration) and I've been having problems for almost 12 years now. If its possible to objectify the damage I took from that incident I could either approach the insurance or the assailant for compensation. Other than that I'm just curious whether I really took structural damage back then or whether I'm just imagining that.

Thanks very much. I studied medicine but had a hell lot of difficulties to pass by. After I finished I worked as a surgeon at my fathers clinic for a year and now I'm looking for a job at the hospital. I'm not from the USA but from Germany.

The imaging that appears to be best at showing evidence of damage is DTI MRI. Diffusion Tensored Imaging. It measures fluid flow in the white matter. There are some who understand how to use fMRI to observe brain functions. They would need to have a good comparative database. qEEG can also indicate problems but again, you need to find a good specialist. SPECT or PET are questionable. MRI/MRA might be interesting.

A normal full battery NPA will measure the various memory functions, executive functions, speed of processing etc. IQ is not as important as function. They can chart your function compared to the general population. They do not usually try to chart before vs after functions. School achievement, family and teacher observations of personality, etc. before and after are usually about as good as it gets.

There are tests that can approximate pre-morbid intelligence. Some skills and functions that exist after the injury are related to intelligence before the injury.

For example, I have short term visual and auditory functions in the bottom 5 to 12 % of the population. My processing speed is in the bottom 10%. My intelligence is in the top 12 to 2% of the population. The weak areas in my intelligence are likely due to injury as they are memory and processing related.

My ability to function at a high level indicates that I had pre-injury over-learned skills that outlasted the injury. These are also intelligence related.

If you are working as a surgeon, what can you claim as ongoing losses ?

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Is this also valid for diffuse damage like in case of a hit to the forehead or only valid for focal damage like penetration/bleeding etc.?

Lack of concentration, fatigue, lack of problem-solving skills. My father runs an outpatient clinic, so we only do small surgeries. Some people might think that I'm lamenting on a high level, but I had a certain personality before that incident and part of it were my intellectual abilities. There is nothing more fundamental in life than a change in personality.

I'm confused. Your quote of my post does not match the question you ask. I'll try to respond.

DTI does not identify specific injury. It just identifies the fluid flow due to that injury or dysfunctional area in the brain. Focal vs diffuse does not make a difference from what I understand.

What income losses are ongoing ?

In the US, it is hard to claim changes that do not result in a loss in income. There can sometimes be a claim for loss of relationship issues, etc. but those are hard to prove and claim. Claiming financial amounts for a change in personality would be difficult too.

If you are denied a hospital job due to your injury, the wage differential may be claimable. I don't know German or EU policies.

Europe uses the term surgery different than the US. Here, surgery is always cutting into the body. From what I gather, surgery in the EU can also mean a medical exam, consult or treatment. Are you a "cut into the body" surgeon ?

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Ok Im going to try and explain. I assumed that if you have selective damage like reduced processing speed or reduced visual functions parallel to high overall intelligence you would possibly have focal damage instead of general damage. Furthermore I used to believe that intelligence was generally affected by traumas to the forehead/frontal lobe. This btw is also what confuses me about your statement. From the studies I read traumatic brain injury leads to a decrease in overall intelligence instead of selective abilities, doesn't it? And last but not least, isn't processing speed a part of intelligence?

Yes its the same over here. The problem is: at the time of the incident I had no income. This is why I would like to know wether it is possible to display structural damage through medical imaging and relate this structural damage to my 10 years of psychiatric history and relate that history to the incident.

Yes of course I cut into the body. I do small surgeries like appendectomies or nail extractions or cutting out abscesses...

"From the studies I read traumatic brain injury leads to a decrease in overall intelligence instead of selective abilities, doesn't it?"

Not so. The various parts of intelligence can be impacted differently. For example, my biggest deficit is verbal processing. My math skills are much better. I would have short term math deficits that I could overcome with training. I never could improve my verbal aptitude. Different skills use different areas and processing protocols. My verbal processing took a big hit 15 years ago from a mild concussion. I could no longer track characters in fiction writing and would get overwhelmed with overly descriptive writing. I ended up not renewing the magazine subscriptions I had.

The WAIS system of testing breaks down all these different functions. https://en.wikipedia.org/wiki/Wechsl...lligence_Scale

Research shows that a disparity between intelligence scales and memory,processing speed functions is indicative of an organic brain injury that happened after the intelligence was developed and matured.

My WAIS-II scales range from a high of 99% to a low of 88%. If you look at the bell curve/distribution of WAIS scales, you will see that is quite a differential. My WAIS-II processing speed was at 10%.
My Wechsler Memory scales are at 5% to 12% with one limited area at 22%.

The psychologist who tested me and wrote the report rejected the disparity as faking. He position was "How can someone with 88 to 99% intelligence have such low memory functions? " btw, My validity scores were 48 and 49 out of 50. Scores below 37 show possible faking.

All this to say that traumatic brain injury can cause disparate levels of function.

Regarding loss claims. If your injury caused you to have to settle for a lower paying job, that could be considered. It would be hard to prove. Trying to establish a monetary value to compensate for your psychiatric struggles would be difficult.

I think it would be extremely difficult to find a specialist who could order and then interpret imaging to directly point to your struggles, especially at 12 years post injury. Any damaged tissue would have be resorbed long ago. Small bleeds can be resorbed within a week or so. An fMRI could show functional weakness but, as I said before, would require finding a specialist with a database of normal functions. We have such a specialist in the US near Salt Lake City who claims to be able to diagnose against a normed database but their practice is unaffiliated with any research institution. I doubt any court or such would accept their report.

qEEG has the same problem. It can point to dysfunctions with statistical accuracy but is not accepted by our courts.

Research shows that severe injuries like yours often result in a failure for the brain to mature in judgement/decision making skills that usually mature during the late teens. That may be measurable with a full battery NeuroPsychological Assessment. From what you said, I don't think you had anything close to a full battery NPA.

Ptsd
 

Is PTSD following the incident also a possible cause for irreversible damage or lack of "maturation"? I always thought that at the age of 16 or 17 the brain has reached full maturation.

The brain continues to mature until 25 years old. The critical issue during the teens is the maturing of the judgement processing system. When the brain's development/maturing is interrupted by injury, this maturing can be limited. This judgement maturing only happens during this period. It will not start up and continue to full maturity with just a delay.

Soldiers are best in battle at 18 to 22 because their judgement system has not matured yet.

A person with brain trauma or illness during these years can be left with a maturity level equal to the age when their injury/illness happened/started. If they recover soon enough, some of the maturing can still take place as the maturing process slows down.

I know a man who was drug addicted during these years and has the maturity level of a 12 to 14 year old. I know a woman who spent most of these years fighting schizophrenia and bi-polar disorder and has a similar maturity issue. Brain trauma that takes years to heal can cause the same.

If a personality can be changed by trauma, it easily fits that judgement maturity can, also.

A common struggle after brain trauma is recognizing facial expressions and other social cues. It is due to a break in the hard wiring.

Understanding these issues can help us move forward by utilizing assistance and guidance as we make decisions.