[Ady_P]

Hi all, I'm really confused

I posted here previously about brain functioning problems following head trauma from boxing (6-7 weeks ago). I've experienced all the usual PCS symptoms plus major loss of motivation to do anything, plus anxiety and severe depression.

My GP had several blood tests done, including thyroid function, testosterone and prolactin - so he rules out pituitary damage and also considers this to be a mental health issue, not concussion. I've been seen by a psychiatrist twice in 2 weeks, he firmly believes this is related to a previous episode of major depression - when I was convinced I had suffered brain damage from listening to neurotechnology CD's. I was very suicidal and ended up in hospital for a large part 2010.

So along with my recent, rapid decline in mental health, my strong voiced concerns around brain damage from sparring is seriously being viewed as a major depression relapse indicator. I've been prescribed anti-depressants and my existing anti-psychotic medication has been restated to therapeutic doses. My psychiatrist also stated that if he was in any doubt it was other than mental health, he would have referred me to a neurologist by now.

Everyone else around me - medical professionals, friends etc all firmly believe my symptoms, including my fears around brain damage are severe depression. I am complying with treatment and will do whatever it takes to get better...only, somehow I can't quite believe the rapid decline in my mental abilities following the head trauma being coincidental with a depression relapse.

I can't tell if this is due to a part of me that intuitively knows part of my brain has actually been damaged or if its the irrational fear/beliefs caused by psychotic depression?

[Mark in Idaho]

I don't see how one can have an intuitive knowledge of a brain injury.

You could ask your doctors to confirm a lack of brain injury by having a DTI (Diffusion Tensor Imaging) MRI. Properly done and read, it will show if you have suffered a brain injury.

You may well be suffering both a brain injury and serious psychiatric dysfunction.

Getting the DTI MRI done can end the debate so you can get down to the psychiatric care you need.

[donniedarko]

Originally Posted by Mark in Idaho

Getting the DTI MRI done can end the debate so you can get down to the psychiatric care you need.

Are you implying that DTI MRI is capable of showing even the smallest damage to the brain? Never heard of it before so I'm wondering. Also, if that's the case, why isn't that the type of standard imaging used for TBI patients?

[Mark in Idaho]

DTI MRI does not show the damage. It shows evidence of the damage. Brain injury changes the way fluid flows in the white matter. They can see this change in fluid flow.

Think of it this way. If there is oil on your driveway where you park your car, it says you have an oil leak. But, it does not tell you where and why you have a leak or what to do about that leak.

A high Tesla MRI can show the fine damage of a concussion if done early. But, it requires a 6 or greater Tesla MRI magnet. They are usually reserved for research.

But, seeing the damage does not change the treatment so health plans will not spend the money for these expensive and rare MRI's.

If you have a nasty bruise on your arm, it says you are injured. But, there is nothing you can do for the bruise. It just takes time to heal.

[MicroMan]

Mark is right. Currently DTI MRI is considered a suitable imaging technology for showing impact (damage) to the brain resulting from all categories of TBI, including mild TBI. It's based on following water diffusion along axonal tracts in the brain. Since damage linked to mTBI traditionally is associated with anterior/posterior contusions and/or damage to axonal tracts, this technology is highly relevant. Mark actually introduced me to this technology a few months ago in one of my early posts. I'm currently trying to get one of these arranged.

Regarding DTI, there was a recent review and meta-analysis of neuroimaging published by Eierud et al. (2014) in which DTI was shown to be a useful tool for mTBI. In particular, differences in brain anisotropy for controls and individuals with acute and chronic PCS were consistently reported. Interestingly, the brains in acute and chronic PCS showed stark differences as well. In the review, the authors state that the application of DTI to TBI is appropriate, but there is need for further research, particularly large studies.

As for why DTI is not more readily available, there are likely a number of factors. It currently represents an emerging application for TBI, and is therefore not widely known amongst GPs or even imaging specialists (I've learned this first hand). Further, it requires specific software and a Radiologist capable of properly reviewing the data. Lastly, there seem to be a paucity of imaging places that are currently doing this, even in facilities with 3 Tesla instruments.

[MicroMan]

On a note related to the thread title, I too have been told that depression is a significant problem contributing to my issues. Despite evidence that I have presented to the contrary, it is difficult to have a physician consider any other possibility that may be an etiological contributor to various PCS sequelae we face.

It's my personal opinion that most physicians who treat someone with PCS are all too willing to accept and conclude that the individuals headaches, mood swings, anxiety, etc. are linked to depression. Whilst depression is certainly something that most of us are faced with at some point(s) in our recovery, for me it has been a resultant factor rather than a causative one. However, physician's often lack the knowledge and are unwilling or incapable of treating the minutia of issues that someone with PCS are challenged with, and find it all to reasonable to chalk things up to depression.

That's enough of my ranting for today...

[Mark in Idaho]

MM, TMI. Few can follow the technical details you posted. It tends to scare people. It helps to keep it elementary.

Regarding depression. The MMPI-II can tend to indicate depression but when analyzed further with the Cripe Neurological Symptoms inventory, tbi issues can be discerned. Google 'Use of the MMPI with mild closed head injury' and/or Lloyd L Cripe and you will find some info. I do not have the subscriptions to access the article. I have the book that it is published in.

My first NPA report said my dysfunctional memory and other issues were due to depression even though my depression scales from the MMPI showed no depression. The NeuroPsych even said he was defying the multitude of test results to say my cause was depression and that I must have faked so well that I beat the validity tests in the NPA. But, that is unique to me. Others should not try to project my results into their situation.