Diagnostic Testing

Various tests may need to be carried out to ascertain the extent of any damage. Some tests will examine the structure of the brain and some the functioning of the brain. The following are the main tests that might be carried out by a consultant:

Stucture Tests

X-rays
These will usually provide images of the skull rather than the brain itself. They can be helpful in detecting skull fractures.

Lumbar Puncture
This is used to analyse fluid which circulates around brain and the spinal cord. An analysis of fluid can show a haemorrhage in the brain or spinal cord, infection or the presence of neuro-chemicals indicating brain damage.

CT Scan
This slices the brain into slabs and passes x-rays through the patient and is used to evaluate conditions including subarachnoid haemorrhages and strokes.

MRI Scan
An MRI gives a strong magnetic field which gives greater detail than a CT scan because of the way that the radio frequencies and protons react. It can show where a blood-brain barrier has been disrupted. An MRI is so sensitive that it can detect silent brain damage.

Functional Tests

PET and SPECT
In PET (position emission tomography), radiopharmaceuticals are injected intravenously to produce gamma rays. These gamma rays can be detected with a scanner which shows the distribution of radionuclide through the brain. Activiation scans permit the mapping of activity during cognitive tasks.

SPECT is similar to PET but is readily available and cheaper. The difference is that SPECT produces radioactive tracers.

Some SPECT and PET tests conducted after brain injury have shown damage whereas MRI scans have shown no damage.

MRA (Magnetic Resonance Angiography)
This is a means of visualising the carotid and vertebral arterial systems in the neck of the brain without having to inject contrast into the bloodstream. The patient is spared the risk of allergic reactions to the dye although the resolution is not as good.

EEG (Electroencephalogram)
This monitors the brain’s electrical activity with electrodes. They record electrical activity.

MRS (Magnetic Resonance Spectroscopy)
This detects how an injured brain reacts. It is a new diagnostic measure used in conjunction with an MRI scan.

Traditional Neurological testing
A Neuro-psychologist is an expert who will carry out a number of tests over a period of time to assess the consequences of damage to the brain and identify any rehabilitation requirements.

Assessing Responsiveness
Following trauma, an assessment is carried out by means of a scale called the Glasgow Coma Scale (GCS). The scale assesses motor and verbal abilities. The maximum score is 15. A score of 13 to 15 usually indicates a mild injury. Scores of 9 to 12 indicate a moderate injury and scores of 8 or less indicate a severe injury.

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