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Dr. Andrew Rynne

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Is an MRI advisable to diagnose trauma due to past head injuries?

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3360 Questions

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Posted on Fri, 18 May 2018 in Brain and Spine
Question: I asked questions of Dr. Olsi Taka (neurologist) on 20 November 2017. These are followup questions. I spoke about a violent impact when my then partner violently smashed my head into a wall on my left 20 years ago, when I was 30. The doctor said that an MRI would show remains of damage to the brain. He said if I had other past traumatic events, it would not be possible to link the damage to the event when I was 30. The only other traumatic events on my head were when I was 9 and 11. Those childhood impacts were both on the forehead--straight on into the dashboard. The impact when I was 30 was being pushed into a wall on my left--a broader impact only to the left side of my head, with no impact to the forehead. Is it worth having a CT or an MRI if I want to show the damage from the event at age 30: is it possible to distinguish the impact at age 30 to the left side of the head as opposed to the childhood impacts to the forehead? Also, at age 30 I had Bipolar Disorder I: can you comment on the kind of damage the impact at age 30 (or the childhood impacts) might have had on causing or worsening Bipolar?

Thank you.


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Answered by Dr. Olsi Taka 8 hours later
Brief Answer:
MRI should be able to distinguish.

Detailed Answer:
Hello again and thank you for the additional information.

Given the different impact points I think if structural damage is found on MRI it would be possible to distinguish between a forehead and a side hit, the areas likely to be damaged would be different. So on that regard it would be worth having having a MRI. On the other hand as I told you on my previous answer that wouldn't change anything in management, there is no medication or other type of intervention of any benefit after all these years.

As for the bipolar disorder issue, it is a very complex disorder, whose origin is still under study, involving genetic factors with alterations in several neurotransmitter levels. Head trauma is not a known causative factor, it can't be blamed about that. Increased stress levels related to the situation may exacerbate the symptoms temporarily, it may affect the patient in that sense, but can't be blamed for the disorder in general.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 12 hours later
Thank you. Re bipolar disorder, what are the different neurotransmitter levels in which there are genetically caused alterations? If a person has a very high IQ at age 13, will bipolar disorder diminish the IQ significantly over 35 years? Re the head traumas, will they diminish the IQ? What are the possible consequences of a violent blow to the head (such as age 30 above)? I imagine that at most, this could cause death? You mentioned that memory & cognitive functioning might or might not be affected? What is the significance of the "brain scar tissue" you mentioned might be visible on an MRI? Thank you.

What, if any, is a "normal" decline in IQ from age 13 to age 50 (assuming or not an IQ of 143 at age 13)? What would be a decrease in IQ from a violent blow to the head at 30? Thank you.
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below

Detailed Answer:

If by neurotransmitter levels you mean figures then there are no such figures. Weare speaking of neurotransmitter actions at a microscopic level, it is not something which can be measured through some blood test. Furthermore neurotransmitter actions depend also on the type of receptors on which they act, they may have different effects on different receptors in different parts of the brain. Say for example one neurotransmitter like serotonin has antianxiety and antidepressant effects when acting on 5HT1 receptor but cause insomnia and anxiety when acting on 5HT2 receptors. So it's a very intricate network still not well understand which will probably be the object of research for years. There are no precise levels, I can only say that studies indicate several neurotransmitters such as adrenaline, noradrenaline, dopamine, serotonin to be implicated in mania and depression (which constitute bipolar disorder). The same way other traits such as eye or hair color, height etc are genetically determined, in bipolar patients there are different neurotransmitter or receptor levels leading to a predisposition for depression and mania.
As for bipolar disorder effects on IQ, in itself it shouldn't have any major effect on IQ. However depression may affect IQ tests performance (without any real IQ loss) as it may affect concentration and motivation. In addition to that in bipolar patients IQ tests may be also falsely affected by the medications which the patient is under which have the unavoidable side effect of causing some cognitive slowing. So there are no accepted figures of IQ changes with age as tests are affected by many factors.
Regarding effect of head traumas on IQ that depends on whether that trauma caused any brain lesion or not. If there was no permanent damage to brain cells, no loss of brain tissue, there is no reason why the IQ should be affected. If on the other hand there is permanent brain damage with cell loss then naturally IQ might be affected. The spectrum of consequences from head trauma is very wide from no consequence at all to severe disability or even death. Naturally your case is not the latter as you are here writing to me, but it is impossible to say whether it has cause some mild damage with IQ lowering since apart from me not knowing your IQ levels, IQ tests as I said may be influenced by your medication, depression etc, their results are not necessarily true indicators of IQ levels.
The term scar tissue is simply a comparison I made to the scar tissue formed when there is a wound on the skin. When there is a lesion (a wound) in the brain from a trauma, the dead cells are eliminated and the space previously employed by them is filled by brain connective tissue cells. If such damage is significant the changes in structure would be visible on MRI.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 16 hours later
Thank you for your help. Regarding the hits to the left side of the brain and to the forehead, what skills/cognitive functions might be affected by hits to these areas of the brain?
doctor
Answered by Dr. Olsi Taka 7 hours later
Brief Answer:
Read below

Detailed Answer:
That depends on the site of damage. The most likely lobe to be damaged for both a side and forehead hit would be the frontal lobe. That is because it is the biggest lobe of the brain. It's involved in many functions such as motor skills (difficulty in fine movements on the opposite side), language, judgement, impulse control, difficulties in divergent thinking (generating ideas by exploring different solutions).
For a hit from the left side the most likely parts to be affected in the frontal lobe would be language and fine motor movement on the right hand. From a hit on the the most commonly affected areas would be those dealing with behavior, and impulse control.
A hit from the left side may also cause trauma to the parietal lobe with difficulties in calculation and writing as well as language issues.
For any traumatic brain lesion seizures are also a possible consequence.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 17 hours later
Thank you for your help. Please clarify "from a hit on the most commonly affected areas would be those dealing with behavior and impulse control"--I am asking about impacts on the left side of the brain and the forehead on me specifically--I am not sure how "the most commonly affected areas" refers to the hits I inflicted on me. Thank you.
doctor
Answered by Dr. Olsi Taka 54 minutes later
Brief Answer:
My mistak, I meant a hit on the forehead.

Detailed Answer:
My apologies, there is a missing word there, the word "forehead", my mistake. It was supposed to be "From a hit on the forehead the most commonly affected areas would be those dealing with behavior, and impulse control". As I said the frontal lobe is the biggest lobe with many areas involved in different functions. So if damage to the lateral left side would be more likely to affect areas involved in language and motor control, a hit on the forehead would be more likely to affect the part dealing with behavior.
Of course all these are assumptions in case there is indeed a lesion visible on MRI, not necessarily your case, thanks to the fact the brain is well protected by the skull most hits do not cause any damage at all.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 25 hours later
What is a concussion? It appears that many hits to the head are diagnosed as "mild concussions." I have read more recently that "mild concussion" is a term that covers a broad range of concussions, many that are not really mild but quite serious. Also, boxers and players of XXXXXXX football often receive numerous concussions and they result in Parkinsons and other brain diseases (something like encephalopathy) that have led to extreme distress and suicide. It appears that there is a broad range in the number of concussions inflicted in people with these diseases--ie. some people are affected after only a few concussions/hits, and others only after many. Please comment.

Regarding concussions or hits, I remember that when I was 30 and I was struck on the head and smashed against the wall, I felt my brain moving or bouncing inside my skull. Would you describe that as a concussion? Thank you.
doctor
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
Read below

Detailed Answer:
Concussion is the most common term used for minor head trauma, an injury with a temporary impairment of brain function. Damage may be due to the direct hit but also due to sudden acceleration/deacceleration of the head. The mechanisms are not very clear but injury is thought to derive by the sudden stretching of the nerve fibers with associated electrical discharges and neurotransmitter release. That can disrupt the balance of neurotransmitters and hence need some time to return to normal that is why there may be symptoms for days to weeks. In some cases symptoms may persist for months although in those cases psychological factors may be strongly at play.

Regarding the risk of concussions to cause neurodegenerative changes with dementia and parkinson like symptoms, it is true that studies have shown an increased risk of that happening in people with repeated concussions, mainly contact sports athletes. I would like to stress the fact that we are talking about many repeat concussion, your case certainly doesn't apply. Even in those athletes it is a question of increased probability of that happening, many lead normal lives.

As for the head smashing you took leading to a concussion....whether it could potentially lead to a concussion, yes it certainly could. Whether that was actually the case, that is up to you and your symptoms at the time to say. If you had loss of consciousness, persisting headaches, mental fogginess, irritability, difficulty concentrating and sleeping specifically in those days/weeks following the hit, it was most likely due to a concussion.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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