Neuropsychological Assessment and Rehabilitation of BI - Interpretation, Diagnosis, and Recommendations

An infant with any brain injury can face major consequences and challenges. Tests must be performed if symptoms are present, but diagnosing the problem takes more than looking at pictures and numbers.

Interpreting the results of a CT scan, MRI, or even an X-ray takes skill. The technician must analyze what they are looking at in great detail. Different types of injuries and pathologies present in their own way, but sometimes the problem develops over time or may be subtle.

Importance of Patterns

A Neuroradiology study in 2010 examined the use of MRI scans, and a process known as proton magnetic resonance spectroscopy, to detect neonatal brain injury patterns. The patterns of injury identified include a basal ganglia-thalamus pattern, which can aid in interpretation in full-term infants with encephalopathy. Hippocampus and brain stem involvement is common. A watershed predominant pattern of injury, seen following prolonged asphyxia, typically involves cerebral arteries and affects white matter in severe cases.

Concussions, diffuse axonal injuries, anoxic brain injuries, and penetrating injuries can be diagnosed by interpreting the results of a scan. A medical team can then make recommendations for treatment by assessing the scope of the injuries and identifying what brain structures are affected. Additional tests can confirm issues such as oxygen deprivation. The interpretation of these results can help doctors make prompt recommendations, including methods to cool the brain, which may prevent damage if used within the first few hours of birth.

Challenges of Recommending a Treatment Plan

Long-term methods of rehabilitation are often uncertain. Infants must reach developmental milestones before some of the effects of a brain injury, and a plan for care and rehabilitation can be identified. The recommendations, therefore, are often to monitor the baby’s condition over time. However, an immediate intervention such as surgery may be recommended if hydrocephalus is diagnosed, to remove accumulated fluid and blood and reduce the pressure on surrounding brain tissues. Recommended courses of action also depend on additional issues such as body temperature control, gastrointestinal, blood (anemia, jaundice), and metabolic problems.