The Role of Neurology, Neuropsychology, and Radiology in Diagnosis and Treatment of Brain Injury

o1.5-2 Million People A Year Sustain Brain Injury FromWHAT IS A NEUROPSYCHOLOGIST?
Motor Vehicle And Motorcycle Accidents, ,Falls, SportA Neuropsychologist typically holds a doctoral degree
Injuries, And Acts Of Violenceo500,000 Severe(PhD) in Clinical Psychology/Neuropsychology from an
Enough To Require Hospitalization.o50,000 Die Fromaccredited university or professional graduate school,
Complications Of Head Injuryo5.3 Million Are Living WithA Neuropsychologist may also have completed
Head Injury Related Disabilityomost Common Amongadditional graduate level coursework in Neurosciences,
Males 15-24 And People Older Than 75.such as Neurology, Neuroanatomy, Neuropathology,
These alarming statistics affects all communities. SinceNeuropsychological Assessment, Neuroradiology, etc.
the advances of medical technology, health care hasHe/she must be a licensed psychologist with
become more specialized and sub specialized.specialized training and experience in the field, which
However, who does one see to help diagnose andinclude predoctoral supervised Internship in psychology
treat a suspected head injury? A Family Doctor?.....Aand Neuropsychology, followed by 1-2 years of
Neurologist?......A Psychologist?....A Radiologist?....WhatPostdoctoral Fellowship in Neuropsychology.
about a Neuropsychologist?.....So many to choose from,WHAT IS A NEUROPSYCHOLOGICAL
but which one would be most helpful?.....The answer is,EVALUATION?
they all offer an important piece to the puzzle. ForA neuropsychological evaluation is a comprehensive
example, Steven (a fictitious name of a patient) wasevaluation of cognitive, behavioral, and emotional
21-years-old, when he became involved in afunctioning performed using standardized tests and
motorcycle accident on Christmas day. An intoxicatedprocedures. A Neuropsychologist uses a wide variety
truck driver collided with his motorcycle while making aof paper/pencil and computerized tests that are very
left turn on a green light. Steven was ejected from thesensitive to even mild brain dysfunction. Typically the
seat of his motorcycle and subsequently landed in theevaluation includes 60-90 minutes of clinical interview
middle of the street. While he had no memory of theabout your problems and background (childhood,
accident, eyewitness notified paramedics who tookeducation, occupation, family, medical and psychiatric
him to a nearby hospital. After 5 hours of being in ahistory), followed by 4-6 hrs. of formal testing. The
coma, he regained consciousness. While he did notevaluation can be scheduled for a single day or divided
sustain any major physical injuries, his family noticed ainto several days, dependant upon the fatigue level and
drastic change in his behavior and thinking. He lost histime. In addition to time spend face to face, time is
ability to read words, experienced difficulty withrequired to review records, score, interpret the tests
attention, concentration, memory, and behavior (i.e.,and generate a report. This could add an additional 4-6
short-temper, aggression, irritable, impulsive). Accordinghours. At the completion of the report, the
to his mother, his son had changed since the accident.Neuropsychologist reviews the results of he evaluation
She was desperate to find someone who could helpwith the patient and his/her family and makes
him. Therefore, his mother took Steven to his familytreatment recommendations. A copy of the report is
doctor who ordered some brain imaging diagnosticalso forwarded to the referring physician and other
tests (CT and MRI scans) and referred him to a longhealth care providers.
list of specialists (e.g., neurologist, psychiatrist, andWHICH MENTAL FUNCTIONS ARE GENERALLY
neuropsychologist) to clarify his condition. His motherTESTED?
wondered, about all these doctors....What did they do?A Neuropsychologist typically evaluates how the brain
How would they be able to help Steven?functions in the following areas:
WHAT IS A NEUROLOGIST?1. Intellectual abilities
A neurologist is a physician (MD or DO) who2. Attention/Concentration
specializes in diseases of the brain and nervous3. Learning and Memory
system. Although they overlap a bit with psychiatrists4. Language
because they share the same organ (brain), they tend5. Problem solving, planning and organizational skills
to concentrate on physical manifestations of6. Reasoning and Judgment
neurological problems, or problems related to7. Perceptual and Motor Skills
abnormalities in structure or function of specific regions8. Visual-spatial skills
of the nervous system. They deal with brain, spinal9. Academic Skills
cord, nerve roots, nerves, and muscles. Psychiatrists10. Emotion, Behavior, and Personality
(also MD) deal with emotional and cognitive disorders,HOW CAN THE RESULTS HELP THE PATIENT?
such as schizophrenia, depression, panic disorders, etc.The results of a neuropsychological evaluation can
A neurologist performs a neurological examinationhelp your doctor clarify weaknesses, differentiate
provides crucial information about the nervous system.among illnesses (Traumatic Brain Injury vs. Stroke vs.
It is a noninvasive way to find out what might beAlzheimer's vs. Depression), establish a "baseline"
wrong. It typically includes an examination of the 12before surgery or before problems are seen, plan
nerves of the head and neck, reflexes, balance andtreatment that uses strengths to compensate
coordination, muscle strength and movement, andweaknesses. The results can also help the Social
mental status- awareness and response to theSecurity office determine if you qualify for Disability
environment, appearance and general behavior,benefits. Following is a sample of some of the many
orientation, attention and memory. Neurologists alsoquestions that can be answered by a
perform diagnostic tests, such as lumbar puncture,neuropsychological evaluation:
electroencephalography (EEG), and electromyography1. * Do I actually have brain injury?
nerve conduction velocity (EMG/NCV).2. What is the cause of my problems? Is it medical,
Based on the results of the neurological exam and theemotional, neurological or stress?
diagnostic tests (EEG, EMG, CT, MRI), a neurologist is3. ** All neurological, physical, and imaging (CT &
likely to refer a patient with head injury to aMRI scans) tests are normal, why do I still
Neuropsychologist for an understanding of which brainHave difficulties doing everyday things?
functions are impaired and which remain intact. A4. Would I be able to return to work/school, drive again,
neuropsychological evaluation will reveal how the injuryor play golf?
specifically affects thinking and behavior.5. Am I getting better? How much? Is treatment helping
WHAT IS NEUROPSYCHOLOGY?me?o * This is especially true following "mild" brain
Neuropsychology comes from the Greek wordinjury, when effects of an injury may be subtle and
"neuron" meaning "nerve," the Greek word "psyche"easily confused with other factors, such as stress,
meaning "mind," and the Greek word "logos" meaningmedications, or depression.o **Just because a skull
"the study of". Put the words together and you have....X-Ray pr CT/MRI scans of the brain are negative
The scientific study of brain-behavior relationships and(normal) does not mean everything is fine. You can still
the clinical application of that knowledge to humanexperience difficulties in thinking, emotion, and behavior
problems...In simpler terms, Neuropsychology is thethat affect your quality of life. Because CT/MRI
study of how different disorders of the brain (i.e.,measure structure, not function or behavior, a
traumatic brain injury, concussion, aneurysm, stroke,Neuropsychological Evaluation is recommended
dementia, tumor, etc) affect a person's thinking,especially when problems persist.
emotion, and behavior.