Footprints of Pathology
The concern that there is “no objective evidence of injury” is predictable but flawed. The medical professionals look for “footprints of pathology” when making their diagnoses. Brain injury is one of those diagnoses that can not always be determined by the obvious findings.
MRI or CT scans are not the only “objective” findings in medicine. Our approach to looking for “footprints of pathology” also a search for objective findings. When an individual cannot see, even if the cause of the blindness cannot be determined, this “footprint of pathology” is sufficient for a diagnosis. This is objective evidence. When a person cannot hear, there is “footprint of pathology”. When a neurologists exam shows focal neurological deficits, that is another “footprint of pathology”.
Neuropsychological testing is a search for “footprints of pathology” As such the assessment provides objective evidence of injury. Neuropsychological testing is designed to determine the brains current capacities.
I believe that these various pieces of objective evidence can provide a triangulation of pathology that cancel out the skepticism that interferes with proper diagnosis.
Change in Brain Function
It is a change in how the brain functions, that is key to the diagnosis of brain injury. An injury to the brain, if it does not involve a change in function, may not be significant. But when the way the brain functions is changed, there may be a changed person. Even if the change is subtle, when it results in disability, the breakdown of relationships, the loss of enjoyment of life, that is dianostically significant. Further, depression, anger and sorrow, are footprints of pathology that more clearly triangulate brain injury, than the most modern MRI or even the neurosurgeon’s view of an intracranial hemorrhage. Brain injury should always be considered if any of these changes occur.