Post Brain Surgery Functional Assessment  

TBI Post-Brain Surgery Assessment.
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Age: 46


This patient is a 46-year-old male who was an educator with a Master’s degree who sustained a severe traumatic brain injury from a fall off a roof. Initial injuries included fractures of the left temporal bone and skull base. Initial CT scans revealed bilateral temporal epidural hematoma, right cerebellar hematoma and various other smaller cerebral hemorrhages. A left temporal craniotomy and temporal tip resection were performed to relieve intracranial hypertension and address the epidural hematoma, followed the next day by a 6 cm resection of the right anterior temporal pole.

The results of this patient’s severe injuries and significant surgical reduction on medial temporal areas are obvious in the image below. Given the extent of this damage in hippocampus and surrounding medial temporal structures, one might wonder about the functioning of critical memory encoding mechanisms associated with these neural systems in this patient. To address this, the patient was administered Notus NeurCogs™ exam f-FMT™, which is a specially developed fMRI face memory test that includes a comparison normative sample of unimpaired subjects. The activation results from the f-FMT™ are displayed overlain on the structural 3D SPGR images of the patient, obtained consecutively with the functional scans approximately 2.5 years post-injury.

A remarkable finding in this patient is the extent of normal activation in medial temporal lobe (though many other severe abnormalities in functional scanning were observed in other brain regions for this task and on other Notus NeurCogs™ fMRI cognitive tests). In this case, activation of the hippocampus and adjacent structures appears in close circumscription along borders of extensive tissue resection, atrophy, and necrosis. All activation values shown in the image fall within +/- 0.5 standard deviations from the mean of the normative reference group (not shown here). This illustrates the unique contribution that Notus NeuroCogs™ can provide in assessing patient outcomes.

The image below includes activation overlain on structural scans of the patient, where normal activation is present on f-FMT™, despite obvious and severe medial temporal lobe damage.

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