Forensic Case 1 – Injury  

Cyclist Vehicular Injury
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Age: 28


This 28 year old male was struck on his bicycle by a truck traveling 40 mph. Amazingly, he sustained relatively little head trauma with no skull fracture, swelling of the brain, intracranial bleeding, or notable brain contusions. However, in the weeks following the accident, he suffered severe post-concussive symptoms, both physical and cognitive. Shortly after the accident, the patient contacted a personal injury attorney. The following evidence was considered in support of this patient’s case.

Functional and structural MRI scans were performed 7 days after the accident.

Traditional structural MRI scans showed only a few small areas of injury. The largest is a lesion of about 6 mm in the left frontal lobe (frontal operculum). The figure below is from a fluid attenuated inversion recovery (FLAIR) sequence where this lesion appears as a bright spot (vasogenic edema). Also found were two additional small lesions (about 2 mm each) as a result of white-matter shearing injuries. All three lesions occurred in the left frontal lobe. (Note: remember that all images are in standard radiological format, thus left=right and right=left. See how to read Notus Cases for further explanation)

                 Standard Structural Imaging Findings

Small lesions such as those shown above can often have no adverse affects, so the patient also underwent an fMRI using Notus NeuroCogs™ to examine the ability of the affected brain region (left frontal lobe) to function normally and to vindicate that the patient truly had substantial verbal cognitive brain injuries from the accident. The left frontal lobe is integral to speech production and verbal ability. Functional imaging revealed normal activation for the patient’s brain on all Notus NeuroCogs™ exams except for one, the f-VMT™, which is a short-term verbal memory test that relies heavily on the left frontal lobe.

The following image shows brain activation of a normal control subject performing the f-VMT™. As expected, there is strong activation of left frontal cortex.

f-VMT™ functional image of normal subject

The following image is that of the patient performing the f-VMT™ exam. In contrast to the normal control subject shown above, this patient shows very little activation of left frontal cortex (indicated by white arrow).

f-VMT™ functional image of patient

It is important to reiterate that all other 5 tests returned “normal” results for the patient, except for the f-VMT™ shown above. This led further credibility to the patient’s claims of injury correlating to a specific area of injury. To illustrate the significance of the patient’s hypoactivation (under-activation) of the left frontal cortex, the image shown below is the patient’s results from one of the other Notus exams, the f-FMT™, which is a long-term face memory test. In this exam, normal activation is seen for the patient’s brain in every critical region for this test (indicated by white arrows) including the hippocampus, the fusiform face area, and right frontal cortex. Compare the strong activation from this exam shown below with that of the weak activation shown above.

f-FMT™ functional image of patient indicating normal activation

Summary: Although the lesions found in the left frontal cortex using traditional structural scans were relatively small, the fMRI findings through Notus NeuroCogs™ indicate significant functional disruption in this area for this patient that correlate well with verbal and phonological rehearsal problems found in the patient.

The patient received a favorable settlement out of court.

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