Brain Injury Imaging and Neuropsychological Testing

Understanding the difference is how a brain injury case is won. Dennis Gonzalez Law, P.A. builds these cases in English and Spanish, and our office answers 24 hours a day.

Why this matters to your case

Insurance adjusters and defense doctors often point to one line in the chart: CT negative. Then they argue there is no brain injury. That argument confuses two different questions:

1. Is there something visible that needs emergency treatment? (What CT is for.)
2. Is the brain working the way it did before? (What testing and clinical examination answer.)

A person can have a clear answer to the first and a serious problem with the second.

The tests, in plain English

CT scan (computed tomography). The first scan in most emergency rooms. NINDS explains that CT can show a skull fracture and brain bruising, bleeding, or swelling. It is fast and excellent for finding emergencies. It is not designed to find microscopic damage to nerve fibers.

MRI (magnetic resonance imaging). NINDS explains that MRI is more sensitive and can pick up more subtle brain changes that a CT scan may miss. An MRI is often ordered later, when symptoms persist.

Newer imaging methods. NINDS describes methods researchers may use to detect milder brain damage, including diffusion tensor imaging (DTI), which could identify damage in white matter tracts; fluid-attenuated inversion recovery (FLAIR), which could detect small areas of damage; and susceptibility-weighted imaging (SWI), which could identify small, hard-to-detect bleeds. These are not routine. Whether any is appropriate is a decision for your doctors. When they are used, their reliability for a specific person can be contested, and the defense will contest it.

The limit of every scan. NINDS states that, despite advances, currently available and clinically validated imaging technologies, blood tests, and other measures can't always detect damage from mild, concussive injuries. And the CDC's recommendations for emergency care of adults with mild TBI advise against routine imaging, using clinical decision rules instead. Many people with a real concussion are never scanned at all.

Neuropsychological testing. NINDS explains that neuropsychological tests are often used along with imaging after mild TBI. A neuropsychologist gives a series of standardized tasks that measure:

• Memory (learning and recalling new information)
• Attention and concentration
• Processing speed
• Executive function (planning, organizing, switching between tasks)
• Reaction time and problem solving
• Language and visual-spatial skills

The results are compared with what is expected for someone of the same age and background, and with what is known about the person before the injury. Good testing also includes measures of effort and validity, which help show the results are reliable.

Other clinical tools. Doctors may also use symptom checklists, balance testing, and eye-movement and vestibular testing. Your doctors decide which tests you need.

Symptoms that should prompt a conversation about testing

Tell your doctor if, weeks after the injury, you still have:

• Trouble remembering conversations, appointments, or where you put things.
• Trouble concentrating, reading, or following a TV show.
• Feeling slowed down or foggy.
• Trouble at work with tasks that used to be easy.
• Headaches, dizziness, or light and noise sensitivity.
• Irritability, anxiety, depression, or sleep problems.

Which specialists are involved

• Neurologist: examines the nervous system and manages headaches, dizziness, and cognitive symptoms.
• Neuropsychologist: a psychologist trained to test brain function and interpret the results.
• Neuroradiologist: a radiologist who specializes in reading brain imaging.
• Physiatrist: a physical medicine and rehabilitation doctor who coordinates recovery.
• Speech-language pathologist and occupational therapist: cognitive rehabilitation and daily-living skills.

What to do now

1. Keep every imaging report and disc. Ask the hospital for copies.
2. Tell every doctor about every symptom, including thinking and mood changes.
3. Ask your doctor whether follow-up imaging or a neuropsychological referral makes sense for you.
4. Gather before-and-after evidence: school transcripts, work evaluations, and the names of people who can describe how you were before.
5. Do not take a defense-arranged test or exam without talking to us first. If one is required in a lawsuit, we prepare you and protect the process.

The deadline

For most Florida injury claims based on negligence, you have two years to file a lawsuit (Florida Statutes § 95.11(5)(a)). That two-year rule applies to claims that accrued after March 24, 2023, the day HB 837 became law (Chapter 2023-15, Laws of Florida, § 28). For most injuries, a claim accrues on the day of the crash or fall. If yours happened on or before March 24, 2023, the older four-year rule may still apply. Wrongful death claims also carry a two-year limit, and claims against a government agency or involving medical care follow their own rules. Some websites still say four years. For new injuries, that is wrong.

Testing and specialist referrals take time to schedule. Do not let the deadline run while you wait.

If they say it was partly your fault

Florida uses modified comparative fault (Florida Statutes § 768.81). If you share some of the blame, your award is reduced by your percentage of fault. If a jury finds you more than 50 percent at fault for your own harm, you recover nothing.

Insurance, in plain terms

After a car crash, your own PIP pays first, up to $10,000 in medical and disability benefits, with medical benefits paid only if you get initial care within 14 days and limited to $2,500 if a qualified provider determines there was no emergency medical condition (§ 627.736). To recover pain and suffering from the at-fault driver, the injury must meet Florida's threshold, such as a permanent injury within a reasonable degree of medical probability (§ 627.737(2)). In brain injury cases, specialist findings and testing are often the proof of permanency. Since HB 837, evidence of past medical bills is generally tied to what was actually paid, or what health coverage or a Medicare-based formula would pay (§ 768.0427).

How a case runs

1. Investigation and preservation of crash or fall evidence.
2. Medical work-up directed by your doctors.
3. Expert review: neuropsychologist, neurologist, neuroradiologist, and when needed a life care planner and economist.
4. Demand, then lawsuit if needed, always inside the deadline.
5. Defense examination: in a lawsuit, the defense may have you examined and tested by its own experts. We prepare you, and we scrutinize their methods.
6. Mediation or trial.

Frequently Asked Questions

My CT scan was normal. Does that mean I don't have a brain injury?

No. CT looks for fractures, bleeding, and swelling that need emergency care. NINDS states that current imaging and tests can't always detect damage from mild, concussive injuries. A normal CT is good news about emergencies; it is not proof your brain is working normally.

What is neuropsychological testing?

A series of standardized tasks, given by a neuropsychologist, that measure memory, attention, processing speed, problem solving, and other brain functions. NINDS notes these tests are often used along with imaging after mild TBI. Results are compared with expected norms and with how you functioned before.

Is MRI better than CT for brain injury?

For subtle injuries, MRI is more sensitive. NINDS explains it can pick up subtle changes a CT may miss. CT remains the first test for emergencies because it is fast. Your doctors decide which scans you need and when.

What are DTI and SWI?

They are newer MRI methods. NINDS describes DTI as able to identify damage in white matter tracts and SWI as able to identify small, hard-to-detect bleeds. They are not routine, and their use in a particular case can be debated. Your doctors decide if they are appropriate.

Will the insurance company make me take its own tests?

In a lawsuit, the defense can usually request a medical examination by a doctor it chooses, sometimes including neuropsychological testing. There are rules about how it is done. Call us before agreeing to any defense exam, so we can prepare you and protect the process.

Can neuropsychological testing tell if someone is faking?

Good testing includes standardized measures of effort and validity, which help show whether results are reliable. Those measures protect honest patients: when effort is valid, the defense loses its favorite argument. Be honest, do your best, and tell the examiner about headaches or fatigue during testing.

How long do I have to file a brain injury claim in Florida?

For most negligence claims that accrued after March 24, 2023, two years (§ 95.11(5)(a)). Older claims may fall under the prior four-year rule. Testing and specialist appointments can take months to schedule, so call early.

Talk to us today

If the scan says normal and your life says otherwise, we should talk. Call (305) 209-0384 or message us on WhatsApp. Our office answers 24 hours a day.

Former Miami-Dade prosecutor · Since 2012 · Super Lawyers Rising Stars · Avvo Rating 10.0