Traumatic Brain Injury

Wear a helmet. Avoid fights. No headers in soccer. Wear your seatbelt. Play golf instead of football.

The impact of head trauma is often overlooked in psychiatry. Even minor head injuries to vulnerable parts of the brain can cause problems for years to come. SPECT is one of the best tools for detecting the functional damage from traumatic brain injury that is often not seen on CT and MRI studies.

Typically, SPECT findings in traumatic brain injury include focal areas of decreased activity from the injury as well as injuries in a contra-coup (opposing area) pattern. Examples of this would be decreased activity in the left front part of the prefrontal cortex and the right occipital lobe; or the front and back aspects of a temporal lobe.

In some cases of traumatic brain injury, we see marked hyperactivity over the site of the injury. We have also seen increased “off center” cingulate gyrus activity after a head injury.

Identifying head injuries is essential for several reasons:

  • School age children and teenagers who have sustained a brain injury may need to receive more specialized services
  • Knowledge of brain injuries is often essential for legal and/or insurance reasons
  • Patient understanding about the effects of traumatic brain injury can enhance treatment compliance
  • Families and support people of traumatic brain injury survivors can have a deeper understanding of what the injured person is dealing with

traumatic brain injury Case Studies

Tim was a high school sophomore with a history of severe conduct problems. He frequently cut school, was defiant and abusive toward his parents, he did not get along with other teens at school and seemed to “never fit in.” He smoked a pack of cigarettes a day, frequently used marijuana and cocaine, and had already been arrested for shoplifting. He had been in one treatment program and was on his way to a second program when his parents brought him to our clinic.

From an early age, Tim was hyperactive, impulsive, moody and frequently angry – especially whenever someone would tell him “no.” His temper flared quickly and often over minor or trivial incidences.

His brain SPECT study showed severe damage to his left prefrontal cortex. As it turned out, when he was 18-months-old, he fell down a flight of stairs. His mother said he was never quite the same after this accident. His personality had changed. As a result of this injury, Tim unfortunately doesn’t have the capacity for internal supervision that is housed in the prefrontal cortex. Treatments, therefore, were geared toward reducing the underlying rage and activating his prefrontal cortex to help activate auxiliary internal supervision.




Betty was the most beautiful 88-year-old woman I had ever met. She was very proper and very proud, but suffering with cognitive problems. She was brought in by her sister. A SPECT study revealed injury to her frontal lobe. When I asked her about her history of head trauma, all Betty could do was look down and cry. When I asked her sister, she reported that Betty’s 90-year-old husband was abusive to her. Sometimes he would grab her by the hair and slam her head into the wall. The sister wanted Betty to go to the police, but Betty said it would only make things worse.

Her sister saved her life…

We knew that Betty needed to be removed from that environment so Adult Protective Services was contacted. Her SPECT studies convinced the judge that her home held potential danger. He then ordered her to have a conservator, and she went to live with her sister.




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