Diagnosing Chronic Fatigue Syndrome with DTI

Between our work, family, school, and social lives, fatigue is a common feeling among people. Defined as “extreme tiredness or exhaustion,” fatigue is one of the most reported symptoms to physicians. It can be hard for doctors to tell if a patient is simply tired or if there is a contributing condition like chronic fatigue syndrome that may be causing their exhaustion.

Chronic Fatigue Syndrome is described as more than just day-to-day tiredness. This condition’s symptoms include exhaustion that is both debilitating and without cause. Patients may have feelings of being extremely tired. Chronic fatigue is usually accompanied by impaired memory or concentration, dizziness, inability to stay awake or upright, and overwhelming exhaustion without exertion. Persisting longer than 6 months, this condition requires more than a caffeine fix and a good night’s sleep — it needs medical attention.

The condition affects more than 1 million adults and children in the United States, according to the Centers for Disease Control and Prevention. Diagnosis is complicated and usually involves ruling out many other conditions.

Chronic Fatigue Syndrome can become more than just debilitating. It can be dangerous as well. Fatigue of this degree can become problematic when the patient is driving or operating heavy machinery. Symptoms related to chronic fatigue can resemble other diseases such as Lyme disease, major depressive disorder, lupus, and hypothyroidism. This makes it difficult for doctors to diagnose these conditions. Physicians would much prefer a standalone test to diagnose CFS. And a 2014 study brings such a test slightly closer to doctors’ clinics.

The additional help in diagnosing this condition comes from using Diffusion Tensor Imaging (DTI).

DTI is a relatively new form of advanced MRI in which the nerve fibers of the brain can be specifically highlighted and imaged to determine possible damage from things like concussions or conditions including chronic fatigue. In the same way that MRIs use sound waves and computer technology in order to image the internal organs, DTI focuses on the nerve fibers in the brain and is able to image them with startling detail. MRIs can show the musculoskeletal and vascular system. But, with DTI, physicians hope to go even deeper into the nerves where doctors can see definitive proof of chronic fatigue syndrome.

In a 2014 study published online in the journal Radiology, researchers studied 15 CFS patients and 14 people selected as age and gender control subjects. When they compared results between the CFS patients and the controls, they found that the CFS group had slightly lower white matter volume, meaning there was less overall white matter in the brain.

Researchers also found that patients complaining of CFS symptoms had high Fractional Anisotropy (FA) values in a certain area of the brain. FA describes how water moves along the nerves within the brain. Results suggested that this area of the brain can serve as a biomarker for CFS where “the more abnormal the tract, the worse the fatigue.”

When the nerve fibers in the brain are experiencing irregularity or degeneration, in combination with the aforementioned symptoms, doctors can diagnose chronic fatigue syndrome faster and with more accuracy. The time delay and inconsistency that was once prominent with this condition can now be eliminated thanks to the advanced MRI technology made by diffusion tensor imaging.

“This is a very common and debilitating disease,” said the study lead author Michael M. Zeineh, M.D., Ph.D., assistant professor of radiology at Stanford University School of Medicine in Stanford, Calif. “It’s very frustrating for patients because they feel tired and are experiencing difficulty thinking.”

“This is the first study to look at white matter tracts in CFS and correlate them with cortical findings,” Dr. Zeineh said. “It’s not something you could see with conventional imaging.”

Dr. Zeineh added that the findings need to be replicated and expanded upon in future studies to refine the understanding of the relationship between brain structure and CFS.

“Most CFS patients at some point in time have been accused of being hypochondriacs and their symptoms dismissed by others,” Dr. Zeineh said in an interview with NBC Today. “And there is still skepticism in the medical community about the diagnosis. That’s one of the reasons these findings are important.”

DTI Now Available at Doctors Imaging

Doctors Imaging is the first facility in Louisiana to offer DTI exams. If you have more questions about the symptoms of concussion or how DTI works, please visit the dedicated website TheConcussionGroup.com.




This reconstructed magnetic resonance image shows the blue tracks and arrows and yellow tracks and arrows in a single patient. These two tracks are overlaid on their respective track profiles. The green arrows point to the middle temporal region of increased cortical thickness. Source: Radiological Society of North America

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How Does a Head Injury Result in Sensory Loss?

Whenever accidents or injuries occur, there is always a concern for the residual effects. Prospects of surgery, rehabilitation, or discomfort are never welcome. But for many people, the problems that come after a traumatic injury can be even more debilitating. Ask any physician and they will readily tell you that the worse kind of injuries to treat are those that affect the head. Because the brain is such a complex and unpredictable organ, the effects and ramifications of injuries to the brain can be difficult to determine or map with consistency.

There are a number of factors that help doctors determine the extent and condition of the brain after an injury occurs including:

  • the severity of the injury
  • the location of the injury
  • the medical response to the injury (response time / procedures / medicines)
  • the rate of recovery

There are five senses and each can have different effects after a traumatic brain injury occurs. Sight, taste, smell, hearing, and touch are the ways that our brain receives information and then interprets that information for us to use. But when the brain is the injured body part, any one of these senses can be impacted.

Sometimes the direct impact is not even needed to create an injury. Sometimes just the shaking or rattling of the brain inside the skull can be enough to cause damage. When this occurs, the brain can begin to swell or bleed. Because of the limited area within the cranial cavity, the brain has no space to relieve the pressure or release the blood and as such, damage ensues — or worse, death occurs.

Types & Causes of Sensory Loss After Brain Injury

To begin, the brain is divided into different sections. The different sections control different functions of the body and interpret different signals so certain injuries will exhibit themselves in different parts of the brain. The parietal lobe, located at the top of the head, is the part of the brain that interprets sensational signals and tells us where our body is in location to different objects in our surroundings. Injury to this area can be the cause of a sensory loss, particularly in terms of our translation of touch.

Let’s take a closer look at the types and causes of sensory loss that can happen after a brain injury.

  1. Loss of sight or disruption of sight is a common side effect of a traumatic brain injury. The occipital lobe, located at the back of the skull, is the part of the brain that controls one’s ability to see. When the occipital lobe is damaged, effects such as eye muscle weakness or double vision can occur known as diplopia. The sudden inability to optically tolerate light is a common occurrence known as photophobia. Other presentations of an occipital lobe injury include involuntary eye movements (nystagmus) or the loss of vision in one eye (hemianopsia). The loss of sight differs from other senses in that there is a slightly larger possibility of it returning as opposed to hearing or smell that are usually permanent injuries.
  2. Hearing problems are another sensory problem that often occurs after an accident or fall. Sometimes normal daily activities can sound unbearably loud. Other common symptoms of brain damage are the inability to filter or recognize sounds or prolonged ringing in the ears, a condition called tinnitus. Luckily with the advancement of technology, devices such as cochlear implants and hearing aids can help those who are dealing with hearing problems.
  3. Smell and taste are two senses that heavily influence each other. Almost 70% of taste is contributed to smell and the smell is the strongest sense in connection with our memories. So when one becomes damaged, the other usually suffers as well. Usually, if there is a frontal lobe injury, the resulting nerve damage can contribute to a loss of taste. The olfactory bulbs lie beneath the frontal lobe and can be the cause of anosmia (or loss of smell) if injured.

For those that do experience a loss of one of their senses, options such as surgery, physical therapy, and counseling should be considered in order to help combat the problem or learning to adjust to life without that sense. If you or someone you know has experienced a serious injury and is complaining of sensory disruption of loss, please seek medical supervision immediately.

The physician may order an MRI in order to determine if there is bleeding in or around the brain. Newer MRI techniques are now being developed to evaluate traumatic brain injuries. DTI is an advanced brain imaging procedure that can measure the extent of a brain injury when other tests are negative and symptoms persist. Learn more about these exams at theconcussiongroup.com.

If you have other questions about sensory loss, brain injuries or medical imaging procedures, speak to your physician or radiologist about scheduling a consultation. For more help, call 504-883-8111.

Car Accident Head Injuries, Safety and Precautions

Car accidents can be some of the scariest moments of one’s life. Despite the innovations and advances in automobile safety technology, human error is still hard to beat. About 20 percent of all reported head injuries are the result of an automobile accidents. Buckling seatbelts is a major preventative measure that everyone should apply when riding in a car. However, car accident head injuries can still come from steering wheel collisions, airbag deployment as well as window, windshield and debris injury.

Head injuries can vary in the degree of seriousness. Some people walk away with a bump on the head often referred to as a contusion, others suffer from conditions like concussions, and some have more traumatic brain injuries such as memory loss. In the event of a car accident, having the proper body and brain imaging can be a major protective measure against the progression of the injury.

At Doctors Imaging, we have lots of experience helping those who have suffered from car accident head injuries. Whether it is our digital X-ray capabilities for broken bones or more advanced exams to determine the extent of brain injury, at Doctors Imaging we are committed to providing high-quality imaging services for the greater New Orleans area.

Our most detailed exam for brain injuries is diffusion tensor imaging (DTI). Because car accident head injuries are so common, we are proud to be offering this service to the Gulf South region because of the numerous benefits it provides. Diffusion tensor imaging is an advanced form of MRI that traces the movement of water and hydrogen atoms in the nerve pathways of the brain.

A DTI exam measures brain injuries that are not seen on MRI and CT scans performed elsewhere.

Conventional MRI scans are the best for determining internal or soft tissue damage in the body. However, CT scans and MRI are not adequate for tracing the nerve pathways in the white matter of the brain and highlighting otherwise unseen brain injuries. DTI goes further than a conventional brain scan. Water molecules follow a certain pattern in the brain along the nerve pathways. When you can see that the path has been disrupted, physicians know to look further into this area to find possible injury. Because head injuries can appear non-threatening, they can develop into more serious conditions in the weeks and months after the accident.

DTI is especially useful for patients who have suffered a concussion. Some concussions can heal in a few days while others can leave more lasting injuries. The only way that diffusion tensor imaging can be performed is with a 3.0 Tesla MRI and special software capabilities. Doctors Imaging is the only facility in the Gulf South. For this reason, we see patients from all over the region who are looking to determine the extent of their sport, work injuries and car accident head injuries.

If you have more questions about head injuries, diffusion tensor imaging or other injuries that require imaging, please contact Doctors Imaging at 504-833-8111 or visit the website of The Concussion Group for more information. If you would like to set up an appointment for imaging, you can use our Request Appointment page any time.

Do You Have Concussion Symptoms?

Concussions (Mild Traumatic Brain Injury or mTBI) have long been a mysterious and worrying injury for doctors to examine. Concussion symptoms can range anywhere from unconsciousness to memory loss to a slight headache. There is such a range of symptoms that it can be a difficult task for physicians to medically diagnose a concussion.

Most head injuries are minor — bumps, headaches or the occasional fall. These types of injuries happen with few repercussions. When they’re not, though, they can lead to serious short-term and long-term problems, including dizziness, headache, memory loss and slurred speech, to name a few.

Sometimes concussions are immediately apparent. Other times, the symptoms are not as obvious. Here are a few signs you should look for in a concussion:

  1. Not thinking clearly
  2. Slow reaction time
  3. Lack of concentration
  4. Loss of memory
  5. Headache(s)
  6. Blurred vision
  7. Nausea or vomiting
  8. Dizziness
  9. Sensitivity to light or noise
  10. Feeling tired or lacking energy
  11. Increased sadness
  12. Nervousness
  13. More emotional
  14. Change in sleep patterns

If you think you might have a concussion, it is crucial that you contact a professional as quickly as possible. This is far easier said than done, though. The signs and symptoms of a concussion can be subtle and may not be immediately apparent. Some symptoms may last for days, or even longer.

Many concussion symptoms may occur without a concussion, which means they can be especially difficult to diagnose. If you have several of these symptoms, though, you should contact a physician immediately. Even if immediate attention isn’t needed, having a concussion without proper medical attention can lead to long-term problems.

How Concussions Happen

In layman’s terms, a concussion is a type of traumatic brain injury that is caused by a blow to the head or body. This can come from a fall, a hit or any other injury that violently shakes the brain inside of the skull.

Basically, your brain is surrounded by spinal fluid and protected by your skull. The fluid normally acts as a cushion, but when your head gets hit too hard, the brain can crash into the skull and get injured. This typically results in a concussion.

Concussions are unusual for most people but for athletes, some workers, and extreme sports enthusiasts, concussions are more common. The problem with this is that as more research is being done on the long-term effects of concussions on professional athletes, we are learning that these bumps on the noggin can have a much deeper consequence.

DTI Exams Measure Brain Injuries Unseen on Other Exams

Any kind of traumatic brain injury is cause for concern but now Doctors Imaging has a beneficial new technology that can help determine the extent of brain injury and nerve damage due to a concussion. It’s called Diffusion Tensor Imaging or DTI.

Doctors Imaging was the first to introduce New Orleans to a 3.0T MRI and we added Diffusion Tensor Imaging to our services in 2016. Where standard MRIs are well-equipped to obtain useful and comprehensive images of brain tissue, DTI is an advanced form of MRI technology that improves diagnostic practices, particularly in the diagnosis of and recovery from concussions.

Most MRIs can tell if there is tissue damage or bleeding, but DTI exams measure whether there is nerve damage in specific areas of the brain’s white matter. Along with internal bleeding, nerve damage is the primary concern for physicians when dealing with a concussed patient. If you were to look at the health histories of former football players or boxers, you would notice that they have a higher prevalence of Parkinson’s, Alzheimer’s, ALS (Lou Gherig’s Disease) and other neurological disorders as they age. Many people believe the increased incidence of these diseases in these athletes comes from repeated exposure to head and back trauma.

DTI exams are able to focus on the connecting circuits of the brain and localize nerve damage. By recognizing this nerve damage, doctors can keep a close eye on their patient and help them during the recovery from their injury.

One factor that most doctors are very concerned about when they are seeing a concussion patient is an axonal injury. An axonal injury happens when a brain injury causes extensive lesions in the white matter tracts in a widespread or localized area. Diffuse axonal injury (DAI) is so worrying because it can be indicative of long-term brain deficiency. DAI occurs in almost half of all concussion cases. And now with a DTI exam, doctors will be able to make diagnoses and recoveries easier and more beneficial.

As with MRI exams, DTI exams do not use radiation. It is a non-invasive exam and has extremely high success rates. So if you or someone you know has concussion symptoms, be sure learn more about DTI exams from our medical partners at The Concussion Group.