“I wish I would’ve gone to see Dr. Ross immediately after my accident.”
05/23/17: Dr. Ross Responds to Article on Incidence of Mild TBI and Chronic Cognitive Impairment
Based on their scoping review of the literature, McInnes et al (1) made the interesting observation that 55% of individuals with a single mild traumatic brain injury (TBI) have chronic cognitive impairment. This proportion was much higher than the often-quoted 15% rate reported in older studies (2-4).
The authors discussed several limitations of their study, but they did not comment on the sources from which the TBI patients were selected. Since selection of samples can have important effects on the results of a study, we examined data regarding sample source that was available on 40/45 (88.9%) of the studies they reported. Of these 40 studies, the categorical distribution of sample sources (number of studies, and percentages of total) were as follows: Emergency department (ED) (35/40 = 87.5%); TBI outpatient clinic (2/40 = 5%); recruited TBI patients via advertisement (2/40 = 5%); and soccer players with a history of concussion (1/40 = 2.5%). Thus, the large majority of studies were based on patients selected from ED settings.
Since the large majority of the patients were drawn from ED settings, the authors’ conclusions should be limited to patients who present to the ED after an injury. Probably this reflects a subset of patients with mild TBI who have a more severe form of mild TBI. For example, a mild sports concussion is a mild TBI that typically resolves fully in hours to days. Most athletes with mild concussions do not go to the ED and would not be represented in the McInnes review. In contrast, a high velocity motor vehicle accident can cause a more severe and persistent form of mild TBI because of greater forces to the brain; furthermore, these patients often have other bodily injuries such as lacerations or fractures that increase the likelihood that the patient would go to an ED. These were the main types of patients represented by the McInnes article.
Consistent with these ideas, a recent well-designed study of mild TBI patients who presented to the ED found that, one year after injury, 59% had persistent postconcussive syndrome (PCS), which includes cognitive impairment (5). Although postconcussive symptoms are notoriously nonspecific, the rate of postconcussive syndrome was higher in mTBI patients than in normal controls. Furthermore, several studies have found that the risk of PCS at 1 year was increased for patients who had symptoms at 1 month compared to those who did not have PCS at 1 month.
Taken together, these findings suggest that the incidence of persistent cognitive symptoms after mild TBI probably is higher than the often-referenced 15% figure, but probably not as high as the 55% figure reported by the McInnes et al. However, for the important subset of patients who present to the ED, and perhaps for other patients who suffer relatively large forces to the head (for example, those which can occur in motor vehicle accidents), the incidence indeed may be 55%. Many of these patients will have persistent cognitive and other neuropsychiatric symptoms at one month after injury, in which case, they are at significantly increased risk of having chronic persistent symptoms.
David E. Ross, M.D.
Jan M. Seabaugh, M.A.
Virginia Institute of Neuropsychiatry
1. McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS One. 2017;12(4).
2. Rutherford WH, Merrett JD, McDonald JR. Symptoms at one year following concussion from minor head injuries. Injury. 1979;10(3):225.
3. Spinos P, Sakellaropoulos G, Georgiopoulos M, Stavridi K, Apostolopoulou K, Ellul J, et al. Postconcussion syndrome after mild traumatic brain injury in Western Greece. Journal of Trauma. 2010;69(4):789-94.
4. Sterr A, Herron KA, Hayward C, Montaldi D. Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome. BMC Neurol. 2006 6 (7).
5. Waljas M, Iverson GL, Lange RT, Hakulinen U, Dastidar P, Huhtala H, et al. A prospective biopsychosocial study of the persistent post-concussion symptoms following mild traumatic brain injury. Journal of Neurotrauma. 2015;32:534-47.
Dr. Ross Invited to Speak at the 2017 APITLA National Interstate Trucking Super Summit
Dr. Ross has been invited to present “Proving TBI Objectively with MRI Brain Volume Measurement” to the Association of Plaintiff Interstate Trucking Lawyers of America’s 2017 Super Summit in Tampa, Florida on May 20, 2017.
Dr. Ross Invited to Speak at the North American Brain Injury Society’s 30th Annual Conference on Legal Issues in Brain Injury
Dr. Ross spoke about the use of NeuroQuant® and NeuroGage® in brain injury litigation at the North American Brain Injury Society meeting in New Orleans on March 29, 2017.
Dr. Ross Invited to Speak at 2nd Annual Advanced Forum on Medical Liability Claims, Coverage & Risk Management in October 2016
Dr. Ross spoke again this year at the Advanced Forum on Medical Liability Claims, Coverage & Risk Management in New York on October 28, 2016 about brain injury litigation during the Post-Conference Master Class.
07/22/16 Brain Injury Medicine Board Exam Committee
On 07/22/16, Dr. Ross served on the committee for the Brain Injury Medicine (“BIM”) board exam to write and review exam questions for the 2016 BIM exam. The exam is given by the American Board of Physical Medicine and Rehabilitation. Dr. Ross was among the first group of physicians to receive board certification in brain injury medicine in 2014.
April 2016: NeuroQuant® and NeuroGage® admitted as court evidence in additional jurisdiction
On April 28, 2016, Dr. Ross testified regarding the plaintiff’s NeuroQuant® and NeuroGage® results in a state court case in the Superior Court J.D. of Stamford/Norwalk at Stamford (Connecticut) (Ying An and Victor Chen vs. Luisa F. Hekal). The results were admitted into evidence by Judge Donna Heller. This is the third legal case in which NeuroQuant® was admitted as evidence in court, and the second case in which NeuroGage® was admitted. NeuroQuant® and NeuroGage® have never been excluded from testimony in court.
April 2016: NeuroQuant® and NeuroGage® admitted as evidence in court
On April 4, 2016, NeuroQuant® and NeuroGage® were admitted as evidence by Judge Raymond A. Jackson in a Federal court case in Norfolk, VA (Federico, et al. v. Lincoln Military Housing, LLD, et al.) despite the objections of defense counsel. This was the first time these brain volume measurement tools were admitted in Federal court. David E. Ross, M.D., neuropsychiatrist, testified on the neuropsychiatric aspects of mold-related illness which had affected the Federicos, including the NeuroQuant® and NeuroGage® MRI brain volume measurements. The results showed a combined pattern of brain enlargement/atrophy similar to that found in two pioneering studies published by Ritchie Shoemaker, M.D. and colleagues. The jury found in favor of the plaintiffs.
Dr. Shoemaker has hypothesized that the brain enlargement/atrophy is caused by chronic neuroinflammation. This idea is supported by his finding that clinical treatment leads to normalization of brain volume.
In court, positive rulings are important because they set a positive precedent, which means that judges in future cases will be more likely to admit these types of results than if there had been previous negative rulings. Also, setting a positive precedent in Federal court is particularly helpful because state courts tend to follow the lead of the Federal court.
NeuroQuant® and NeuroGage® are commercially available software products which are able to measure and track brain volume abnormalities in patients with mold-related illness and many other brain disorders. They provide important objective data which vindicates our patients’ subjective reports of many neuropsychiatric symptoms which cause suffering and impair function. It is good news for our patients that these software tools are being accepted by our courts.
2015: Dr. Ross Invited to Review Journal Articles
In 2015, by invitation, Dr. Ross began reviewing journal articles for the American Journal of Radiology and Journal of Neurotrauma. These are world-leading journals in the areas of brain imaging and traumatic brain injury.
October 2015 Brain Injury Litigation Invited Speaker
Dr. Ross was invited to speak at the American Conference Institute’s National Advanced Forum on Medical Liability. Specifically, he spoke to the Post-Conference Master Class on 10/27/15 about the use of cutting edge brain imaging techniques to evaluate patients with traumatic brain injury. http://www.americanconference.com/2016/827/medical-liability-claims-coverage-risk-management
Dr. Ross Invited to Assist with Exam Questions for 2016 Brain Injury Medicine Certification Exam
In 09/15, Dr. Ross was once again invited to serve on the committee for the Brain Injury Medicine board exam to write and review exam questions for the 2016 exam given by the American Board of Physical Medicine and Rehabilitation.
09/04/15 Richmond Times-Dispatch Letter regarding Mold
On 09/04/15, Dr. Ross’ letter to the editor of the Richmond-Times Dispatch discussing the increased frequency of mold-related illness and available diagnostic tests and treatments was published. http://www.richmond.com/opinion/your-opinion/letters-to-the-editor/article_26f1c448-0858-5963-b23b-0dd776d1600f.html
06/12/15 Brain Injury Medicine Board Exam Committee
On 06/12/15, Dr. Ross served on the committee for the Brain Injury Medicine (“BIM”) board exam to write and review exam questions for the 2015 BIM exam. The exam is given by the American Board of Physical Medicine and Rehabilitation. Dr. Ross was among the first group of physicians to receive board certification in brain injury medicine in 2014.
I feel fortunate to have found Dr. Ross and the Virginia Institute of Neuropsychiatry in 2004. I had a rare movement disorder which was disabling and disfiguring. It caused me to have severe anxiety. I went to several doctors and had a lot of workup but got no real answers or help with the problem. Dr. Ross was the only doctor who was able to diagnose the movement disorder. He prescribed treatment which helped me manage the problem. Without him, I would have been bedridden and on disability many years ago with little to no quality of life. I still have to attempt to explain the unusual movement disorder to new doctors.
Dr. Ross is especially good at understanding both my neurological as well as psychiatric problems. As of February 2015, I still feel fortunate to be one of Dr. Ross’s patients.
“I would like to sincerely thank Dr. D. Ross and Jan Seabaugh at the Virginia Institute of Neuropsychiatry for helping me through a life changing event. After developing Tardive Akathisia from medicine I was taking, I could not think straight. I often wondered if I would live and at times did not want to live as I experienced unbearable incapacitating symptoms. They were the difference between life and death for me. They embraced me and took me in as though I was family and I will never forget it. Day after day they worked with me to help get those unbearable symptoms under control. Dr. Ross made himself available whenever I needed him. I had office, home, and cell phone numbers. I know they truly care and that is why I am here to share this story. You guys are amazing!! I can’t thank you enough for giving me my life back. Thanks again!!!”
“I was dreading the 9 hour drive to see Dr. Ross for my initial evaluation, not because of the long trip itself as much as wondering if it would be worth it. But it was well worth the trip. He and his staff spent all day evaluating me. The whole day was centered around me. They kept the overhead lights off all day so it wouldn’t bother my eyes. They understood the problems caused by my brain injury better than any other doctor I had seen. At the end of the day, Dr. Ross gave me his home and cell phone numbers, which is unheard of for a doctor to do. I don’t want to call him unless I really need to, but just having his numbers makes me feel better that I can call him if I need him.
After the initial evaluation, my husband finally understood what was wrong with me. I think that saved my marriage.
During follow up evaluations, Dr. Ross changes one medication at a time, so he can figure out what causes what. I was relieved to finally find a doctor who would do that.
They require you to pay out of pocket, but it has been worth every penny. They feel like family to me.”
-Patient Jennifer T.
10/06/14: Dr. Ross Certified in Brain Injury Medicine
Dr. Ross recently passed his board exam in Brain Injury Medicine, a subspecialty of the American Board of Medical Specialities (http://www.abpn.com/sub_bim.html). The exam was first offered this year. Dr. Ross also is board-certified in general psychiatry and neuropsychiatry.
Although the board notified successful examinees individually, they have not yet published a list of the diplomates (that should be forthcoming). But they did report that nationally 327 physicians passed the exam; of these, 274 were previously certified in physiatry (rehab medicine), and 53 were previously certified in neurology or psychiatry (https://www.abpmr.org/candidates/exam_statistics.html).
Given the estimate that 5.3 million or more people in the USA are living with a TBI-related disability (Langlois and Sattin, 2005), we can estimate the following:
- There is 1 physician certified in brain injury medicine for every 17,000 TBI patients in the United States.
- There is 1 physician dual-certified in brain injury medicine, and psychiatry or neurology, for every 108,000 TBI patients in the United States.
- In Virginia, if we follow national trends, there are 8 or 9 physicians certified in brain injury medicine.
- In Virginia, there are around 2 physicians dual-certified in brain injury medicine, and psychiatry or neurology.
So we have made a good start, but we have a long way to go.
“Dear Dr. Ross,
Thank you so very much for all your time and effort. I greatly appreciate it. Words cannot express my appreciation for you and your entire staff. Thank you for your brilliance and incredible competence, tenacity, & compassion.
This combination of traits are rare to find in one single Healthcare Provider.”
“When I had to make the decision and come to the realization that I needed help with my brain injury, The Virginia Institute of Neuropsychiatry and Dr. David Ross, M.D. were highly recommended to me. I was in denial but knew I needed help. The staff: Dr. Ross, Jan, Daniella and Maria were not only able to provide me knowledge about my injuries but did so in a way that I could digest this information with hope for my future. They have become my friends, my biggest supporters and my rocks in such a difficult and unexpected time in my life. I am grateful that I was led to them and feel very blessed and secure that with them, I am on a road to recovery. Thank you to the entire staff at The Virginia Institute of Neuropsychiatry especially Daniella and Maria who are always checking on me, comforting me, and even make me laugh when I’m sad. Dr. Ross takes the time to build a relationship with his patients, none of us are just a chart, we are in a way his family and that is missing in so many healthcare practices! Thank you, thank you, thank you to the entire staff at The Virginia Institute of Neuropsychiatry!”
Two-part video explains pre-injury brain volume estimation method
Dr. Ross made a two-part YouTube video in which he explained the volume estimation method (that was previously detailed in the published paper, “Back to the future: Estimating pre-injury brain volume in patients with traumatic brain injury”). The volume estimation method is used to measure or estimate the volume of the brain in patients with traumatic brain injury the moment before the injury. With this cutting edge technique, our patients now are better able to understand the effects of the accident on their brain, and in many cases to obtain additional objective evidence of brain injury. https://www.youtube.com/watch?v=QUFhJwJt4CE and https://www.youtube.com/watch?v=RF-WuxJuxTk
A paper featuring NeuroQuant® and estimating pre-injury brain volume was accepted for publication
Dr. Ross and colleagues published a paper, “Back to the future: Estimating pre-injury brain volume in patients with traumatic brain injury,” which describes an exciting breakthrough in MRI brain volume assessment.
Decades of research have shown that the brain shrinks (atrophies) in patients with traumatic brain injury (TBI). But there have been almost no studies on brain volume before the injury, because no one can predict when the patient will have an accident. Therefore, the holy grail of research on MRI and TBI has been to measure brain volume before the accident and compare it to brain volume after the accident.
Dr. Ross and colleagues’ solution to this longstanding problem was to estimate brain volume just before the time of injury. They accomplished this by integrating two previous lines of research.
Tate, Bigler and colleagues previously found they could estimate the size of maximal brain volume (which occurs during adolescence) by using intracranial volume measured later in life. Hedman and colleagues used 56 studies of brain volume in normal subjects to graph brain growth/atrophy throughout the lifespan.
By integrating the methods of Tate and Hedman, Dr. Ross and colleagues were able to estimate brain volume at any age during the lifespan based on intracranial volume measured later in life. We performed brain MRI scans on 26 patients with mild or moderate TBI, and 20 normal control subjects, and used NeuroQuant® to measure brain volume before and after injury. We found that the patients had rapid atrophy of cerebral white matter and rapid enlargement of lower brain regions. These patterns in brain volume changes may lead to the development of diagnostic tools for mild to moderate TBI.
With this cutting edge technique, our patients now are able to better understand the effects of the accident on their brain, and in many cases to obtain additional objective evidence of brain injury.
Ross, D. E., A. L. Ochs, M. D. Zannoni and J. M. Seabaugh (2014). “Back to the Future: Estimating Pre-Injury Brain Volume in Patients with Traumatic Brain Injury.” NeuroImage 102: 565-578.
VIN adds new Clinical Coordinator
In June 2014, Daniella Breder joined VIN as the new Clinical Coordinator. She will be a valuable addition to the clinical and research staff. Welcome, Daniella!
A paper featuring NeuroQuant® and mold-related illness was accepted for publication
A paper entitled “Structural brain abnormalities in patients with inflammatory illness acquired following exposure to water-damaged buildings: a volumetric MRI study using NeuroQuant®,” was accepted for publication. This paper was written by Dr. Ritchie Shoemaker and colleagues and will appear in the journal Neurotoxicology & Teratology. This study compared brain volume of a medical control group to patients with suspected illness from mold exposure. The study found that those with mold-related illness had statistically significant differences in brain volume, namely atrophy of the caudate nucleus and enlargement of the pallidum, left amygdala and right forebrain. These structural brain abnormalities, along with inflammatory markers, suggest a model for structural brain injury in mold-related illness. NeuroQuant® continues to be shown as a useful tool in providing objective evidence of brain injury or disease for those who suffer from neuropsychiatric symptoms.
Dr. Ross lectures to VCU psychiatry residents
On 06/02/14, Dr. Ross gave a lecture to fourth year VCU psychiatry residents on traumatic brain injury.
Neuroquant® expands to Europe
Neuroquant®, the FDA approved software that measures brain volume and provides objective evidence of brain atrophy from MRI images will now be available in Europe. See the article here.
New video on Neuroquant® and Mold-Related Illness
On 05/11/14, Virginia Institute of Neuropsychiatry published a video, NeuroQuant® and Mold-Related Illness. This video describes how NeuroQuant® shows MRI brain volume abnormalities in patients with mold-related illness, providing vindication for patients who report neuropsychiatric symptoms associated with mold exposure.
New video on Neuroquant® and TBI
On 05/11/14, Virginia Institute of Neuropsychiatry published a video, NeuroQuant® and Traumatic Brain Injury: Man Vs. Machine Part 2. This video describes the results of our study comparing radiologists vs. NeuroQuant® with respect to the ability to detect brain atrophy (shrinking) or asymmetry in patients with mild or moderate traumatic brain injury.
Dr. Ross lectures to VCU psychiatry residents
On 04/14/14, Dr. Ross gave a lecture to the VCU psychiatry residents on movement disorders caused by psychiatric medications.
Best wishes to Megan DeSmit!
On 04/12/14, Megan married Cesare Zannoni. After her honeymoon, she and her husband will be moving to Charlottesville, where she will begin a Master’s in Clinical Nurse Leadership (MSN) program at The University of Virginia. We appreciate her dedication to the clinical care of our patients and her contributions to VIN research and wish her the best of luck in her future endeavors!
VIN listed as approved NeuroQuant® center
In February 2014, CorTechs Labs, owner/developer of the NeuroQuant® software, listed VIN as an approved NeuroQuant® center on its redesigned website.
Letter to the Editor
Chesterfield Monthly, March 2014 – Jan Seabaugh and Dr. David Ross wrote a letter to the editor commenting on the article “Banging Our Heads.” The letter discusses brain injuries resulting from football or other accidents and how NeuroQuant® can identify brain changes. To read the full text version visit the Chesterfield Monthly.
Dr. Zhou and his colleagues replicate VIN research findings
Radiology, June 2013 – The article addressed global and regional brain atrophy after injury. Read more.
Invited Speaker at the Williamsburg Brain Injury Rehabilitation Conference
Williamsburg, Virginia, May 2nd-3rd 2013 – Dr. David Ross was invited to speak about neuropsychiatric evaluations and treatment of patients with traumatic brain injury. For more information visit Rehabilitation of the Adult and Child with Traumatic Brain Injury.
Invited Speaker at Brain Injury Conference
Philadelphia, Pennsylvania, March 14th-15th 2013 – Dr. David Ross was invited to speak at the Brain Injury Claims and Litigation conference. Dr. Ross will be discussing various brain imaging techniques including NeuroQuant®. For more information visit The American Conference Institute.
Letter to the Editor
Richmond Times Dispatch, December 5th 2012- Dr. David Ross wrote a letter to the editor commenting on the challenges veterans face receiving benefits from the VA medical system. To read the full text version visit Richmond Times Dispatch Letter to the Editor.
Longitudinal Paper Published
November 2012– The Virginia Institute of Neuropsychiatry and our collaborators had a paper published in the journal Brain Injury. The study showed the brain volumetric software NeuroQuant® had excellent test-retest reliability and proved to be a valid method for assessing brain volume changes. The study concluded that progressive atrophy may continue years after injury. Read more: Progressive brain atrophy in patients with chronic neuropsychiatric symptoms after mild traumatic brain injury: A preliminary study.
Richmond Times Dispatch Correspondent of the Day
Richmond, Virginia, September 29th 2012 – Dr. David Ross wrote a letter to the editor of the Richmond Times Dispatch describing the new techniques available to individuals with traumatic brain injuries. These advancements aid in the detection of mild traumatic brain injuries previously overlooked by older techniques. Read more: New advances help detect brain Injuries
Medical College of Virginia Grand Rounds
Richmond, Virginia, September 28th 2012- Dr. David Ross gave an MRI and traumatic brain injury lecture to MCV doctors, faculty, residents and students during Grand Rounds on Friday. The lecture highlighted the important advancements in brain imaging and how they can be applied to patients today. See more: MRI and Traumatic Brain Injury
Virginia Institute of Neuropsychiatry Announces New Assistant Director
Midlothian, Virginia, September 6th 2012 – Virginia Institute of Neuropsychiatry clinical assistant Jan Seabaugh M.A. was promoted to assistant director of the Virginia Institute of Neuropsychiatry. Jan has been a valuable member of our practice since 2009 and will continue to work with our patients in the years to come.
VCU School of Medicine Career Fair
Richmond, Virginia, April 20 2012 – Dr. David Ross was an invited guest at the MCV Alumni Carrer Fair hosted for current medical students. The fair was an opportunity for medical students to gain information about a variety of careers options in the medical field. Dr. Ross enjoyed meeting the medical students and sharing his knowledge of Neuropsychiatry.
24th Annual North American Brain Injury Society (NABIS) Conference on Legal Issues on Brain Injury
New Orleans, Louisiana, September 14-17 2011 – Dr. David Ross was invited to speak about NeuroQuant, at the 24th Annual NABIS conference which included attorney’s, physicians, and clinicians from around the country.
Virginia Institute of Neuropsychiatry New Facility
Midlothian, Virginia, March 30th 2010 – The Virginia Institue of Neuropsychiatry moved to its new home on Browns Hill Court in Midlothian, Virginia.