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    ERP Testing after Accident May Help Diagnose TBI in Patients Who Don’t Remember

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    ERP Testing after Accident May Help Diagnose TBI in Patients Who Don’t Remember

Ehline Law and our personal injury lawyers understand how devastating a traumatic brain injury (TBI) can be on the victim and the family, and it’s even worse when traditional imaging tests do not correctly diagnose a TBI.

Here, our experienced car accident lawyer will go over the types of TBI, the traditional imaging tests recommended by medical professionals, and how ERP testing after an accident can help diagnose TBI better.

There Are Two Main Types of Traumatic Brain Injury

The two main categories of TBI include:

  • Penetrating TBI: When an object pierces the skull and the brain tissue, it is typically referred to as penetrative TBI, and this type of injury can cause damage to the brain.
  • Non-penetrating TBI or closed head injury: When an external force hits the head with enough pressure to shake the brain inside the skull, it is typically referred to as non-penetrating TBI.

Certain types of incidents, such as natural disasters and explosions, can lead to both types of TBI in the same person. Although a brain injury occurs on impact, most of the damage associated with a TBI arises from secondary injuries, which may develop a few days or weeks after primary injuries.

How TBI Affects Brain Function

A TBI can either be in one part of the brain (focal injury) or spread across a much larger area (diffuse injury). The effect of a TBI on a person depends on the type of injury sustained, so let’s look at a few different types of brain injuries and their impact on the brain.

Diffuse Axonal Injury

Considered to be the most common type of brain injury, diffuse axonal injury occurs when there is widespread damage to the brain. It typically occurs when there is a rotational force or sudden forceful stopping and can affect the communication between the nerve cells. A diffuse axonal injury can lead to a chemical release in the brain which can cause further damage to it.


Often referred to as a mild brain injury, a concussion can take anywhere between a few minutes to several months to heal. Concussions occur when there are non-penetrative blows to the head, causing the person to either lose consciousness or alter their state of awareness.

Although a minor concussion may not be so dangerous, a close second or multiple concussions can lead to severe brain injuries and, in some cases, even death.


When a blood vessel breaks, it causes the blood to accumulate in the brain. Increased intracranial pressure can cause damage to the tissue, depriving the brain of oxygen which can affect brain function.

There are different types of hematomas depending on where the blood collects, and these include:

  • Epidural hematomas: This type of hematoma occurs when there is bleeding between the skull and dura mater, the outermost protective membrane covering your brain. It can lead to severe headaches and loss of consciousness.
  • Subdural hematomas: A subdural hematoma is a serious condition where blood collects between the skull and the brain’s surface. It can cause a headache that tends to get worse over time.
  • Subarachnoid hemorrhage: This is an uncommon type of stroke caused by bleeding on the brain’s surface.
  • Intracerebral hematoma: This type of hematoma occurs when there are ruptures in the brain tissue, causing the blood to pool and damaging the surrounding tissue.


When small blood vessels break or bleed into the brain, it can lead to contusions. These are bruises, most commonly along the undersurface and poles of the frontal and temporal lobes.

Skull Fracture

The injury is commonly known as a skull fracture when blunt force trauma breaks one or multiple bones in the skull. It can cause serious damage to the blood vessels, membranes, and the brain.

Chronic Traumatic Encephalopathy (CTE)

CTE is a progressive neurological disorder linked to repeated head injuries and blows to the head, and it can lead to severe cognitive impairment and affect motor skills. 

A CTE can cause depression, confusion, memory problems, tremors, and dementia. Many college footballers have either died from CTE or suffered from one, leading to several lawsuits filed against the NCA.

Diagnosing Traumatic Brain Injury

There is no single test to determine a TBI and the extent of the injury. Medical professionals must conduct a neurological exam to test the patient’s speaking, communication, memory, mood, motor and sensory skills, and other skills.

The Centers for Disease Control and Prevention provides an Acute Concussion Evaluation (ACE) form and a few other forms for medical professionals to assess TBI.

After the medical professional carries out the initial assessment, they may require the patient to undergo diagnostic imaging to determine the extent of the injuries, and these include the following:

  • CT scan: A CT scan is an X-ray that produces two-dimensional horizontal or axial images made using a form of tomography to help assess moderate to severe TBI.
  • Magnetic resonance imaging (MRI): This type of testing uses a magnetic field and computer-generated radio waves to create detailed images of the brain.

Despite the two most common imaging tests, a traumatic brain injury may go unnoticed, and exploring other forms of testing, such as ERP testing, is essential. A person who experiences a car accident and does not remember the accident scene (common signs of post-traumatic amnesia) may have a traumatic brain injury. In such situations, ERP testing can help identify the anomalies and diagnose the TBI.

Using specific cognitive tasks, ERP testing helps assess memory, executive functioning, information processing, problem-solving skills, and other brain functions.

COGNISION® System: An FDA-approved Device to Detect TBI

The COGNISION system is one of the FDA-approved devices that help medical professionals and specialists to evaluate complex neurologic disorders and diagnose TBI. 

It can help doctors quickly evaluate a patient’s altered mental state, such as concussions, post-concussion syndrome, mild TBI, and other neurological disorders. It does not require licensed technicians to handle the device.

ERP Measures for Traumatic Brain Injury

Since the early 1980s, studies have explored the use of ERPs in explaining and characterizing sensory and cognitive deficits. Recent research suggests the potential role of ERPs in diagnosing traumatic brain injury, with the American College of Occupational and Environmental Medicine recommending Cognitive Event-Related Potentials for TBI diagnosis purposes.

Certain TBI patients may demonstrate normal clinical findings, leading to an oversight in diagnosing TBI. However, recent research suggests that ERPs can help detect subtle deficits in information processing, which may go under the radar in some TBI tests. ERPs have a critical role as biomarkers that can aid in TBI prognosis.

In a study carried out by Duncan et al., the different combinations of N100, mismatch negativity (MMN), and P300 can offer excellent prognostic value awakening and cognitive recovery. Although the combinations may differ among investigators, ERPs can be an essential testing criterion in assessing coma.

Active Auditory Oddball Paradigm test can help determine cognitive deficits that arise in traumatic brain injuries. During this test, the patient must hear a tone typically played during a frequent (standard) stimulus sequence. A third tone may be then introduced as a distractor, and the patient must respond when they hear the target tone.

Under the Active Auditory Oddball Paradigm, the test generates P3b, P3a, and N200, which provide information sensitive to cognitive deficits pertaining to a traumatic brain injury. The P3b reflects an update in working memory and is a sensitive measure of ERP to detect anomalies in cortical synaptic function.

In a study carried out by Baillargeon et al., the findings revealed that the P3b is significantly lower in amplitude in athletes with concussions compared to athletes who have not suffered any injuries.

Another study that examined the brain functions of college students revealed that the P3b is significantly lower in amplitude in students suffering from a mild traumatic brain injury, and the change in the P3b component was directly related to the severity of post-concussion symptoms.

The P3a is closely linked to the engagement of attention and information and generated with distractor stimuli. The peak amplitude on the P3a measures focal attention, which, according to several studies, changes after a person suffers a traumatic brain injury. 

A study conducted on football college players who suffered a concussion revealed that the players who had their last concussion a year before ERP testing had a significantly lower P3a. However, that anomaly was no longer present in college football players who had their previous concussion two years before the ERP testing. Another study conducted by Moore et al. also demonstrated similar findings.

Solbakk et al. carried out a study on survivors of moderate to severe TBI. They found that the P3a amplitude reduced drastically when assessing people with injuries in frontal or frontotemporal brain regions. There was also a trend toward prolonged peak latency in survivors.

Unlike P3a and P3b, which is a positive-going component, the N200 is a negative polarity closely associated with stimulus identification and distinction cognitive processes. The N200 is often reflected in patients with moderate to severe TBI.

Sarno et al. conducted a test on TBI survivors and found a prolonged N200 latency, while two other studies reported smaller amplitude and prolonged latency in N200 in moderate to severe TBI survivors.

Is ERP Testing Necessary for Evaluation of Traumatic Brain Injury?

When a person suffers a traumatic brain injury, the medical professional will often require structural neuroimaging data typically gathered using CT scans and MRIs. 

However, there may be inconsistencies with the data generated using the two mentioned tests, and none of the two can detect diffuse axonal injuries, the most common form of TBI.

ERP testing frequently showed decreased amplitude and/or prolonged latency for some of the ERP markers in many groups of patients, suggesting a deficit in executive function, attentional impairment, and slowing of processing speed.

Dockree and Robertson, when reviewing biomarkers and their usefulness in detecting cognitive deficits, concluded that cognitive testing provides sensitivity to impairments often not found in CT scans or conventional MRI sequences.

Schedule a Free Consultation with Ehline Law ERP Testing Lawyers

If you’ve suffered a traumatic brain injury due to someone else’s negligence, contact us at (833) LETS-SUE for a free consultation with our experienced brain injury lawyers, as you may be able to seek compensation.

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Michael Ehline

Michael Ehline is an inactive U.S. Marine and world-famous legal historian. Michael helped draft the Cruise Ship Safety Act and has won some of U.S. history’s largest motorcycle accident settlements. Together with his legal team, Michael and the Ehline Law Firm collect damages on behalf of clients. We pride ourselves on being available to answer your most pressing and difficult questions 24/7. We are proud sponsors of the Paul Ehline Memorial Motorcycle Ride and a Service Disabled Veteran Operated Business. (SDVOB.) We are ready to fight.