PMC4673569_01
L = Left. The CT image on the left is from the day-of-injury (DOI) and shows focal intraparenchymal haemorrhage in the left frontal lobe with a contrecoup focal haemorrhagic lesion located posteriorly in the right parietal area. By 2 weeks post-injury, focal areas of decreased density deep within the frontal and parietal parenchyma have developed, reflecting damage substantially larger than the original haemorrhagic lesion.
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CT demonstrated a distinct frontal haemorrhage associated with a right contrecoup parietal haemorrhage, as shown in Figure 2. Clearly evident (also see Figure 2), follow-up CT imaging demonstrated even larger parenchymal changes as a result of the original haemorrhagic lesions and brain injury (MRI studies were never done with this patient because of artifact from the craniofacial reconstruction). Prior to sustaining the severe TBI, the individual shown in Figure 2 was college educated with executive level employment. What would it mean in a patient with SVT 'failure', like that in Figure 2, if the neuropsychological test findings are reflexively interpreted as implicating invalid symptom endorsement and behavioural deficits post-injury? Obviously neuroimaging demonstrates structural damage to key regions associated with motivation and drive as well as attention. However, as pointed out by the case in Figure 2 there may indeed be variation in SVT performance by type of disorder and location of pathology as well as type of neuropsychiatric disorder.