There are persistent post-traumatic symptoms involving the brain and spine following a motor vehicle accident (MVA). Over the past 6–8 weeks, the patient has undergone consistent conservative management, including prescription medication, physical or chiropractic therapy. Despite this treatment course, symptoms remain unresolved and functionally limiting, necessitating further diagnostic evaluation. 

MRI of the Brain:
Indicated to evaluate for post-concussive sequelae including intracranial hemorrhage, white matter shear injury (diffuse axonal injury), or microvascular trauma not detected on CT. Symptoms include chronic headache, dizziness, cognitive disturbance, and photophobia.

MRI of the Cervical Spine:
Justified due to ongoing axial neck pain and upper extremity radicular symptoms (e.g., numbness, tingling, weakness). High-resolution MRI is required to assess for cervical disc herniation, ligamentous injury, facet arthropathy, spinal cord edema, or foraminal stenosis; conditions that may have arisen or been aggravated by hyperextension or acceleration-deceleration forces during the collision.

MRI of the Thoracic Spine:
Persistent midline thoracic pain and paraspinal tenderness post-MVA may reflect occult disc injury, vertebral trauma, or costovertebral instability. MRI is needed to visualize thoracic spinal cord signal changes or posterior element disruption not seen on plain films.

MRI of the Lumbar Spine:
Indicated for unresolved lower back pain with or without lower extremity radiation. Post-traumatic injury to the lumbar discs (particularly L4–S1), facet joints, or nerve roots may contribute to radiculopathy or altered gait. MRI is critical for identifying annular tears, nerve impingement, or epidural inflammation; especially with symptoms unrelieved by prior conservative therapy.

== EARLY MRI

Medical Necessity Statement – MRI Brain (Post-MVA, Neurologic Findings Present)

The patient is less than 4 weeks post–motor vehicle accident and presents with persistent neurological symptoms including headache, dizziness, visual disturbance, cognitive slowing, and imbalance—clinical indicators concerning for post-concussive syndrome or structural brain injury. These symptoms have not resolved with initial conservative measures and warrant urgent advanced neuroimaging.

MRI of the brain is medically necessary to assess for traumatic brain injury such as cerebral contusion, petechial hemorrhage, or diffuse axonal injury not typically visible on CT; intracranial pathology such as subdural or epidural hematoma, parenchymal edema, or vascular injury; and midline shift or mass effect resulting from acute trauma. Additionally, MRI is superior to CT for evaluating posterior fossa and brainstem abnormalities, which are often implicated in symptoms such as imbalance, nausea, or cranial nerve dysfunction.

Given the presence of neurologic findings and the time-sensitive nature of intracranial pathology, MRI brain is medically indicated at this stage. Early identification of structural injury is essential for treatment planning and to mitigate long-term neurocognitive sequelae.

MRI Cervical Spine
Indicated due to post-traumatic cervical pain accompanied by upper limb numbness, weakness, or hyperreflexia. These findings raise concern for spinal cord impingement, disc herniation, or ligamentous injury at the C1 to C7 levels. Early MRI is critical for detecting myelopathy or cord compression, particularly in the context of neurologic deficits following high-velocity trauma.

MRI Thoracic Spine
Midline thoracic spine pain, especially when associated with upper or lower extremity symptoms or a defined sensory level, may reflect central cord involvement or occult vertebral trauma. MRI is necessary to evaluate for thoracic cord compression, edema, hematomyelia, or soft tissue injury not visible on X-ray or CT.

MRI Lumbar Spine
Justified due to persistent lumbar pain with lower extremity radiculopathy, weakness, or reflex changes. MRI is essential to assess for acute disc herniation, nerve root impingement, epidural inflammation, or early cauda equina syndrome. These conditions require timely diagnosis and may necessitate interventional or surgical treatment.