Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
|lilarky2003 - Fri Nov 14, 2008 3:23 pm|
at the end of march 2008 i jumped(with force) over a 2-3 ft platform into a thick steel bar. when this happened i didn't loose concousness or vomit. i felt very light headed, dizzy, and nauseated. i went home and put ice on my head and took motrin. the next day (a friday) i went to sickcall (military doctor) and told them my symptoms and told them it felt like my head was too heavy for my neck to support it. they did an Xray and found a T1 fracture. they never sent it to the neurology department...a military doctor just glanced at it and said "it looked" old and asked if i'd ever been in an accident. i told him no...they put me on cyclobenzaprine (muscle relaxer) and hydrocodine. since then i still have really bad neck and upper back pain, i started getting tingling sensations in my fingers, my neck and back, and my hand goes numb if i rest my elbow (above the elbow) on a surface. they told me i had soft tissue damage/ whiplash/ a neck sprain. i don't understand why it still hurts. i've done physical therapy but the doctor said it was getting worse, i've seen a chiropractor several times, and i've done "neck exercises". stretching mostly doesn't help. when i do stretch my neck it hurts more and i feel nauseated...last week i was referred to get a brain MRI...i don't know the results yet.
i'm in the military and the doctors don't have the same training as civilian doctors. i'm worried that the fracture might not have been old...i think i would know if i had fractured my neck before. the military doctors can sometimes ignore things so that the military "isn't at fault" and they won't have to fix it and will kick people out for it.
oh and also, when i hurt my head i kept on "spacing out" i lost things all of the time such as my purse, phone, keys...things that i never loose! it's better now and my neck makes a kind of crunching noise when i turn my head too far. PLEASE HELP IF U CAN.
|John Kenyon, CNA - Sat Nov 29, 2008 10:45 pm|
I've worked in MilMed and understand the special problems that can be encountered. I also doubt that, at age 20, you'd have an "old" T-1 injury. Given the "ram" type head injury you suffered in your accident, it is entirely possible your T-1 fracture is new and probably was incurred during the collision between your head and that bar. While you seem to have post-concussion symptoms (which could as easily be caused by the combination of cyclobenzaprine and hydrocodone), you also almost certainly have problems related to that T-1 injury based on the symptoms you describe. This is serious enough to make an issue of it, since a nerve is being impinged upon, causing the symptoms in your neck, upper back and fingers. One or both ulnar nerves could be compressed at their outlets because of the fracture, and this would account for many of your neck/back and hand symptoms. It is absolutely consistent with the location of the fracture, and the fracture is completely consistent with the mechanism of injury caused by your head trauma.
You need to have this treated aggressively to avoid permanent nerve damage. If you don't have severe and disabling muscle spasm in your neck or upper back, you'd probably be better off not using the cyclobenzaprine (except at bedtime), as it can cause most of the "spacing out" problems and forgetfulness, especially when combined with an opiod like hydrocodone (which may serve as a muscle relaxant anyway, as well as a decent pain med, if needed).
Also, with all due respect to the art of chiropractic, I'd stay away from chiropractors until the T-1 injury is stable and resolved, as chiropractic adjustment could actually make this problem worse.
I hope this is helpful to you. Good luck with the system, too. Please follow up with us here as needed.
|lilarky2003 - Mon Dec 01, 2008 2:50 pm|
i went in to review my last head/brain mri about a week ago. they found fluid in my mastoids. the military doc, as usual, insisted it wasn't from the head injury. he insisted that i had bilateral mastoiditus as a child, even after i told him i've never had ear infections or ear aches as a kid. i decided to get a second opinion.
the new doctor reviewed the mri. i told her about my history. she said that i was born with underdeveloped mastoids and she thinks i had a concussion but didn't know it..since i never threw up or passed out and my motor skills and reflexs were good, the doctors didn't ever look at my head. she said that when someone has a concussion the brain can swell and the fluid can be compressed in the skull, and that maybe it tried to "take the path of least resistance" thru my underdeveloped mastoids and the maybe i do have PCS.
when i was in physical therapy, i was having neck spasms. they took me off of physical therapy because of it. i haven't taken the cyclobenzaprine or the hydrocodone in about 6 months. i haven't been on any pain meds in about 5 months and i'm still feel spaced out at times...i have to think really hard to remember what someone told me 15 minutes ago at times. and i didn't start getting spaced out until like 3 months after the injury..is that possible?
is there anything i can do for my T1 fracture? the doctors here won't help me. they insist it's old. they're calling my neck problems "chronic pain" like it's in my head or some thing. i feel like they can't find out why i'm in pain and rather than admitting that or trying harder they'd rather say it's chronic pain..to cover thier butts.
i am getting a portible machine, that's used in physical therapy...i don't remember what it's called. it has electrodes that are put on the affected area and shocks the muscles. do you think it'll help?
|John Kenyon, CNA - Tue Dec 02, 2008 1:23 pm|
Hi again -
The underdeveloped mastoids theory makes sense and could, in fact, be responsible, with PCS, for the "spacey" feelings and short term memory problems, especially since you've been off the meds for so long. That pretty much rules them out as a cause.
As for the T-1 injury and subsequent pain, although you've been told it's inconsequential, I'm assuming the same doctor ordered the TENS machine? At any rate, that's what that's called, and those can be very effective in many cases, so give it a chance to work, because sometimes it can actually undo some of the spasm that causes the pain. It'll be interesting to see how that affects things.
As for any other therapy for the T-1 fracture, it would depend on the interpretation of the condition of the vertebra. If it's displaced, is causing compression of a nerve, or is otherwise not quite right, there could be physical therapy (only cervical traction would seem to be a tolerable approach), or possibly a surgical fix. A neurologist or orthopedist would have to work in concert with a neurosurgeon to make this call, and having a nerve conduction study done would be a good first step to determine whether or not this is actually causing the symptoms.
Keep us updated, please.
|lilarky2003 - Wed Dec 03, 2008 8:33 pm|
Thank you and i will keep ya updated..the tingling isn't so bad anymore...it seems to be getting better...and it started getting better when i started jogging again. I still get tingling especially in my finger tips but i used to wake up in the middle of the night(approx 4Xs a night) with throbbing tinling pain in my whole hand. i will give the TENS unit another chance..this new doctor actually seems very intelligent and has a general interest in finding out what is wrong and how we should treat it. she told me there is no treatment for PPCS but that if it still bothers me after surgery maybe i should try seeing a therapist. i guess i don't really get how it works and i googled it the other day and it said that a lot of doctors don't believe PCS is an actual syndrome...
they're sending me to ENT (ear nose throat) to "double check" and make sure it isn't mastoiditus at the end of december so i'll know more after that hopefully.
once again thank u so much for all of ur help. i can't tell u how much it's appreciated!
|John Kenyon, CNA - Thu Dec 04, 2008 12:25 pm|
I'm glad to hear the tingling situation is improving. It's hard to describe to someone who hasn't experienced it just how annoying/disturbing that can be.
I'm also glad you've found a doctor more interested in treating patients than merely processing them. And she's right, there is no real treatment for PCS, it's something that slowly resolves on its own. It is somewhat controversial, but among the trauma doctors I've worked with on both coasts it is a given, so I buy into it, just don't have much useful to offer in terms of making it go away quicker.
Great, too, that you're going to have mastoiditis ruled out. With a history of fluid residing in there it's always a possibility.
You're very welcome, and thank you for the update. Stay in touch.
|lilarky2003 - Tue Feb 10, 2009 8:07 am|
quick question...in your medical opinion ofcourse...i was told that i was born with under developed mastoids. i have fluid in both mastoids, more so in the right..from a suspected cerebral concussion. Is it safe to leave the fluid there...
i guess my main question is, what happens if for some reason i were to suffer another concussion, the brain swelled, compressed cerebral spinal fluid, yada yada wouldn't it make it worse...for instance make brain damage way more likely or anything like that? the first concussion caused a lot of short term memory problems, so i can only wonder what would happen.
a military doctor is basically telling me that he wants to leave it there because it isn't affecting me to perform...i agree that it isn't affecting me now, but i'm worried what will happen in the future. do you think i should get a second opinion, or "don't fix what isn't broken?"
|John Kenyon, CNA - Tue Feb 10, 2009 12:52 pm|
I think the congenital small mastoids with consequently relatively greater amounts of fluid residing there is one of those things that falls under the "If it's not broken, don't fix it" rule. It's unlikely, in the case of a future head trauma (and let's try to not have more of them, just as a standard practice!) to add significantly to ICP, and of course since it's part of your known history, it could, if necessary, be readily tapped. It probably wouldn't matter, however.
Concussions will often cause some pretty annoying short-term memory loss, at least for a while. This isn't unusual.
Hope this answers the question.
|lilarky2003 - Wed Feb 11, 2009 8:22 pm|
ok thank you. Sometimes, as i've told you before, I just don't know if I trust military doctor's "medical opinion". so thank you for the verification! Have a good day.
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