Author: Fred Kahn MD, FRCS (C)
Source: Meditech International Inc.
The patient, L.B., is a 53-year-old bank executive specializing in marketing strategies at a major bank. Her history revealed that while at work she forcefully extended the cranium and the cervical spine when she laughed explosively and in moving these structures backwards rapidly, the occiput collided forcibly with the unyielding sharp edge of a corner in the wall. She has not been able to work subsequently.
After this contact she was momentarily dazed, however the majority of her symptoms began gradually over the next 48 hours and additional symptoms continued to develop over the course of the first year. These included disruptive sleep patterns, progressive fatigue, memory loss both short and long-term, difficulty finding appropriate words, an inability to focus or concentrate and fuzzy vision, sometimes so severe that it felt as if she were going blind. Her thought processes were often confused and she began to experience “silent headaches” that presented on most days and would last for many hours, sometimes extending to the following day. The patient described these episodes as an “aura-type” syndrome where she would see small coloured lines that expanded from a central small area to a large C as time progressed. This process had a debilitating affect, however at some point in time the problem was partially controlled with a variety of medications including Nortriptyline, Gabapentin, etc.
These events, which occurred at least 5 times each week, were quite disturbing and caused severe depression. The headaches, although relatively acute early on, were largely disregarded.
The patient is right handed. The right grip is 32 and the left 5 lbs. Range of motion of the cervical spine with regard to flexion, extension, lateral rotation and lateral flexion is less than 20% of normal.
Significant paracervical muscle spasm was noted to be present extending over both the cervical and thoracic spine. The degree of tenderness over the occiput and cervical spine was relatively severe and extended to the T6 level. Lateral abduction of both shoulders was to 50° only.
There was significant tenderness over both shoulder joints.
No overt neurological abnormalities were identified.
- Cerebral Concussion.
- Myofascitis/Degenerative Osteoarthritis – Cervical, Thoracic and Lumbar Spine.
- Diabetes Mellitus (the patient had diabetes which was under control utilizing Metformin).
- Multiple Soft Tissue Injuries.
This case is somewhat unusual as none of the physicians who initially attended the patient entertained the diagnosis of concussion, despite the fact that the latter was the most significant component of her injury. Not until she consulted a specialist almost a year post-trauma was this diagnosis seriously entertained. Initially the primary injury had been described as a severe sprain of the soft tissues of the neck. Analgesics and anti-inflammatory medications, along with a prolonged course of injections to the cervical spine region at weekly intervals were utilized to treat her problems and no particular consideration was given to the brain injury.
The patient herself, although she agreed with the diagnosis of the neck problem, thought that the primary damage had occurred in what she believed to be the “pain centre” of her brain and this was partially confirmed by the symptoms of acute pain in the neck with subsequent extension to the thoracic and lumbar spine and radiation to all the extremities.
COURSE OF THERAPY:
Initially Laser Therapy was applied to the cervical spine, including the brain stem and cerebellum and gradually extended to the thoracic spine and eventually the lumbar spine. Therapy was instituted on May 14, 2014, on the date of presentation and is still continuing at time of writing, July 19, 2014, on a bi-weekly basis.
At the time of this patient’s most recent evaluation on July 19, the majority of her symptoms have either disappeared or have been substantially reduced. Her chronic fatigue, which was at times almost paralyzing, is gone and has been replaced by new found energy expressed by resuming driving, trips to the gym and travel to more distant points. Sleep patterns have normalized as anxiety and depression have been completely relieved. Her memory loss and ability to concentrate continue to improve and to date have recovered in excess of 75% of normal capacity. The headaches have been diminishing in intensity since her 10th treatment session out of a total of 20 treatments to date.
At the time of her initial presentation, the patient was ingesting a total of 9 medications daily in various dosages. Currently, she is only utilizing 4 of these pharmaceuticals and another 2 should be eliminated over the next month. There have been no withdrawal symptoms and indeed, the patient continues to improve.
Her recovery process at this time is felt to be 70% complete from a global perspective and is continuing to improve with ongoing treatment. The prognosis, both short and long term, is positive and should result in a normal state of health based on the results to date.
It is anticipated that the patient should be able to return to work, if she so desires, in a year at most. The most salient feature of this case is the frequent failure to diagnosis concussion at the time of injury and institute effective therapeutic solutions at an early stage.