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Neurology (Expert Forum)
Recovering from brain injury
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Recovering from brain injury
by 2112, Mar 16, 2007 12:00AM
I am a 34 y/o female with no medical history untill 4 years ago. I had back to back concussions( with in a week)with the second one knocking me out for about 20 minutes. Didn't notice anything different untill 4 months after the accident. Went to several doctors, and finally found a neurologist that started me on aricept. It has been 6 months since I have started this drug, and have seen a huge improvement, on memory, concentration, and problem solving. Even with the improvements, I still have some problems/ with understanding people, complex projects, getting from one place to the next, dizziness, and word finding. Will these things improve to like they were before the accident? If aricept is stopped will the other things that have improved, worsen? I want to be the person I used to be, to be able to function, and live the life I used to have, but I don't understand what is taking so long. Any information is appreciated.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Apr 05, 2007 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
The symptoms and story that you provide are typical for post concussive syndrome that occurs after traumatic brain injury (TBI). This syndome includes mental dullness, poor memory, depressed mood, personality changes and feelings of lightheadedness and dizziness. These symptoms are thought to be due to frontal lobe and temporal lobe damage that often occures with TBI. These symptoms do generally improve with time (to some extent at least), but many patients with TBI have permanent troubles with the above symptoms. The use of Aricept (Donepezil) have given hope to many patients for a faster and more extensive recovery (but often not a complete recovery). The extent of time and the amount that you would potentially relapse if the Aricept were stopped depends on the extent of your injury. As long as you are not having side effects I would continue the aricept until you feel closer to your baseline. I would also suggest an MRI of the brain to help determine the extent of your injury.
I hope this has been helpful.
The symptoms and story that you provide are typical for post concussive syndrome that occurs after traumatic brain injury (TBI). This syndome includes mental dullness, poor memory, depressed mood, personality changes and feelings of lightheadedness and dizziness. These symptoms are thought to be due to frontal lobe and temporal lobe damage that often occures with TBI. These symptoms do generally improve with time (to some extent at least), but many patients with TBI have permanent troubles with the above symptoms. The use of Aricept (Donepezil) have given hope to many patients for a faster and more extensive recovery (but often not a complete recovery). The extent of time and the amount that you would potentially relapse if the Aricept were stopped depends on the extent of your injury. As long as you are not having side effects I would continue the aricept until you feel closer to your baseline. I would also suggest an MRI of the brain to help determine the extent of your injury.
I hope this has been helpful.
The evalution of a neurobehavioural aspect of head trauma is a big field and its very hard to summarize it in these few lines, but we usually start by classifying the patient clinically into mild, moderate, and severe traumatic brain injury .
From your description of LOC of 20 min you are in the moderate category (we need more like the hospital chart for the GCS score, any amnesia+ the duration, and the assumed type of injury)
When it comes to prognosis, we lump the mild and the moderate catigories together because they have much better prognosis than the severe cases.But we need to do some kind of special tests like a detailed neuropsych testing batteries, by a specialised nurse at least, to clearly identify the area of deficits, and correlate it with the neuro imaging like SPECT scan which is more sensitive than a CT or an MRI in detecting cerebral abnormalities in cases like yours some also recomend a functional MRI fMRI/ PET, though no harm of repeating a routine MRI looking for any delayed changes (ventricular or temporal lobe atrophy).
T o keep it short, we have to separate the organic damages from the neuropsycological ones post head trauma , and then we could choose the best stratigy to treat it.
Bob