Dear Dr Nee, your advice and opinion would be much appreciated.

[Jean82]

Tags: migraines, MTBI, Non-epileptic seizures, post concussion, Vision Disturbances
Early last year I was knocked unconsciousness for not less than 20 minutes by falling equipment at work. I had a severe migraine afterwards and a very sore neck. Returned to work after the weekend and continued working full -time for 8 weeks until my principal insisted I take leave as the symptoms (severe chronic migraine headaches that wouldn't respond to my normal medication, diziness, blurred and double vision, short-term memory problems etc, etc) were only getting worse.  CT was clear but 6 months later I was diagnosed by specialists at a Concussion Clinic with a MTBI and PCS resulting in reduced cognitive function etc.
Subsequent to this diagnosis I was knocked unconsciousness twice in one evening, each time for a period of not less than one hour. (An accident followed by a violent assault).  A week later I collapsed and was sent to hospital for a check up - again I was very fortunate with a clear CT scan and only soft tissue injuries (although these were extensive).  Over the following weeks I started to have problems with syncope episodes and my chiropractor reported that I had begun to have seizures and that these were becoming increasingly severe - the seizures seem to only occur when I am lying down and I seem to be more prone to them if I am physically tired and/or hot.  As a result of the syncope episodes, I have continued to experience blows to the head (from falling down), some of which are concussive, and am continuing to experience severe chronic migraine headaches (sometimes it is difficult to discern when one is finishing and another one is starting) extreme sensitivity to light and noise, double vision and vision disturbances and disrupted sleep patterns.  Epilepsy and diabetes (low blood sugar was reported by medical staff on more than one occasion after a syncope episode) have been discounted as possible causes (EEG was normal and ECG only exhibited sinus tachychardia). On more than one occasion the syncope episodes have been associated with postural hypotension and on one occasion my BP fluctuated from 149/110 to 85/60 and back to 137/94 within the space of 5 minutes as monitored by emergancy medical staff. It has also been reported that my pulse can become very faint during a seizure. From the reports I have received, the seizures vary in length from 1 minute to 10 minutes and are apparently of the grand mal variety.  After a prolonged seizure I have also been told I can be quite disorientated for up to 30 minutes. A week ago I was sent to ED by my chiropractor following a prolonged seizure (that had been preceded by a blow to the head causing a black eye and severe bruising to the forehead); apparently I had failed to fully recover consciousness for more than a hour afterward and was seriously disorientated.  I have no recollection of the event, the 30 minutes preceding it or the following 3 hours.
Prior to the concussion at work a year ago, I had suffered from migraines but was able to control them sufficiently well with the prescription medications (sumitripton, ibuprofen, paracetamol etc) that I hadn't had a day off work due to illness in over a year.  I have experienced about 8 serious concussive events in my life prior to the accident at work but apart from the migraine headaches didn't experience any other longterm side effects. My IQ score in a test in 2005 was 148.  I am really frustrated and concerned about the ongoing symptoms I am experiencing and desperately need to understand what is causing them and how to treat them effectively so I can get back to the job I love (I'm a secondary school maths teacher) as soon as possible.
Any advice or information you could provide would be very much appreciated thank you, Jean

[Jean82]

Dear Dr Nee,

Thanks very much for your help and advice.  Unfortunately the MRI has been ruled out - apparently I would need to be sedated and the anathesiest has said it is too risky. The seizure activity became more severe over the last week (3 series of repetitive grand-mal seizures over 3 days plus 2 series of minor grand mal seizures); I am now starting to take gabapentin to see if this will control them.
I had been prescribed gabapentin for neuropathic pain last year and it was helpful for this but a specialist I was referred too didn't recognise it as a useful medication fro the treatment of migraines and advised me to first reduce and then eliminate it - this coincided with the 2 successive 1 hour long concussions on 21 Sept and the beginning of the seizures which became much worse in the following weeks and with the discontinuation of the med.   I was actually told though to take a fairly substantial dose of gabapentin prior to the EEG to prevent a false positive result due to its proximity to several preceding minor concussive events (LOC approx 5mins or less); I've later been told this could have instead produced a false negative result - I'm really confused and sick and tired of being sick and tired with no answers and no clear idea what to do.
Anyway on the positive side despite the ongoing syncope episodes, I haven't had a concussive event since my last post and while I haven't been able to discuss things properly with my GP (he is just too busy and totally stressed out by his new practice) I have managed to arrange to go back on gabapentin - it is making me feel rather sick and dizzy - but it's been 48 hours and my chiropractor thinks it is an improvement. I feel as though I can only deal with the symptoms now as I don't have the medical support to do anything else - it will be a process of trial and error but it's the best I can do - I just wish I had more guidance from my GP but i imagine I can manage on my own if I have too.
Regarding the CHS you suggested as a possible explanation my chiropractor agrees with you and says he has been trying to warn me and my GP for months - I'm sorry I just haven't been able to get my head around it or focus on what people are saying - voices just merge into a wave of meaningless sound after the first few sentences when I have a headache - which is most of the time - and I end up just trying nod and agree in the right places! I seem to be very slow and clumsy with everything - my eyesight is appalling due to the vision disturbances (ie double vision etc), I have trouble trying to speak at times and apparently ataxia is quite pronouced in my efforts to walk and balance - its like trying function in a dream.
However on the plus side if the CHS exists and is evidently small enough to need a contrast MRI to find it, it is unlikely to kill me and provided I'm very careful the body can heal itself from almost anything given time and the right conditions - migraines and seizures could be bad for a chs - if it exists - so I am going to work on getting them under control with the right medications while trying not to aggravate the syncope episodes - again a process of trial and error but important to continue with - regardless of how busy my GP is and how guilty I feel every time I have to bother him!
Again thank you for your advice and support, They are very much appreciated,
Jean

[Jean82]

Thank you very much for your advice; very much appreciated, thank you, Jean82

[Dr. Kokil Mathur]

Hi
Thanks for writing to the forum!
You have been going through a lot! Well, MTBI involving frontal and occipital lobes can cause memory and visual problems. Your fainting attacks are the most dangerous.
There is a possibility that you have a slow leak and a chronic subdural hematoma.
In a chronic subdural collection, the problem is not discovered immediately as blood leaks from the veins slowly over time. The initial bleed is too small to give symptoms. The symptoms of chronic subdural hematoma begin several weeks after the initial bleeding. Hence with a history of vision problems, increasing headaches and a seizure like activity, this should be looked into. A contrast MRI may be required for a confirmed diagnosis.
Another possibility is that your seizure like attacks are indeed seizures. A negative EEG does not rule out seizures. EEG report has to be clinically co related. Please seek another opinion regarding your seizures. Maybe you can ask to be put on anti seizure medication and see its effect. Repeated head trauma is indeed dangerous and complicated the already existing minimal brain injury.
Hope this helps. It is difficult to comment beyond this at this stage. Please let me know if there is any thing else and do keep me posted. Take care!