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Dear Dr Rajgopal - your advice would be very much appreciated

by Jean82, Oct 30, 2009 03:22AM
Dear Dr,

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 migraine headaches that wouldn't respond to my normal medication, dizziness, 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 fairly extensive).  
Over the following weeks I started to have problems with syncope episodes (these have been associated with hypotension) and my chiropractor reported that I had begun to have seizures and that these were becoming increasingly severe - apparently the seizures vary in length from 1 minute to 10 minutes and most are of the grand mal variety - they seem to be associated with bumps to the head, fatigue and stress.  After a prolonged seizure I have also been told I can be quite disorientated for 30 minutes or more.
A 15 minute EEG was done and came back clear which was I thought was good news but I’ve since been told that the fact that I was on a high dose of Gabapentin at that time completely invalidated the results – is this right?
As a result of the syncope episodes, I have continued to experience blows to the head and concussions and am continuing to experience severe chronic migraine headaches, extreme sensitivity to light and noise, double vision and vision disturbances, balance/coordination problems and severely disrupted sleep patterns (often I can’t sleep at all for days and other times I can’t wake up for over 15 hours) along with short term memory and concentration / cognitive problems – I had a degree in pure and applied mathematics and am now having trouble with basic arithmetic – this has taken me days to write.
An MRI was suggested at one point but was apparently vetoed because they would have to put me out (because of the noise) and a specialist said it was too risky because he said there was a “high probability the patient would not come round”.  
Early this year following a prolonged seizure (that had been preceded by a blow to the head causing a black eye and severe bruising to the forehead) I was sent to ED by my chiropractor; apparently I had failed to fully recover consciousness for more than an hour afterward and was apparently seriously disorientated.  I have no recollection of the event, the 30 minutes preceding it or the following 3 hours but things seem to have deteriorated even more since then.
Eventually following another series of seizures over about an hour preceding an “unresponsive episode” lasting about 8 hours another CT scan and a spinal tap were done but thankfully came up clear whatever that means – blood tests came back with very high prolactin and C reactive protein levels and low haemoglobin levels but I don’t know what this means.
The seizures are persisting as are the prolonged unresponsive episodes – apparently I am totally unconscious of anything that is happening “including painful stimuli” and my BP is low – they seem to be triggered by blows to the head caused by continuing vision/balance i.e. just recently I fell off a set of steps while trying to change a light bulb (I live alone); I came round the next day (about 24 hrs later) but then collapsed and was admitted to ED where I have no recollection of the next 10 hours – from what I could make out another unresponsive episode. I am on gabapentin and amitripyline but they’re not fully controlling either the migraines or the seizures; my GP says that he’s not comfortable altering the medications without specialist input but I can’t get an appointment to see a specialist. I’m having real trouble consulting with my GP as I have difficulty focusing on what he says and I lose track of what I need to ask and remember.
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 (sumatriptan, ibuprofen, paracetamol etc) that I hadn't had a day off work due to illness in over a year.  I have experienced 8 -10 serious concussive events  prior to the accident at work but never experienced anything like this. My pre–injury IQ score in a test in 2005 was 148. From what I’ve recently heard I did experience partial and absence seizures as a child but grew out of them in my teens when I was no longer experiencing frequent concussions (following one when I was 10 I stopped growing completely and permanently).
I am really frustrated and concerned – I haven’t had a day free of severe or migraine headache in 18 months since the accident and the neck and head pain is often at blackout level when I try to get up in the morning (I literally faint when I try and lift my head or stand up) - I 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 – if I can’t resolve the problem soon I face losing my home as the insurance company now claims that the problems have persisted too long to be consistent with the original diagnosis of post concussion syndrome and MTBI
Any advice or information would be very much appreciated thank you, Jean
PS apart from poly cystic kidneys and polycystic ovaries I don’t know of any other background medical conditions.

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