Extreme fatigue in TBI patient 5 years out

My husband is 5 years out from a TBI resulting in a Glasgow 3 coma for 30 days. he has recovered all bodily functions and cognitive skills (aside from memory losses, word salad and slow computing time) but suffers from extreme fatigue. He has been tested for everything know to man and no one can find a cause for this. It is so debilitating that he sometimes cannot even get out of bed. Short routine daily activities like taking ashower require a rest period in order for him to be able to do anything else that day. We are at a loss as to what to even do next. he has exteme fatigue and balance issues, always feeling like we is about to fall over. he cannot not stand up straight without losing his balance, so he walks all hunched over. Any help would be appreciated.

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your husband and obtain a history, I can not tell you what the exact cause of his symptoms is. However I will try to provide you with some useful information.

Fatigue after TBI is unfortunately common. It can result from a variety of factors, often in combination. Parts of the brain, when damaged, such as the frontal lobes, thalamus, or cingulate gyrus (these are just names for different areas of the brain), and others, can lead to fatigue, and also apathy, just a lack of interest and motivation. Fatigue can also result from depression. Balance problems can result from deconditioning, whereby at one point mobility was reduced due to the acute illness, but after a while, mobility is reduced from the reduced mobility itself. Also, excluding other independent causes of gait trouble (an entirely unrelated problem such as neuropathy due to for example diabetes or vitamin B12 deficiency, or some other neurologic disorder, or metabolic problem like a thyroid problem) would be important as well. Evaluation for sleep disorder (with a sleep study, a polysomnogram) is important as well, since sleep problems such as sleep apnea can lead to extreme daytime fatigue.

For fatigue after TBI, treatment of depression if it is present is very important. Often, the level of energy and the apathy/lack of motivation responds to specific antidepressants. There are also stimulant medications, similar to the ones used for patients with ADHD, that can sometimes help in these cases. Follow-up with your neurologist is recommended. Physical therapy for gait training is important as well. Evaluation at a center specialized in TBI, where a neurologist and rehab specialist can both work with your husband, may be beneficial.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.