Head Trauma and Parkinson

Have a 2 part question

Was in a car accident last year in which the airbags deployed
Ended up with bulging and herniated disks

After a couple of months started to have tremors in my hands and
head that one neurologist diagnosed as essential tremor and the other
as PD I was having resting tremor in my left hand but also mild head
tremors He gave me a dose of simet while in his office and the symptons
got better Brain MRI was negative

Now he thinks it is essential tremors with an indication of PD

My questions are the following Could the head trauma brought on the symptoms

Help.............................................
How do I get a more specific diagnosis Will fusion at c5/c6 eliminate the pain
After 3 or 4 hours the meds do not work

[Joyce K Lee, MD]

Dear aa262,

Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am extremely limited in not having the opportunity to perform a full neurologic examination on you, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

Interestingly, people who have suffered a head injury are four times more likely to develop Parkinson's disease than those who have never had a head injury, according to a May 19, 2003, news release from the Mayo Clinic, Rochester, Minn. The risk is eight times greater for patients who have experienced head trauma that required hospitalization and 11 times greater for patients who have experienced a severe head injury (ie, involving prolonged loss of consciousness and bruising visible on a computed tomography scan). Mild head injuries (ie, involving brief or no loss of consciousness) were not found to be associated with Parkinson's disease.

Researchers found that, on average, head trauma occurred 20 years before the onset of Parkinson's disease. Although the exact link between head trauma and Parkinson's disease is not known, researchers offered three hypotheses.

* A head injury kills brain cells at the time it occurs, and normal aging kills brain cells. Parkinson's onset would occur when loss of brain cells reached a certain threshold.

* A blood-brain barrier is disrupted, releasing certain proteins or poisons into the bloodstream that then enter the brain, triggering a process that takes 20 years to produce symptoms.

* Head trauma causes brain cells to make certain proteins that normally would not have developed. These proteins start a cascade that leads to cell death.

These hypotheses have not been tested. The researchers also point out that it is likely that the head trauma is only one of various factors that may lead to development of Parkinson's disease.

In sum, yes -- your car accident could have contributed to the development of Parkinson's disease, but if your symptoms occurred only 1 year after the accident, this is unusual.  Most case studies show a delayed effect, usually up to 10-20 years after head trauma.

The important part of all of this is to make sure that you have been diagnosed properly.
The fact that you responded to Sinemet goes in favor of Parkinson's.
It is also reassuring that your Brain MRI was negative.

I cannot tell you whether a surgical fusion of C5/6 would eliminate your pain without reviewing the images or examining you.
Please be reminded that although surgeries are often helpful, many (in particular, spine surgery) are not curative.

Please allow me to make 2 recommendations:
1) If you haven't seen a movement disorder specialist, I recommend you do this.
Drs. Walter and Itin at the Cleveland clinic are wonderful and extremely experienced in this field.

2) If you are having a lot of neck/cervical pain, see a spine specialist.  Again, our spine neurosurgeons are world-renowed and leading experts in their field -- Kalfas, Benzel, Steinmetz, Bingaman, and Schlenk.  You can't go wrong with any of them.

I hope this helps,
Best of luck,
JKL, MD