brain injury

My father, who is a very healthy and fit 70 year old, fell last November and banged his forehead off a curb. He was unconscious and taken to hospital where they did a cat scan which came back clear. Although there is still quite a visable mark on his forehead he seemed to recover fully within a few days. However over the last ten weeks or so 4-5 months since the fall he has been having episodes where he will suddenly go quite pale and disconnected, he will ask a strange question or become confused about where he is and this will last about 5-6 mins. Having been for testing and doing research (we are still waiting for MRI) we are pretty sure that this is a kind of complex partial seizures. Afterwards he suffers from memory loss not just of what has just happened but of other events from days weeks or months before, which takes some time and a lot of prompting to come back...and recently these memories did not return at all, so I am worried at the speed his condition is worsening and wondering if he gets the right medication will these memories return? also in the months building up to this, before he had his first episode that we are aware of, he had been having feelings of "Highs" and "Lows" that would last a day or 2 at a time. Could these be a symptom of something else? or related to the seizures? any help would be greatly appreciated.

[Christopher R Newey, DO]

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 obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

Seizures post craniocerebral trauma may occur up to 5% of patients with closed head injuries. The risk of developing seizures post injury is related to the severity of the head injury. Severe head injury is defined as loss of consciousness or amnesia. The interval between head injury and seizure development varies. If the seizure arises weeks to months after injury, it is referred to as posttraumatic epilepsy. The frequency of these seizure types tend to decrease with time. The treatment is accomplished with a single antiepileptic medication, if clinically indicated. It is important to remember that every medicine has risks and benefits. If a cortical scar for the epileptic focus is present on MRI and the seizures are not controlled with medications, surgical resection may be an option.

Memory gaps (aka traumatic amnesia) usually remain in patients with cerebral concussions. The memory gap usually spans a period from before the accident to some time following the accident. The gap may be filled with what is told to them. The severity of the head injury and the longer the gap in formation of new memories, the more likely permanent damage will be. Studies have shown that maximum degree of improvement is seen within 6 months of the injury.

It is difficult to comment directly on the cognitive changes your father has been having before and after the event other than what I have already written. I would recommend that your father be seen by a neurologist and obtain an MRI of the brain.  It may also be of benefit to have neurocognitive testing performed to evaluate for other causes and also to evaluate the severity of the cognitive causes are post trauma.

Thank you for using the forum, I hope you find this information useful, good luck.