Head Trauma

[Janitor]

Hey,

I was involved in a fist fight with four males about two months ago. I sustained bruises and laceraations to the face and was taken to the emergency room for treatment immediately. The doctor stiched my face up and asked me questions for about half an hour but did not diagnose me with a concussion or any sort of brain injury.

During the incident I wasn't knocked onto the ground or unconscious, nor was I dizzy or incoherant. I did however, sustain a very mild headache in the back of my head (occipital lobe area).

The next week I was doing some assignments for university and found I had difficulty concentrating, but I'm not sure if this was related to the incident or if it was just a case of me looking for problems and subsequently noticing concentration problems (funnily enough, I received a high distinction and a credit for the assignments). I also found things a bit hazy, however I have OCD and it's possible that I just over worried about things and ended up 'inventing' symptoms. Furthermore, I also developed a headache after running around for a bit (about four weeks after said incident).

I now have a clicking/crackling sound in my neck when I turn it to the left however this is not painful. I suspect this may have something to do with the headache.

Anyway, I feel pretty good now and I just wanted to know if you think there is a chance that I've sustained any sort of permanent brain injury. Bare in mind I've had quite a few fights in my life (however I've never been knocked out or sustained a concussion).

Thank you.

[Massive Head Wound]

I was a professional cyclists.  On Feb. 8, 2000 on a training ride while stop in the road trying to make a left turn an automobile re-ended into me. I suffered a closed head injury.  I spent 4 days in ICU and have been ongoing treatment with a neurological psychologists and neurological doctor.  I have had several MRI, ECCG, CAT scans & neurological testing.  I damaged my right frontal lobe. I am really frustrated with the treatment and the injury. I take many medications that include: Efferox XR150mg (1 capsule twice a day), Adderall XR 20mg (3 every morning), Adderall 10mg (1 pill every 3 hours), Requip 2mg (at bedtime) & Clozazepam 1mg (at bedtime).  I suffer from depression, attention problems and chronic fatigue issues.  5 months ago my doctors had me do a sleep study where they found that I never reach stage 3 or 4 of sleep.  On average I wake my brain up 20 times every hour.  The sleep medication has no effect on my fatigue.  I can barely function during the day and have lost all motivation and drive that I once had.  Is there any types of alternative neurology treatments or doctors?  I have been reading a lot about the return of ECT and the success that CMC has been having with that.  Is there any viable option out there or will this be the way I will always be?

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   It is unlikely that you have sustained any permanent brain damage from the symptoms that you have described.  It is unclear to me why you have been in so many fights, you may not be so lucky in the future.  There are 2 delayed injuries that you should keep in mind.  The first is a subdural hematoma that may occur with symptoms of decreased conciousness, weakness and/or seizures hours or even days after an incident.  This occurs due to tearing of small bridging veins that leak slowly.  Given that you are 4 weeks from the incident this is unlikely.  The other delayed type injury is the "punch-drunk" syndrome that professional fighters, etc get after repeated head trauma.  This can lead to Parkinson type symptoms including slow, shuffling walk, arm tremors and stiffness.  This occurs only after many years of head trauma.  
   Given the crackling type sound in your neck and the occipital headaches, I would suggest an MRI of your Cervical spine.  You would also likely benefit from some neck physical therapy.  
I hope this has been helpful.

[JCmcc]

Hello,
  I am sorry to hear about your symptoms and the violence. If you had a visit with an attending physician at an ER directly after the incident and there were no clinical findings, a mass effect or midline shift would be unlikely.
  Your sense of malaise or feeling distal during studies could be produced by OCD, however, if this has not ben a prior issue with OCD I would be less likely to consider it. It could be, if related to OCD, an effect response.
  You may want to see your general physician and request a ref. to a neuropsychologist who can run a battery of tests and differentiate this along with your MD. If the problems persist and you have not received a clear explanation I would suggest a visit with a neurologist.

Good Luck!
JCmcc.

[JCmcc]

Hello,
  I am sorry to hear about your symptoms and the violence. If you had a visit with an attending physician at an ER directly after the incident and there were no clinical findings, a mass effect or midline shift would be unlikely.
  This could have only been discovered through MRI studies. You should have had T1/2 Weighted/FLAIR/Saggital Stir sequences to determine findings and if this was not obtained it was not possible for the attending physicians to evaluate. Due to your injury you may not remember and in that case your family doctor should request records.
  Your sense of malaise or feeling distal during studies could be produced by OCD, however, if this has not ben a prior issue with OCD I would be less likely to consider it. It could be, if related to OCD, an effect response.
  You may want to see your general physician and request a ref. to a neuropsychologist who can run a battery of tests and differentiate this along with your MD. If the problems persist and you have not received a clear explanation I would suggest a visit with a neurologist.

Good Luck!
JCmcc.