LMLS,

Thanks for your hard work to put this together. You did great.

Nobody can predict a timeline of recovery. Every concussion is different. The challenge you have is 2 or 3 fold. First, you have Multiple Impact Syndrome. Each concussion robs the brain of a bit of its ability to recover. You may have sensed you recovered fully but you likely had residual deficits that did not manifest until you were under stress. After each concussion, your tolerance for stress was reduced. One concussion expert complains that most doctors fail to recognize the impact past concussions have and encouraged others to properly document past concussions in medical records for future consideration.

This one issue is important to me because I have a history of 14 concussions. One severe at 10 years old, 4 serious concussions, and 9 mild concussions. My last concussion was a mild concussion but it changed my life the most.

Second, you have a rear of head concussion. They are very tough. They include a neck injury that is very difficult and time consuming to recover from.

Third, you are used to a very busy and productive life with high expectations. You sound like an intelligent Type A personality. This adds a stress component that magnifies everything.

An additional factor is your age. The brain becomes less tolerant to injury as we age, especially as we enter the 40s.

I understand your NPA scales. My visual memory is at the 5% level. My auditory memory is at the 12% level. My processing speed is at 10%. My intelligence scales range for 88 to 99th percentile.

In school I was also high honors even though I had an academic crash and seizure disorder my sophomore year due to a mild concussion from soccer.

My neuro said he had never seen a brain that was so dysfunctional. He was amazed that I could accomplish so much. He attributed it to using intelligence to work around my memory and processing dysfunctions. It takes work but we can learn to move on with our limitations.

I had the same over-stimulation problems early on. I could not endure a grocery store. I would freeze in congested traffic. Sounds were a horrendous problem. The self doubt about whether my struggles were real or imagined only made things worse.

The B-50 complex is good. You should add 1000 to 2000 mcgs of methylcobalamin B-12. All of the anti-oxidants are important to help your brain with oxidative stress. C and E are most important.
It takes a lot of curcumin to get a benefit. Many curcumin formulations have the right bioperine but not enough concentrated curcumin. Even with bioperine, the gut does not absorb much curcumin.

I would encourage you to look into anti-inflammatory diets. The keto diet has a lot of anti-inflammatory value. I think that is its primary value, not the ketosis since few ever enter ketosis.

My biggest concern is how your neck is being treated. The subtle neck injuries that are part of concussion, especially backward falls, require very gentle treatment and disciplined posture discipline. Most chiros are too aggressive. The range of motion efforts of PTs can be just as challenging.

Do you by chance have presbyopia requiring multi focal glasses? The neck extension needed while looking for the right part of the lens can be a challenge.

Have you been assessed by a behavioral optometrist? They are different than a neuro ophthalmologist. Proper visual function aids vestibular function. NORA.cc has a good database. Acuity (focus) is different that visual coordination and convergence issues.

Your quality of sleep is more important than the amount of sleep. Many try to sleep longer than the brain wants and that can actually have a detrimental effect. Breathing can be impacted by upper neck injuries. Do you dream pleasant dreams or stressful dreams?

Rather than taking melatonin, you could try 5-HTP. It is a precursor to serotonin and melatonin and the combination can help the mind settle down. I take 100 mgs every morning as a replacement for an SSRI. The brain knows what to do with 5-HTP. It usually gets it from L-Tryptophan. My doctor is in support of my use of 5-HTP. It can quickly help you with anxiety related symptoms. Do not take it with Cymbalta ( I relalize you stopped). Many take up to 500 mgs. I take enough to feel relief.

The lesions in the white matter can relate to your struggles with over-stimulation. This issue is not fully understood. This is a sign of your anxiety. BUT, your anxiety is not causing your symptoms. Your anxiety is a symptom of your physiological injury. Reducing those stimulation triggers is important. Foam ear plugs, tinted lenses, changes in environment, and such can be helpful. Yes, I realize there is only so much you can shut down in your life.

Your aunt's CSF leak issue is interesting. A spinal tap/lumbar puncture to measure pressure can sometimes indicate a problem. Some have an over-pressure issue that the spinal tap resolves immediately but returns over time.

I think the laying flat may indicate a neck injury that likes the lay flat posture. I have personal experience with this. When I am in my best posture, I sleep and wake up feeling alive. In the early days, poor neck posture would cause malaise and depressed pulse and BP and even suppress my breathing.

btw, I often get my best sleep in a recliner or laying flat. I use a very thin pillow but curl it around my ears so my head does not roll to the side. We figured this out when my wife noticed my facial expression being different with different sleeping postures. She could tell when I was going to have a good or bad day.

Where do you live? There may be some specialists in your area.

I'm sorry for giving you a fire hose of information. I suggest you print this out so you can read it at your leisure without the glare of a computer screen. You can even paste into Word so you can use larger fonts.

I have even more to tell you but......

My best to you.