I am an avid cyclist who had a rather unfortunate encounter with an SUV being driven by an inattentive driver. 11 months post accident I am still struggling with PCS. I am an Operations Manager for a large utility company in California. I have slowly progressed from being off work, to 2 hour days, then 4, now 6, but I have not made much progress in the last 6 months. My employer needs me to be back to full hours and work output in the next 30-60 days or they will have to consider long term disability. Because of this, my Dr. team is trying everything to speed things along including some off label use of Amantadine and Ritalin, but neither seem to be helping much (although the first 36 hours after starting Ritalin I felt amazingly calm, focused and present). My biggest complaints are feeling foggy and not able to concentrate/focus, noise sensitivity, feeling like my brain is only using the information from one eye at a time??? and that my eyes are not working together despite doing convergence exercises regularly, headache, I cannot tolerate more than one source of information at a time, and constant tinnitus.

Any thoughts/history with Amantadine or Ritalin?

has your neurologist ruled out a hands on clinical diagnosis to rule out a occipital nerve injury....around c2 vertebra?

I am not gonna rewrite it all...so I am just copying and pasting this.

First off…my history.
I was an active person. Tennis, trail jogging, hiking, backpacking, basketball, road and xc cyclist, avid dirtbike trail rider and relaxing paced jumping on private mx tracks, home fixer upper (seriously large and physical and heavy labor hours projects. (from tree felling,removal, heavy equipment digging to woodwork or metalwork projects…to laborious landscaping…to additions…to roofing. I was also a swiss style cnc screw machinist. (I was a go get r dun kind of guy). Then a distracted driver plowed into my all but stopped car, sent me spinning and off a telephone pole. And my world changed forever?
Evac to hospital. Severe concussion per first neurologist. Long road ahead of physical therapy, speech therapy, cognitive therapy, life adjusting therapy, eye retraining and strengthening, etc. As time went by, improvement started to level off and certain things still had very impactfully unwanted results.
First neurologist eventually became frustrated with my lack of continued progress, had me put in even more aggressive physical therapy with instructions to try to keep pushing past the symptoms that were literally forcing me lay awake, unable to sleep for up to 30hrs or so, tears streaming down my face, in bed for days at a time, barely able to crawl to a restroom, or get easy quick nourishment for myself. She eventually accused me of things in front of my wife that were blatantly false, and when I called her on it…she thought it was best I see someone new.
Second neurologist at a WELL known facility for concussions. Dr performed same usual physical exam, did not understand why I said my responses to things were what they were...(but did not entertain me about these micro impacts and said he would inquire and review with colleages). Next visit, I heard the word somatoform, and he advised first with neuropsych testing and counseling. (I had to look the word up to find out…talk about WTH? moment).
Limited eye endurance, but kept searching online for any answers, any leads, anything. Third neurologist….this one I found out about by online patient testimony on a generic forum.
First visit, within 90 seconds, he had actually foretold what he thinks had been misdiagnosed, had performed a simple hands on test (single finger tip each hand on my neck area), and I all but fell off exam table in pain.
There is a spinal nerve located near your C2 vertabrate. There is a vital spinal nerve called the: occipital spinal nerve. If you research these two (C2 spinal nerve….and occipital neuritis…occipital neuralgia), you will see just what this spinal nerve can limit your eye use, cognitive, balance, hearing, tinnitus, and just overall ability to function in life). When your head is thrashed in a way it should not, this vital spinal nerve can be at least one or more of the following: damaged or misplaced or face inflammation induced compression, or scar tissue build up which causes misplacement, compression, neuroma?, etc. Icing that area of your neck to the point of somewhere between burning cold to numb to touch will allow greater function and endurance, but once it “thaws” out…lol…You will pay the price as if you never iced it. (temp. survival skill…of numbing that nerve). This occipital nerve can also cause peripheral sensitivity to the upper left rear of head….like even laying still on a pillow there….will cause pain.
The neurologist performed a three round attempt of nerve blocking injections to that neck area…over 4 months….and icing…and severe activity restrictions along with icing. Most patients have a measurable response to clearly decide whether a likely candidate for nerve decompression surgery, etc. I regretfully only had a measurable but low response. I was warned ahead of time that due to over a years plus of approved neck therapy, scar tissue had likely formed and he did not expect similar responses to nerve blocking injections…because of it.
If twisting your neck left and right, stretching it, up down, left right, tilt left right….increase your symptoms….very good chance of possible occipital nerve issue. A hands on physical test just by fingertip pressure point locations on your neck that takes under 20 seconds…can possibly diagnose it.
I have been referred to pain management to further collect data and see if occipital nerve surgery would have a high enough likelihood of success in helping me function better in life. (not yet a candidate for the invasive surgery).
But now to my unresolved brain and head movement related issues.
I also suffer from the micro vibration, micro impact, bumps, wife moving on bed mattress, someone else moving on sofa, nephews and nieces running around on wood floor when I am sitting in a chair on the wood floor, driving, walking, rough pot holed roads or just patched pavement, road feel on a road bicycle, or just even micro impacts from riding on a railtrail, etc. and just about anything that has a more solid impact transfer. It all adds up depending on severity and duration…and has taken over 2 weeks before to settle out. Until settled out, hypersensitivity will persist.
If I introduce the stimulis, or I am in charge of the object introducing stimulis…symptomatic elevation tends to be less. (me drive vs someone else drive, me jump into the air vs just an elevator starting and stopping…even with my knees bent and ready for it, me moving around on a couch or bed vs someone else moving around on the same couch or bed, me moving my head vs someone else moving my head, me tapping on my shoulder vs someone else tapping on my shoulder, and so on and so forth). Yes as previously mentioned above, it is like my brain is unable to keep up with the outside stimuli, and fights to try to play mental catch up.
Depending on symptom levels, an elevated heart rate will proportionately increase symptoms.
These symptoms may include at least one or more of the following: eye soreness, light sensitivity, cognitive loss, ability to react, balance, brain area pain and burning, tinnitus, left eye shutting, mentally glazing over like world is around me, but I am just somewhere between reality and what’s going on.
I can temporarily run a weed trimmer, with limited walking, but walking gets me. I can spin at slower cadence on a fat tire xc full suspension mt bike on a paved and smooth rail trail, but have it turn to crusher run stone and I start feeling it instantaneously…sometime slowly, sometimes faster.
I know that the 15minute drive to my local lake and back bothers me more than paddling my kayak the 10 miles over a 2 hour period. It is like the water acts as a cushion to the impacts of my paddle going into the water and my body movements as I paddle. Now if you add in choppy water from other boats or wind, symptoms will increase. (I prefer nighttime flatwater paddling when maybe 2-3 boats are on the entire lake). Smooth water, but a way for me to get exercise and feel kinda normal again…as close as I can right now.
To avoid micro impacts on the bicycle, I try to spin on an indoor trainer. But session to session, it varies, and once my cadence reaches a point where the small rhythmic movements of my head barely moving in response to my not so perfect spin….lol…symptoms elevate.
I have also experimented with a metronome in use. Free standing squatting, once the pace of up and down motion get too fast, (vertical head movements), symptoms elevate. I have done the same with my linear ball bearing smith machine. (truly trying to limit head movements….with and without a snug Velcro padded cervical neck collar…just to try to isolate g forces vs possible neck movements. At a certain pace, varying day to day, the G forces on my head of up and down movements…elevates my symptoms.

to the california cyclist...also research: intracranial hypotension. I copied and pasted this from another thread...for you...

I just can not help but writing this when I hear your stories and symptoms. I understand that you have been wondering a lot about these symptoms and I don't want to sound like I am a smartass, but when I read all your posts it sounds to me that you do, besides from your PCS, also suffer from a condition called Intracranial hypotension.

Around our brains we have a fluid called cerebrospinal fluid that works like a cushion for our brains. Sometimes if a person hurts his neck, back or cranium he/she can get a tear in the dura (sack) that contains this cerebrospinal fluid and it can start to leak. This will cause less volume of fluid around his/her brain and lower than normal pressure inside the cranium. This in turn will make the brain more sensitive to vibrations or impacts.

You can check if you are suffering from intracranial hypotension by holding your breath and increase your abdominal pressure (this increases your intracranial pressure momentarily), while you drive over a bump. If this maneuver helps you take the bump, then you know that you are suffering from too low intracranial pressure.

You typically diagnose this with a MRI with contrast of your skull.
It is treatable, but it will typically not go away without treatment.

btw...I am 28 months since mine.
NEVER GIVE UP. NEVER GIVE IN. I AINT ABOUT TO QUIT.

I am still checking with the person who handled my physical and vestibular therapy. I know that my neck was an early cause of many of the headaches I was having. My therapist spent a good deal of time over many appointments working on my neck, but I am unsure if Occipital Nerve Injury at C2 was something she was looking for specifically.

I have ridden bikes my whole life. I was training for my first 24 hour event when this accident happened. I can't imagine moving forward with a life without cycling in it, but every time I push too hard on the stationary trainer I end up increasing my symptoms.

I would test that heart rate, without movement. (of course warm up...lol) then: wall squat with a hrm....then rest. then SLOW cadence via same hr bpm. (60 or less)(i know...not best on knees) then rest. then spin at 95-100 to same hr. rest....then "spin out" for a minute or so...till you know u start seat bouncing a little...lol (this will reveal things to you)

me been there...done that. the fingertip pressure point test can be rather quick and effective...especially if the nerve is possibly overlapped with a neck ligament...when you head maybe played thrash about. (almost 2 years of doctors and therapist missing such a simple test....for me)(knowledge is power)

the other thing I hate to tell you is...if your head was thrashed about...nerves in your vestibular area can be damaged if not severed...and until they regrow...extremely slowly if at all....your head may always be playing catchup (mentally) to outside physical stimulus on its movements. (and it SUCKS).

another thing to try is set up your trainer facing a mirror. find something for you to sit upright, hold onto something nearby and watch your head in the mirror as you attempt to completely cease any head movements as you spin. then after a couple of minutes...release your hand steadying your upper body and allow your self via the mirror reflection to have your head move with your cadence rhythm. (just another test to prove possible vestibular nerve damage)(of which I hope you do not have...trust me...i know)

another thing. I have discovered over time that either vestibular stimulation, occipital nerve inflammation, or too much screentime (and combination of eye exercises)....can seperately or ALL induce delayed tinnitus. even just too much screentime alone can lead to this delayed but certain tinnitus increase.

I will try these when I get home! My heart rate has been rather low since the accident. The accident and subsequent symptoms have caused an elevated BP (I used to be borderline at 135/75, but now am always elevated, often as high as 190/95). They have me on two BP meds (metoprolol and lisinopril). My resting HR is always around 50 BPM, but only goes up to 120 BPM under heavy exertion. I can ride on my trainer for an hour at 150 watts and never break 110 BPM (seems weird, but I think it is the BP meds). That sort of exertion would have normally had me at 150-160 BPM.

What exactly will the HR test tell me? What should I be looking for?

The tinnitus has not stopped even for one second in the last 11 months. It does get louder on bad days. Also I notice that my head is often cocked off to the side at an angle. I will try and notice if it is always tilted left, or if it tilts both ways??

If head or shoulders or hips are tilted and not level... maybe look into upper cervical adjusting.. it is not the same a regular chiropractic.
info-
Up C Spine
Up C Spine - A New Approach - Sign / Symptom Checklist