Is PCS real?
 

My 13 year old son suffered a back injury on May 1. Nine days later, after the back injury was resolved, he started displaying concussion symptoms...agonizing headache, memory loss of the event, vision disturbances, extreme vertigo. I witnessed the injury and saw the force with which his head hit the turf. It was a whiplash type event. Thus, I have no doubt that he suffered a concussion.

Today, we went to a new neurologist who conducted a few physical tests i.e. reflexes. He then stated that "it was all in my son's head" and that he had not suffered a concussion! He could not explain the symptoms and stated that the physical symptoms were manifestations of some psychological stress. He even suggested that it was a result of some past abuse. Believe me, my son has never been abused.

I am frustrated to the point of tears. When I stated that I had read that concussion symptoms can appear days/weeks after the injury, he denied it. He did order an MRI but stated that he was sure nothing would show on it.

Has anyone else experienced this before? Is it possible that the neurologist is simply incompetent in the area of concussion or should I be giving merit to what he is saying? Can PCS appear 9 days after an injury to the head.
Help!

I don't think a 13 yr old would make up those types of symptoms.
I'd find a new dr..:(

Have you considered seeking out an expert chiropractor that also does the upper cervical adjustment? {also called c1,c2 or atlas /axis}??
I found a very good DC in 05 { I took a header off my horse as a teen, and some other hits & falls from cars /sports} and 30+ yrs later I think the minor misalignments played a part in my chronic RSI work injuries.

here is some info to get you started - it might be all that your son needs to get on the mend.

SIGN / SYMPTOM CHECKLIST
http://www.upcspine.com/self.htm
home page -
www.upcspine.com

Find a new doctor!!!! PCS is real and this is not in your son's head or underlining psychological issues - been down that path with concussion doctors that are supposed to know what they are doing and it wasn't a fun experience. The stress and anxiety they cause my daughter and myself made things significantly worse.

Yes, PCS symptoms can be delayed. Not all concussion symptoms show up right away and they will fluctuate. Stress will make them worse. My daughter's system got very out of whack about 5-6 weeks into her concussion and symptoms appeared that weren't present after her initial injury. I also think as some things start to resolve, other things become more apparent. For example, my daughter had a lot of memory issues with learning new things and remembering what was happening day to day. I didn't figure those out until maybe 4-5 weeks into the concussion when she started to feel a little better. Then we had a major back side that took a good month to recover from...

I would second an upper cervical chiropractor. We started seeing one about 2 months ago (at about the 5.5 month mark) and it seems to be making a difference.

The key in right now is lots of REST and not stimulation. Some people have success using amitriptyline (Elavil) for headache issues. My daughter used trazodone for a little while to help with sleep issues. We were prescribed Elavil - tried it for a few days but made her fatigue worse - so we stopped. I think it would have been really helpful early one. We couldn't get anyone to prescribe anything until about 3-4 months into the process. Elavil is an antidepressant that they use in low dosages for pain and sleep.

BTW - my daughter is 15 years old and recieved a concussion back in October. She is significantly better than she was initially. It's been a long slow process. I've shed many tears along the way.

Take a deep breathe and take it one day at a time. Trust your instincts - you know your son better than anyone else.

T97tab,

Your experience is very common. The basic neurological test will rarely show any problems. The neurologist likely did not do a complete neuro assessment. They often fail to do the MMSE (Mini Mental State Exam) to evaluate his cognitive issues. The MRI will also be a waste of time. A better evaluation would be with a neuro-psychologist. Taking the ImPACT test or CNS Vitals Signs test can also tell you a bit about his condition.

Without a baseline, the tests can only be compared to others his age. They can be taken online then the results forwarded to the specialist of your choice. Google ImPACT test and look for a practitioner in your area to send the results to.

The upper cervical chiropractor can help. The whiplash can effect the cervical nerves that effect lots of functions.

Do not be surprised if you can not find a medical doctor with a good understanding of concussion.

You might want to be careful about getting worthless consults. If he gets too many comments of 'somatoform' or 'malingering' in his medical record, doctors will dismiss his symptoms even further.

As other said, concussion symptoms can manifest many days later. Up to six weeks is not uncommon. The brain tries to recover. At some point, it self diagnoses the cells that are damaged. It then sends out a suicide signal, Some think this is done with tRNA (transmitting RNA). The malfunctioning cells will die and be absorbed by the body.

Studies have shown that initial serious damage will not show up on a CT Scan until the third day or so. It is rare for a CT to be administered at day three so imaging of the concussion is rare.

Unless you are near a high Tesla MRI clinic like Chicago or Portland and a few other places, you will just be wasting you time and money. You need at 6 Tesla or higher resolution to image concussion damage. If he has a sudden onset of severe head pain, the normal 1.5 Tesla MRI or CT Scan will be adequate to show a brain bleed. This is unlikely at this time for him.

He needs to be extremely careful to avoid any risk of a second impact for at least three months. After than, he should still not play contact sports or engage in risky activities.

IMPORTANT,

Go to www.tbiguide.com and download Dr Glen Johnson's TBI Survival Guide. Print it out. It is the best explanation of what is happening to your son. Have the whole family read it.

If he is still attending school, he will likely need help with test taking. He will need more time and a quiet environment. He may also do better with an oral exam. I need to use a blank sheet of paper to cover the text above and below the problem I am trying to answer. Otherwise, my mind will try to mix up the questions.

Tell him he is not alone. Many have gone before him.

My best to you.

Thank you
 

I appreciate your responses more than you can know. As I stated, witnessing the event, knowing my son (well adjusted, happy, strong student), and reading so much on the internet about PCS has floored me as to this doctor's response and dismissal.

His balance is so off that he is unable to stand, much less walk, unassissted. I don't mean just a little...he cannot stand up straight and sways like crazy. The neuro "tests" this doctor did contradicted this.
Has anyone else heard of balance problems this severe?

The doctor did not test his vision issues. He turned out the room lights and looked into the back of his eyes. Yet, my son cannot read due to the letters being scrambled.

Your responses have been the first "help" we have been able to locate and I am holding on to them like a lifeline. :) Thank YOU!

possibly some vertebral artery symptoms??
from misalignments or even muscle spasms?
I had all of these at the worst of my work injury.

[VERTEBRAL ARTERY

DIZZINESS, LIGHTHEADNESS

VERTIGO, SYNCOPE

DIPLOPIA, DYSARTHRIA, DYSPHONIA, DYSPHAGIA

TINNITUS, EAR PAIN]
the info above is from a thoracic outlet syndrome website - http://www.tos-syndrome.com/old1/newpage12.htm
but you can find more on vertebral artery symptoms with a web search

First I'd find another neurologist;
Second, I'd find an ear,nose & throat doctor who specializes in vestibular issues.

That is also my daughter - high achieving, motivated, straight A student and accomplished equestrian. She had pretty significant PCS issues that were dismissed as anxiety/psychological issues. They didn't come right out and say it -but strongly implied that her issues were a school avoidance issues and not PCS. We had NO issues before she hit her head.


That seems odd that he could pass the neurological tests but not stand/walk unassisted but then my daughter could too but she did have times where she was very out of balance. I remember back to one appointment, we she passed the balance tests in a exam room with the lights dimmed, and then when she left the room, she could barely walk down the wall way to leave. She crashed into a wall and almost fell down. There were times when she walked around with her head down and kind of shuffled around rather than walking. At about 8-10 weeks, most of my daughter's balance issues seemed to have resolved.

There is another mom on the board who's daughter has optic nerve trauma. She might be more helpful in regards to the eye issues.

Hang in there!

Hey, there! Sorry to hear about your son's injury. PCS is real...and it really sucks.

It is definately all in your son's head...as in his vestibular system, his optic nerves, his brain chemistry, etc. I doubt he would or could make up symptoms that mirror PCS quite so precisely.

I'm the mom whose daughter had optic nerve issues. Her worst symptoms didn't show up until 8-10 days post injury. As some of the acute stuff wore off we started noticing major issues with her eyes. You need more than a 20/20 eye chart to tell what's going on. She couldn't read for about 3 months. She has nystagmus (eyes jump) and still (10 months post-injury) letters and numbers will jumble up on her, especially under stress. Her center line of vision is sort of skewed so she tends to run into door jams, car doors, etc. Sometimes stationary objects seem to move. She starts vision therapy in a couple of weeks so we are hoping to get some resolution. The neuro opthamologists we saw said "give it a year" our hometown optomitrist said "try some therapy."

The things that have helped us the most (other than the basic passage of time) are accupressure around her face and reflexology on her feet. This has reduced the frequency and intensity of her headaches. She doesn't have the balance issues your son has, but she does feel like the room is tilting on her sometimes and complains of being "lightheaded".

I agree with others who suggest an Ear Nose and Throat doc. Ask for a tilt table test. There is something called BPPV (google it) you should check into.

Best of luck as you navigate these therapies. Things will get better.

I second the recommendation of an ENT. Or you might take him to a hearing and balance clinic (hearing aid clinic). Sometimes, the non-MD will have a better understanding. Many MD's are so quick to jump to conclusions.

The vertebral artery issue is an interesting suggestion. I have suspected a vertebral artery problem in my neck but have not been able to get any help from the doctors.

Jo*mar, what kind of specialist did you see to resolve you vertebral artery issues?

I have a good PT who helps with my TOS but not the brain blood flow. I get tingling on the left side of my head. It seems to coincide with a pressure (inflammation) at my left occipital condyle.

PCSLearner,

I remember those days of running into door jambs and the corners of walls, many shoulder bruises.

Then my neuro prescribed too much phenobarbital and it got worse. I would try to turn as I walked and my body would keep going the same direction even though I had turned my body. I would end up stumbling along until I could get my orientation back.

My mind wanted to change direction but my body did not want to follow.

Now, this is a rare occurrence.

... No officer, I am not drunk. I did not have any alcohol.....

I almost failed a roadside sobriety test once. I could not keep track of my steps (supposed to take ten), track the sidewalk crack, and turn around without looking like a klutz.

The cop was just taking a statistical shot on Christmas day evening. Who would not have some alcohol in their system at 9:00 at night. Not me, I have PCS and the doctor said to not consume alcohol.

To make matters worse, I have a bit of horizontal gaze nystagmus in my left eye.

Good thing there is no DWPCS. Driving With Post Concussion Syndrome.

Mostly it was my chiropractor, getting me back into alignment {the C1/C2 also} and he treated the spasms/ sore muscles/ imbalances and trigger points that were the cause for me.

I also did Sharon Butlers TOS program stretches and took some ideas from PT sessions that seemed to help.

My concussion was 30+ yrs ago so it only played a part with the misalignments - the work injury was the main cause of all those weird symptoms - they faded away as the worst of the injury began to heal.

vestibular system
 

Is it possible for a child to "pass" all the coordination/reflex tests and still have severe balance/vertigo issues? (Vestibular Disorder)

Anyone dealt with this? I am still trying to understand.

My work injury that caused my problems made me feel very dizzy & spaced out.
I could still drive fine -didn't seem to bother me if I was in a car - but if standing or walking - a wooziness & felt like I was swaying around - really had to focus on where I was and my movements.
I did pass most all of the strength, reflex, grip tests.

Of course this was for a RSI/TOS injury and not PCS, but wanted to say I think it could be possible to pass some of those tests and still have issues.

Yes, I think it is possible for someone to "pass" those tests and still have a vestibular issue because sometimes those symptoms seem to come and go with specific movements, etc. That's why you want a tilt table test...I think.

The reality of PCS - the parent's role
 

Sadly, PCS is real. Definitely. 100%.
Parents will see a dramatic difference in their children; children who may have been previously completely healthy and who have never feined illness in order to get out of school or anything.
Could people all over the globe be inventing a set of symptoms, perhaps for insurance reasons? People who don't have any contact with each other? Why would children join in?
Clearly they wouldn't and any statement that PCS is not real is complete rubbish.

Could some neurologists be incompetent in recognizing PCS?
Yes, they could.
Believe your child.
I think that that is the best thing that a parent can do for a child with this terrible condition, just believe what they say and act accordingly.
It must be an incredibly tough disease for children, especially for children. Parents don't want to be making it worse by disbelieving what their children are saying.
I know that children can sometimes make stuff up. Not in this case.

CS

Yes, this is real.

I don't know if I would classify my vestibular issues as severe, I can still get around slowly and carefully, but I do tend to run into corners and edges, have a hard time walking straight when I'm tired, need to lean on things or hold on a lot. I passed the basic neuro tests, but I definitely have plenty of PCS issues. Like Jomar I can handle driving because I'm sitting and holding onto something, walking and standing are different and harder.

The first neurologist I saw said I never had a concussion because I wasn't knocked unconscious, and was making it up because of abuse in my past (after talking to me for a couple of minutes). Ridiculous! I had no symptoms before my accident nor do I have a lot of abuse in my background. I found a different doctor who took me seriously and has helped me a lot. You need to find a different doctor for your son. Call and talk to their assistants find out if they have experience with PCS, what they do. It was helpful to me to check the online doctor rating sites as well.

As others have said, rest and time will facilitate healing. Good luck!

Wow, Doctors still believe this old wives' tale <The first neurologist I saw said I never had a concussion because I wasn't knocked unconscious,> This has been disproven decades ago. Some doctors never learn.

How long does it take to teach a neurologist about concussions?

Nobody knows because the neurologist has to be willing to learn first.

Thank you all!
 

This board is such a tremendous support and source of valuable information!! Thank you all!

My son was suffering from unexplained (according to the neurologist), severe vertigo and had blurred vision. He could not read due to the letters on a page being disorganized and "jumping" around the page. He had a constant headache and cognitive issues. Despite having slammed his head onto turf in a soccer incident, the neurologist wrote off his injury claiming that it was "all in his head"!

I researched upper cervical chiropractors after it was suggested by a couple of people on this board. I found a NUCCA chiropractor who immediately demonstrated real concern and compassion for my son. (Incredibly appreciated after what we experienced at the neurologist's office.) Approximately, an hour after the first realignment (xrays and physical tests indicated a relatively significant misalignment of the skull/first vertebrae) my son's blurred vision cleared. He was treated every day for five days and we saw remarkable improvement that very first week. The chiropractor even came in to the office on his day off to treat my son. (We definately did not see that kind of concern from the medical community.) It is now two weeks after we started with the chiropractor and my son is symptom-free with the exception of a few cognitive issues!!

The chiropractor explained how a misalignment of the cervical vertebrae can put pressure on the brainstem resulting in all kinds of neurological issues.

Despite the mechanism of injury, never once did anyone in the medical community suggest that there could have been any neck trauma that should be evaluated. In fact, one MD discouraged me from even consulting a chiropractor.

I truly believe that it was the chiropractor's intervention, along with time, that is bringing my son back to complete health.
Thank you all!!!

t97tab,

Great to hear of your son's improvement. Now, the task will be to prevent another concussion. You need to seriously consider removing him from all contact sports. His next concussion will be much worse from even less impact force.

My best to you.

I found the same thing with our NUCAA doctor as well. He actually listened to our concerns and was also very compassionate. I'm a excited to hear that it's made such a huge difference for your son. It's made a difference with my daughter's headaches and energy level. I also think it allowed her to start being able to exercise again. Prior to the adjustments, too much cardio brought on worsening symptoms. Since the adjustments, she has had no problems.

For the cognitive issues, you might look into neurofeedback. We have done that as well. I don't know if it was time or just the neurofeedback, but it was like one day a switch flipped in her brain and her memory/recall started working again. It probably took another couple of months for things to mostly get back to where she was. We still have some residual executive functioning issues, but she is SO much better than she was.

Be careful when he start back exercising and follow a gradual ramp plan. Too much too soon can cause set backs. My advice would be to stay out of contact sports at least until he has recovered cognitively. My daughter doesn't play contact sports, but knowing what I know now, I'm wouldn't want her to pick them up now. It's just not worth it.

I would define nancys last comment about returning to contact sports very strictly. Most Post Concussion subjects believe they have regained their cognitive skills when they 'feel' like they have. Studies show that this is a false sense of recovery. Only a neuro-psych assessment can determine if all cognitive abilities have returned. An ImPACT Test will give a very simplified assessment, not valid enough to determine 'return to play' condition.

Even a neuro-psych assessment will not be able to diagnose when a subject has recovered to a point where their brain will tolerate another impact without making the brain damage much worse. Studies show that this healing point never comes.

Back in 1970, I suffered an undiagnosed concussion playing soccer. When I started having serious academic problems and some seizure disorder issues, my neurologist only knew enough to tell me two limitations. He said to stay away from any contact sports and an alcohol consumption. Both recommendations were beyond the concussion understanding of the day. He gave me good advice.

My concussions since then happened even though I took precautions to avoid any head impacts. I can't imagine what my symptoms would be like if I had continued to play contact sports.

My next concussion in 1974 was very minor but caused me to have to entirely change my direction in college due to the return of my academic struggles. I had entered college as a honors student after attending a Connecticut high school that had high standards for college prep students.

The challenges I have had with the roller coaster ride of PCS is my main reason for being such a strict poster. The young people with concussion histories will likely follow the same life path if they do not prevent repeat concussions.

I have a difficult time understanding how medical professionals and sports professionals are so willing to let young people continue to put their brains at risk with a return to play. The medical professionals mostly agree that second and third concussions do much more damage with less impact force. Yet, they somehow feel the need to clear an athlete to return to play.

There is a saying.

Mess with me once, shame on you. Mess with me twice, shame on me.

You could paraphrase this to: A first concussion may be an unintended event. Getting a second concussion is a known risk that is accepted.

How someone can intentionally put their brain at risk after experiencing a first concussion is beyond me.

I've got a pre-concussion background that includes soft-style martial arts, yoga, climbing, cycling, gymnastics, ballet, etc. My ability to perceive myself in space and navigate that space was top-notch. I could easily walk around the house, or walk a balance beam, with my eyes closed.

Post-concussion I've got some very big vestibular problems. Walking and standing are challenging. Getting back on a bicycle seems suicidal. More than once I've stumbled past small groups of hobos (drinking cheap booze from paper bags) and been greeted with "Hey man, are you alright? You need any help, man?" I'm not proud, but am I'm not ashamed to admit it.

Certain sounds make me dizzy. Loud noises make me jump.

I had a few sessions with a neuro-vestibular-physiotherapist, and she told me that if it wasn't for my background with physical movement, I probably wouldn't have been able to stand up: that's how bad my balance was (still is?). At the last session she mentioned that it made no sense to her that in some ways I was improving, but in other ways I wasn't. If anyone can comment on that...

Anyway, one of the things I've learned to do pre-concussion is allow myself to use visual and tactile feedback to control my balance. Post-concussion, it's the only way I can stand up. 9+ months later and still, if something moves through my field of vision it will almost knock me over.

I can stand in a doctors office, visually focus on a point, and walk in a dead-straight line for a a meter or two. But if you put me on a sidewalk with noise, cars, buses, people, etc then I stumble like a drunk. In laboratory conditions my balance is fine, according to that test. Everyone is different, but even for people without a background in physical movement the "laboratory conditions" of a doctors office, combined with a very brief test, could probably make things look better than they really are.

notcrazy,

If these are your 'you wont believe this' symptoms, they are uncommon but not unheard of. I have trouble standing with my eyes closed. Never did before. The balance in a chaotic environment is due to over-attending. Your brain has too much information to process. This, again, is not unheard of.

You likely have a problem with how your brain is gating information between different areas. Instead of a constant flow of balance information, it allows sound and visual to 'cut in line' and disrupt the flow of balance information. You brain's bandwidth of information processing has been seriously narrowed, if you understand some computer speak.

Some intense vestibular therapy may be able to strengthen the vestibular neural pathways but it is a slow process. Starting in a sterile clinical environment and then add external stimuli. As the brain relearns how to block the distractions and stay focused on the vestibular information, hopefully, you will improve.

You might want to check out http://vision-audio.com/ease_overview.html to see if their system of auditory desensitization will help.

You mentioned martial arts. Have you done sparing where you get hit in the head, even if while wearing head gear?
This can set your brain up to be overly sensitive to the knock out blow you took. It is knwo by some that sub-concussive impact can cause brain injuries, especially when there are many with concentrations of these sub-concussive impacts during practice sessions.

Studies show that the average football (American) players suffer 600 to 900 sub-concussive impacts during a season. They may not suffer any concussion symptoms from any individual impact but the accumulation is showing to be dangerous. Helmets do not decrease these subconcussive impacts but in fact, make them more likely to happen. The head gear creates a false sense of security.

Your use of visual and tactile information to balance may have been in response to losing some of the basic balance skills from martial arts head impacts. You were multi-tasking to balance. Now, you have lost the ability to multi-task, at least temporarily. This is very common with concussion.

Hope we can help.

My best to you.

your on the right track
 

It was 8 days after I took a hit on the head before I experienced anything other than a headache, bruising and sorenesss. On the 9th day I awoke and sit down at the desk to start working only to find I was spelling everything wrong, unable to concentrate, experiencing jolts/shots of intense pain in my head. I thought it was the flu because I was also having dificulty with coordination and balance so I laid down for the rest of the day. The next morning I awoke to find I not only couldn't type but I couldn't write either. My letters were backwards or sometimes even a compleyely different letter. When people called I had to strain to understand what they were saying and the 10 minute drive to church had me in tears as I repeatedly found myself coming to stop because I had moved my foot off the accelerator. A CT and MRI found nothing. Take care of your son... try to find a neurologist that can do more than read back your image results and that will take the time to listen and research the symptoms and give you counsel...

I was informed that most PCS's go away within 3 months... I hope your son is better soon and I hope you can find a dr that will do more than tell you it's nothing... It's been 9 months and I have been told my physicians and friends alike that maybe it's in my head or the change... I know my body, s well as, you know your son. If something is not right trust your instincts and pursue knowledge about options but for the most part I think you just have to wait it out and not push your son and give his body time to rectify the problem. And if you are a believer pray cause as much as you need answers you'll also need patience as there is no way to hurry the healing up.

Sherry

Just soft-style forms (mostly tai-chi), and no full-contact or full-force sparring. I've had knocks in the head (not martial arts) but no more than a 20-30 seconds LOC (that was once; I was about 10 years old). The most recent hit (before the BIG one) was about 10 years ago and resulted in 1-2 seconds LOC. I can probably count on one hand, maybe two, how many times I've had any significant knocks to my head.

Edit: Based on my understanding of physics, I'm lucky to be alive after the BIG one. I don't think sensitization was a factor. Based on what I deciphered from the bruising and cuts (a: I know my own body pretty well and b: I used to be an emergency medical technician) it was a solid hit against a tile/concrete floor.

notcrqazy,

The 30 sec LOC at 10 yo was a very significant impact. Even the 1-2 sec LOC is significant.

LOC elevates any concussion to a serious level. Your comment about any 'significant knocks to the head' is interesting. Your brain does not need a significant knock to the head to be concussed based on your history.

Have you ever had a light bump to the head where you had a metallic taste (like chewing aluminum foil) in your mouth or you say spots for a few seconds?

Studies show the brain can tolerate some severe hits without any immediate concussion symptoms. Impact forces from 60 to 170 G's were recorded. Many were not even obvious when video tape was reviewed. The brain's tolerance is variable from one person to the next. It is known that immediate symptoms or lack thereof do not necessarily predict later symptoms.

For you, the important issue is your current symptoms. Concussion is not treated as a cluster of symptoms. Rather, the individual symptoms are treated. By treated, many times this just means developing acceptance of the symptoms and learning to work around or with the symptoms.

Learning to avoid certain environments is imperative. Learning to minimize all symptoms is valuable because studies show that healing is most likely during symptoms free periods.

You definitely sound like a Multiple Impact Syndrome candidate. You may have reached your limit for recovery due to available reserve brain capacity. Your only opportunity for recovery may be learning to minimize some symptoms and learning to live with the others. Work-arounds and other accommodations can enable you to return to much of your previous life.

At this point, you will need to get to know your 'new' body/brain. Your prior physical capabilities have little bearing on your current condition.

List your most disturbing symptoms so we can offer suggestions for work-arounds and other accommodations.

My best to you.

I really don't know how long I was out, that first time. Long enough for a small crowd to gather, not long enough for anyone to do anything. Based on the circumstances, my guess would be 15-30 seconds. I spent a few days laying in bed, eating soup, and then I was back to normal.

The one about ten years ago, I went over the bars on a bicycle. I woke up laying on my back, in the middle of the street, but the bicycle was still in the air and I had enough sense and time to kick it away from me; otherwise it would have landed on top of me. I couldn't have been out for long but there was definitely a sense of lost time and "where am I? How did I get here?" feeling.

I think I may have had another brief(?) LOC falling out of a tree when I was a kid.

The first time and the last time where the only ones that left me with any fatigue, dizziness, headaches or any other symptoms I would typically associate with a concussion.

Oh man... There was also the time I fell asleep at the wheel and split a utility pole with my VW rabbit. I was young and I didn't realize that driving while tired is just as bad as driving while drunk. That may have rattled my brain...?

Well, the most recent knock was significant by any account.

Almost 20 years ago I got into a fight at school. I let the other guy get the first punch before I kicked his @$$ (The rules of engagement on school property encouraged me to not throw the first punch). His first shot was pretty good; His class-ring against my left eye. I saw stars and had a helluva lump, but otherwise no damage that I noticed. Several people commented that they heard the sound of how hard I got hit and they were impressed that it didn't fall down from it. That was the last time anyone at school picked on me :cool:

I should mention that the neurologist I was sent to, who I have no respect for, made it clear that these types of prior incidents have no bearing on my current "alleged" symptoms.

I don't recall any metallic tastes. After getting punched in the eye I'd say I saw stars. Haha... then I got my bearings, and I just remembered the look on the other kid's face... He looked terrified that I was still standing.

If that's the case, I also have to convince ACC.

* If I take it easy, I'm sleeping about 50% of the time - 12 hours out of 24
* Memory, focus, concentration, reading comprehension are all crap. This puts a damper on my career with computer stuff
* Balance is a huge problem. Walking is a challenge
* Headaches. For both practical and ideological reasons I don't do painkillers

not crazy,

Not attempting to relive your head aches could be making things worse. You need to get some relief. I just use Tylenol and aspirin. I do not use any of the stronger meds. If you state your refusal to use meds to a doctor, that can go against you. keep these comments to yourself.

You definitely qualify as Multiple Concussion Syndrome. Do some online research and take a few peer reviewed article to the next doctor you see.

You found a doc who does not believe in persistent PCS. That is not uncommon.

Write down your history of concussion/head impacts with your immediate symptoms and recover timelines. You may or may not have lost consciousness. You may just have experienced PTA, Post Traumatic Amnesia. It is more common that LOC. You can experience PTA without LOC. Some docs do not believe a concussion happens unless you have LOC.

LOC does not make much difference anyway. You treat the symptoms, not the event. I have not had LOC since 1965 at 10 years old. But my minor concussions since then have devastated me. My personality has changed. My IQ is still very high but my memory and cognitive skills are very low.

You need a neuro-psychological assessment. It is the long evaluation. Can be 2 hours to two days, depending on the battery of tests used.

Limit your time on the computer. Take frequent breaks. Watch for mental fatigue and get up and walk away as soon as you notice any fatigue.

I find myself rereading the same line or staring blankly for a moment. This is a sure sign to stop and do something else.

My memory is so bad that I have learned to use the computer screen as short term memory. I can reread what I have typed to keep track of my thoughts.

Did you read the nutrition posts? This is very valuable for a healing brain.

btw, I use frequent paragraph spaces so that i can follow the text from line to line. More than 5 or 6 lines and my eyes can not follow to the start of the next line. Work at learning these kind of skills and accommodations. I depend on spell checker. Firefox has spellchecker that works within online forms like this post.

Do not try to be proud. Humble yourself and let your life happen. You can always get stronger later, but fighting your symptoms only makes them worse.

You sound like you are in your 40's. This is a common time for past concussions to catch up with you. The brain starts deteriorating and the past damage starts to rise to the top. Welcome to middle age.

I'll try to send you the TBI Survival Guide doc file. It is very good. So is the file at http://www.lapublishing.com/blog/wp-...al_English.pdf

My best to you.