Please read/analyze my situation. (Long Read but need help/support)
 

First off, I would like to say thank you in advance for taking the time to read my thread. Your forums here are a great resource. I will do my best to explain thoroughly my situation to help you guys get the best understanding for feedback. (Keep in mind I am going to my neurologist this Thursday....)

Okay, so my story begins January 5th, 2012:
I was playing a game of basketball w/ friends at my local YMCA when all of a sudden I collided with one of my friends in a head-to-head hit. It hurt VERY badly for only at matter of seconds (I was NOT knocked out) so I was able to continue playing for the remainder of the night with no pain/other effects. My friend was in enough pain so that he went home and took aspirin and had no prolonged effects. I have since asked other friends who observed the incident and asked them how hard it looked to which one responded :
"It was pretty f'ing hard."

January 8th:
Only symptoms were small tick/pinch-like feelings before I went to bed that night.

January 9th:
Looking back, here is where I was really foolish. I went snowboarding with a pal and took a couple of spills (and YES, I WASN'T wearing a helmet). However, I do not recall hitting my head directly but I do remember landing oddly with my neck bent forward.

January 10th:
This was the day I felt "not right". The best terms I can use to describe would be: tired, out of place, disinterested.

January 11th-January 25th:
Symptoms Persist/Worsen. Develop headaches (not specific to any part of head and are either very quick "flares" or longer/dull). Also, I started to feel like my eyes lost their ability to blink and that I had to do it manually.

January 25th (Important):
Visit usual physician, explain symptoms, etc... I TELL HIM I WOULD DESCRIBE MYSELF AS A HYPOCHONDRIAC/ANXIOUS PERSON. I tell him from mid-Nov to present that I was under a lot of stress at home (mom sick, dog being put down soon). He does routine neuro exam (eyes/ears): he says no bleeding in skull and no pressure in skull...

January 25th (CONTINUED):
I explain to him why I think I am anxious... This previous summer I was vacationing with a friend at his family's house in FL and he pointed to a picture of his cousin. My friend tells me she just had a BRAIN TUMOR...Fast forward to me in my doctor's office and I tell him that. He calms me down and tells me rest is the only solution.

January 26-January 30th:
Symptoms persist, anxiousness builds. Begin to feel random quick pains/twiches in body parts and an urge to move my legs because they feel "different".

January 31st-Febuary 1st:
I presume I had a panic attack this morning. Woke up with trembles, mind racing, contemplate calling 911.

February 1st:
Return to physician, he repeats neuro exam: again no pressure in skull or internal bleeding. We discuss my anxiety and set up a meeting with a psychiatrist.

February 3rd:
Appointment with psychiatrist, I explain all the details, etc, etc. She concludes that I have always been an anxious person(true) and that the stress and concussion(presumed) have made my anxiousness worse. She prescribes Xanax(.25mg twice a day).

February 4th-Present:
Overall quality of life is better I guess due to Xanax but still the thought of a BRAIN TUMOR is still on my mind. As said previously, going to neurologist this Thursday (2/16).

Current Symptoms (In Detail):
-Headaches: I never have any serious pounding/pulsating pain in any reoccurring/specific area but rather usually quick sensations in any part of the head. Sometimes I experience dull tightness in the back of my head.
-Legs: I think this is an anxiety issue, but I seem to have an increased alertness to them from my knees and below. I feel like I have to move them.
-Neck: I get neck pain in when I lean it backwards. This seems to come and go.
-Eyes: This symptom is an on/off thing. Sometimes I go a while without experiencing it. The best way to describe it is like I have to force myself to blink a lot on my own.

Other Important Information:
-I went snowboarding before my basketball incident (Dec 22 and Dec 29), again WITHOUT helmet and falling a lot, but didn't have any concerns in the days after.
-As briefly mentioned, I've been under a lot of stress since mid Nov with Mom's health (driving the house crazy, so far nothing found with her). I guess I get my hypochondriac mindset from her...

MY THOUGHT PROCESS WITH THIS ANXIETY
Regarding my story about my friend's cousin with the BRAIN TUMOR...I have been vigorously searching my mind/asking friends/recounting dates on facebook to PROVE TO MYSELF that I was NOT experiencing any of these symptoms (headaches,etc) prior to the dates that I have given. I keep coming back to the answer that it's unlikely a tumor developed between late December (when I was feeling fine) and being hit in the head but I keep doubting myself and even the severity of my concussion. Everyone I've spoken with says that I am highly over-analyzing the situation.

I've read on some sites that the occurrence Post Concussion Syndrome has little correlation with the severity of the concussion sustained. Can anyone confirm this and does it sound likely that I'm having PCS?

So, well, there is my story. Thank You so VERY MUCH for taking the time to read it. Please help me out with my thought process and if this all sounds normal in regards to the symptoms.

Yes, there is little correlation between "severity" of the injury and severity or duration of the symptoms. I have talked to several professionals who indicate that people who have "little bumps" often have very painful and/or enduring symptoms.

The symptoms you describe sound very much like my post-concussion symptom progression, including the increased anxiety.

Sorry to hear you're suffering. Glad you found us here, though! Best wishes for a speedy recovery!

Dalton,

Welcome to NeuroTalk. Sorry to hear of your recent experiences.

What you describe all can be due to a concussion. Add a predisposition to anxiety and you get a double whammy.

The concussion was on the basketball court. The snowboarding added to the concussion with sub-concussive impacts. Any time a concussed brain is shaken, it can act like a new concussion and make the symptoms worse.

To define you, I'd call you a cyber-chondriac. That is a hypochondriac who self-diagnoses from online (cyber) information.

A brain tumor will usually manifest with focal symptoms related to the specific area of the tumor. Your symptoms sound more global as in diffuse axonal injury. This is a subtle injury or stress to thousands of fine connections between brain cells.

I assume that your are a guy (Dalton) but your age may also play a part in your symptoms.
How old are you?
Have you played any contact sports or soccer?
Any prior concussions?

And, forget about the brain tumor. You are more likely to get struck by lightning than have a brain tumor from the symptoms you describe.

Anxiety is the enemy when recovering from a concussion. You need help with your anxiety besides the Xanax. I am concerned that you are taking a benzo (Xanax) while trying to recover from a brain injury. Your brain is already struggling and sedating your brain will not help it heal.

Do you drink any caffeinated drinks? coffee, tea, energy drinks?

You need to stop if you do.

Keep us informed how you are doing. We are here for you.

My best to you.

Thank you both for your kind words. I am 20 years old and I have never been diagnosed with a concussion but have hit my head plenty of times I'm sure. Just never any lasting symptoms. For example, I hit my head earlier in 2011 (late summer-beginning of fall) while rising up from a bent over position and struck a metal beam right above me at work. It hurt like hell for a few minutes but I took some ibuprofen and never had any problems after that. I don't drink coffee, etc at all.

I do understand your concern about the Xanax sedating my brain because my initial physician did seem to mention that he felt reluctant to prescribe something like that because of the uncertainty of my head. When I went to the psychiatrist, she seemed more concerned about assuming me being an anxious person in my life prior to this incident. She suggested that the concussion+recent stress manifested have resulted in an increase in an already present anxiety.

I never wanted to be medicated at first but I felt compelled to have 'something' just due to the overwhelming anxiety/panic induced by a belief in any possible 'scenarios'. I will say that I do become more anxious when I am alone/unengaged as opposed to being around my dad or doctor (someone who will listen/calm me down).

Sorry to be a pest but I have a couple more questions/thoughts:

1) I know exactly where I got hit playing basketball...Is it common to have these 'headaches' in many different areas of the head/neck besides just the area of impact?
2) Is it also normal for some days to feel okay for the most part with minor instances of headache and than some days I feel the headache as constant/dull or quick flares in different locations?
3) I can understand the twitching/random quick pains being from anxiety/stress BUT how does my leg issue sound... I really can't think of a term to describe it. The feeling isn't constant but when it does come, it lasts in episodes for a few hours and I just feel like I have to move them or else...

Like you said, the anxiety is a huge enemy right now. I just can't seem to stop doubting that I was feeling fine in mid-late December. Its as if I am minimizing my basketball injury and saying to myself :"That hit couldn't have been enough to warrant a concussion, right?"

Thanks again, I'll be keeping everyone updated

Thanks for you good response. This helps me understand your situation.

Your age means you don't have to worry about the issues of adolescence and concussion.

The caffeine and alcohol are also good answers.

Your history of diagnosed concussions of just one needs to be updated with those head impacts that caused head aches and any other symptoms besides a simple swollen bump. This puts you in the spectrum of Multiple Concussion Syndrome.

There is a concussion specialist back east who suggests keeping record of any and all head impacts. He even suggests that ER doctors note possible concussion in the medical records of any patients who are seen in the ER from falls or other like of trauma. He considers it valuable information for future doctors to consider when PCS like symptoms may manifest.

What this means is your symptoms MAY be more prolonged with a lesser level of recovery. It also puts you at a much greater risk of more damaging head injuries. As concussion count increases, the damage caused by the same or even less intense impacts can be much more problematic.

You need to give very serious consideration to finding a way to resolve your anxiety issues and hypochondria. With your history, anxiety will likely follow you do to the weaknesses your brain has from your concussions. Doctors tend to dismiss patients with concussion like symptoms from what appears to be a minor impact. They frequently label the patient's symptoms psycho-somatic or somatoform. This ends up being a ball and chain that can follow the patient for years.

As far as getting on the road to recovery, there are some basic things to do. Get started on a supplemental vitamin and nutrition regimen. This means a B-50 or B-100 complex, 300 mgs of B-6, 500 to 1000 mcgs of B-12, D3, E, niacin, Omega 3's, folic acid, calcium and magnesium, a strong multi-vitamin like GNC Mega Men's. There are a few others that I forget (brain damaged).

Regarding your questions,

It is very common to go through a roller coaster ride with symptoms. After a while, you will start to notice triggers. Many triggers will not cause an increase in symptoms until the next day. Hard to understand but the truth. We can discuss triggers in a latter post.

The head aches in other areas of your head just mean that your injury was not a focal injury at the point of impact but a diffuse injury or coup contra coup (hit with a rebound hit as the brain bounces inside your skull). The head aches are usually tied to the brain's loss of its ability to regulate blood pressure in the skull. There are also head aches from the upper neck injuries common to concussions (the head bone is connected to the neck bones, hit the head and the neck is impacted by the head). These will usually manifest from behind the ears and move to other parts of the head as tension increases.

The restless feeling in your legs can be connected to the concussion for a myriad of reasons. I need to take an anti-seizure med to help my legs settle down so I can sleep without kicking my wife. Gabapentin (Neurontin) works well for this for me. It is well tolerated with minimal side effect, especially compared to Xanax

Regarding your anxiety and hypochondria, if you arm yourself with complete and accurate information, it is quite possible to exclude the many risks that are often obsessed on. There is a saying in medicine, When you hear hoof beats, think horses, not zebras. The idea is to consider the most common and logical issues (horses) and ignore the extreme or rare issues (zebras) until all the common issues are ruled out.

Understanding your concussion symptoms allows a simple, "Oh rats, I did that and now I have to deal with some symptoms for a bit." Download and print a copy of the TBI Survival Guide at www.tbiguide.com. As you read through it, you will have many 'ah ha' moments. Then, realize that concussions rarely ever kill anyone, and usually only when a second concussion happens within the first three or four weeks of a previous concussion.

So, no basketball or risky activities at all for a few more weeks at least. Even better if you wait until you are completely symptom free for two months. If you develop an excruciating head ache or lose control of your muscles or balance or focus or other extreme symptoms, get to an ER right away. But, that will be a very rare situation, again about as likely as getting struck by lightening. There is not much the doctors can do to help you except prescribe meds for individual symptoms. Amitriptyline (10 mgs) is often prescribed for head aches and insomnia. Propanolol can be used as an anti-anxiety med. It is fast acting and easier on the brain and body that benzos like Xanax.

There are lots of trick you can use to help tolerate your symptoms. Tell us about your worst and we can help you with them.

There, I gave you the full flow fire hose treatment. Print this post out so you can read it later and show your parents.

And, get some quiet rest.

My best to you.

Wow, thanks again. Sorry about double posting; I didn't know the first had went through. You mention the horse/zebra and psychosomatic topics and I think these may be playing a large role in my anxiety. I'm the type of person who needs all the information available so I think hopefully having a CT scan and an MRI (if needed) will do a lot towards reducing my anxiety (assuming the results confirm I have no serious illness).

You may also want to ask about something like Prozac for anxiety. I was on it before my concussion, and increasing my dose afterwards helped with the increased anxiety I was experiencing.

I also have the restless leg feeling off and on, especially when I am lying down and trying to go to sleep. I think it is just part of your nervous system being a little haywire. I also have random arm twitch/jump things sometimes.

Yeah the leg feelings are truly hard to explain. Its almost like a dull soreness that requires motion to satisfy the feeling.

EDIT: These feeling occur mostly below the knees and in the back of the legs wheres calves/muscles are.

Hi Dalton
 

I want to welcome you to Neuro Talk. I am sorry you are experiencing the pain and anxiety. This site will help you through it. There are alot of individuals who have suffered this kind of injury. Hope you get alot of responces and help. You found a good site to help you with this. I hope you get better soon. I will keep you in my thoughts and prayers. ginnie

Dalton,

Welcome to NeuroTalk.

It looks like your already getting some help.

I just wanted to drop in and let you know I get the same feeling you describe in my legs. It actually happens in my arms too. This happened before the injury but it happened even more after the injury. When you move, kinda stretch the muscle or flex it you'll satisfy the feeling, correct? If so, I've got the same thing going on. Not sure what it is...I've always wondered myself.

Best of luck to you, bro.

There is something called Restless Leg Syndrome I have read about, but I'm not aware of any relationship to concussion. Anyway, might be interesting to read up on and/or ask your doctor about. I know there are medications & treatments for it.

Okay everyone, had the neuro appt today. I told him about my anxiety regarding a brain tumor and he agreed to let me get an MRI tomorrow because he also thinks it will help my mindset to reduce my anxiousness. As far as my symptoms go, he concluded its more anxiety based than physical.

He did the eye check/pressure check and explained that more in-depth than my usual physician was able to so I think that did a lot to make me feel more confident.

Hopefully tomorrow after this MRI, I can put my unnecessary worrying behind me and get back to living under my own control again.

Hey can anyone tell me if decrease appetite is also a sign of PCS?

I'm not sure if it's directly a symptom of PCS, but it certainly can be a symptom of both anxiety and depression, which are symptoms of PCS. Does that help?

Dalton,

Decreased appetite is not a common symptom of PCS but can be a symptom of anxiety and depression. It can also be a side-effect of many meds for anxiety and depression such as Xanax.

As I stated earlier, you need to find help to overcome your anxiety and obsession issues . If you need an expensive test to overcome ever concern, you will serious damage your ability to get doctors to help you and put your health insurance into a questionable position. The doctors will start getting grilled by the insurance company to justify the script for the expensive tests.

The term "medically necessary" will become a big issue as the insurance company tries to contain costs. The forms that get signed before exams and procedures usually have a clause that says the patient accepts full liability for the bill if the insurance company refuses to pay or only makes a partial payment .

I have been on the paying end of this problem when my insurance company refused to pay to all of the bill due to denial of "medical necessity."

There is substantial data to show that medical shows on TV cause a serious increase in doctor visits with patients complaining about concerns they are suffering from that weeks disease or medical condition. News reports and information from family and friends can cause just as many unnecessary concerns.

Concussion only makes this worse.

Hopefully, the neuro can use the concussion as the reason to request the MRI.

I hope you can find some help with your anxiety. The ups and downs of PCS can make anxiety worse without any need to add thinking about a disease or other conditions.

As others have mentioned, getting a review for a better med such a Prozac or Paxil or Zoloft will be worthwhile. A sedated mind that is still anxious shows a need for seeking a better treatment.

Hope you have a good experience with the MRI. I am claustrophobic and need to keep my eyes closed and hug my arms in tight so that I do not feel the inside of the MRI tunnel. Good ear plugs are also valuable.

My best to you.

I had the MRI today and started my first Paxil pill.

I have a question directed at 'Mark in Idaho'. After describing my headache symptoms to the neurologist, he prescribed Nabumetone which he described as an "Industrial strength Aleve-type drug". After 3 days so far it may have had minimal impact if any. Is there anything else that is normally given for PCS headaches which are proven effective?

I use a combination of Tylenol and aspirin. But I do not have migraine like head aches.

What is your blood pressure? Could you have a higher than normal BP causing or contributing to the head aches? Anxiety can cause elevated BP.

btw, Nabumetone has nervousness and insomnia listed as side effects.

Is Nabumetone normally prescribed in PCS situations?

Are you on amitriptyline or nortriptyline yet? Those are commonly prescribed for headache prevention in PCS. You take them every night at bedtime.

No but thanks for the suggestions. I'll mention them on my follow up. Would either one of those be safe to use with the Paxil I was prescribed? I ask because the Paxil does seem to be helping my anxiety...

According to this drug interaction checker there are some interactions, so definitely ask your doctor or pharmacist for their opinion.

http://reference.medscape.com/drug-interactionchecker

The serotonin interaction for amitriptyline is a very rare possibility called serotonin syndrome. It was a possibility of an interaction for a drug I took with amitriptyline but neither my doctor nor pharmacist were worried about it, and I had no trouble with it at all.

I'm not sure what the QTC interval means.

You might also ask about Topamax if you are having migraine-like headaches. It is used for migraine prevention and doesn't seem to have any interactions with Paxil at all.

Hi Dalton,

With anxiety and obsessions, our natural tendency is always to run from or resist the thing we are fearing. With OCD in particular, this manifests itself in the form of compulsions that include checking, seeking reassurance, counting, washing, and a number of other behaviors, some of which are quite bizarre.

What you describe here sounds like a classic obsessive-compulsive thought process (I'm not diagnosing you with OCD--just talking about this thought process). An obsession (intrusive, disturbing thought) gets stuck in our heads, and we go around looking for information in order to prove to ourselves that our feared consequence (e.g. brain tumor, something bad happening to a loved one, etc.) will not happen or is not true. But this is a losing battle; no matter how much evidence we produce (those of us with OCD, anyway), we can never achieve absolute certainty that our feared consequence will not happen, and we still feel anxious thinking about that tiny chance that our feared consequence could occur.

The idea here is that reassurance, in the short term, does help to alleviate the anxiety; all compulsions do, and that's why people engage in them. But as a long-term strategy, it is not likely to be helpful. The general rule of thumb with any type of anxiety--which is much easier said than done--is to go toward what you fear. With a brain tumor, this might mean working on accepting the possibility that you might have a brain tumor and that there's nothing you can do about it, rather than looking for more information to try to achieve certainty. This is very hard at first, and it is best done under the supervision of an anxiety or OCD specialist (depending on your diagnosis), or at least with a very good self-help book.

Can you get a referral to see an anxiety specialist? Medication alone will only take you so far with anxiety; lasting progress requires an understanding of the condition, as well as changes in behavior and thinking. If what you have is OCD, then the best treatment is Cognitive-Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). Anyone who claims to be an expert in OCD and is not using these techniques is probably misinformed and out-of-date. Again, I'm not trying to diagnose you; let the therapist take care of that. I'm just trying to say that once you are diagnosed, it is very important to get a therapist who is an expert in whatever particular anxiety disorder you have (if you have one).

If you are able to read with your current head injury, you might look into getting the following books:

Dancing With Fear, by Paul Foxman

This one focuses on anxiety in general, and is more relevant for disorders like Panic Disorder, Phobias, and Generalized Anxiety Disorder.

Freedom from Obsessive-Compulsive Disorder, by Jonathan Grayson.

This is an up-to-date and fairly comprehensive treatment of OCD by one of the foremost experts in the field. It may also be of some benefit in helping to understand and cope with other anxiety disorders.

When in Doubt, Make Belief, by Jeff Bell

This one also focuses on OCD, but may also be helpful for other forms of anxiety such as Generalized Anxiety Disorder and maybe Panic Disorder.

There are some good Yahoo groups for people with anxiety disorders. Some are general and some focus on specific disorders. It might be best to first see if you can get a diagnosis, but some of these Yahoo groups are extremely helpful, and they are moderated by experts on these conditions.

Please feel free to PM me if you want to discuss your anxiety further, or if you have any questions that you don't want to ask in public.

Thanks for your informative post! I just want to let everyone know that the MRI results came back NORMAL! Thanks for all your support and vast amounts of information. I just have one further question, Since the MRI came back normal, there is no point in having a CT Scan correct?

A CT Scan would sound redundant but could be helpful if done properly to look for upper neck injuries and abnormalities.

Regarding your OCD, everybody's OCD is different. No one size fits all. OCD can also have vast differences based on the various world views and even philosophies.

If the Paxil is helping, good for you. It has powerful anti-anxiety effects.

It may help for you to write down a score sheet. List your concerns and what the possible outcomes can be and what you can do to change these outcomes.

Many of the things we get stuck on have much less bearing on our life than we make them out to have or have little ability to be effected by us. Learning to accept them and work within the parameters of those issues can strengthen us in many areas of life.

I may not be able to prevent some of my PCS symptoms but I can learn how to manage and tolerate them. It also helps to be able to let go of the past.

I hope your condition continues to improve with the Paxil. I find I need something in my stomach to help with the occasional nausea I notice when I try to go to sleep in bed. A few saltine or other crackers with some peanut butter usually does the trick. Sometimes, just the crackers does the trick.

My best to you.

Yeah the Paxil makes me feel like I need something to put in my stomach waking up in the morning. I ask about the CT Scan because my neuro said an "MRI is the best thing we have" when I mentioned what I was thinking could be inside my head.

Hi Dalton
 

[No, you don't have to have the other test. I am glad your MRI was normal. focus on the good stuff now. ginnie

Hey guys I've been feeling a bit better over time but I still have one thing on my mind. The issue is concerning my eyes. In normal outdoor lighting, my pupils are their normal size. Same goes for well lit indoor areas. However when I am in a room with a light say, on the other side of the room, my pupils look pretty dilated. I know its normal for the pupils to dilate when exposed to the dark (is it normal for them to be COMPLETELY dilated in the dark?) but does it seem odd that they seem to be dilated in just "okay" light situations?

I've been testing my eyes to make sure they are not dilated at all times by going into the bathroom, closing the door, and turning the lights off then on. As is natural, they have always returned to their average size. I'm guessing this is just a result of my increased anxiety or I just never noticed how they respond to different lighting situations before in my life until this whole fiasco.

Dalton,

You are trying to make something out of nothing. Pupil dilation only has bearing if they are not equal or do not react to light. It sounds like yours are equal and reactive to light.

Try to relax and let time help with your healing.


My best to you.

Thanks again Mark. You've been a great counsel to me during this time.

Hey guys, just checking in to let everyone know that I'm doing better than I was just a few weeks ago.

From anyone's experience, is it common to have any kind of eye strain/'painish' like feelings from PCS? I feel like in the mornings when I wake up my eyes are dry and become strained as the day goes on. I'm not positive here but I don't think it has anything to do with being more sensitive to light but I could be mistaken. I noticed immediately after the concussion I was having urges to blink a lot and now that is going along with the strain. It also looks the 'bloodlines' in my eyes are more pronounced.

Could any meds cause this sort of effect?

Yeah, eye strain can be caused by several things. Meds could cause your eyes to be dryer. You could also have damage to the eyes in a couple of different ways. If you haven't already, it might be worth having a medical eye exam AND a vision efficiency evaluation.

After my concussion, my medical eye exam was fine, but my vision efficiency eval showed that I was having trouble holding two images together as one. This caused eye strain and contributed to my headaches.

I found the doctor who did my testing here: braininjuries.org

I have a lot of problems eye strain and pain in the eyeballs, which appear to be associated with my light sensitivity. However, I also have chronic dry eyes (possibly from meds), which contributes to the strain. I have found Systane Ultra Eye Drops to be very effective, though I sometimes have to take them several times a day. They are not cheap, but for me they are well worth it.

I checked out fine with both the optometrist and opthamologist, but I will soon be seeing a neuropthamologist.