Mechanism of cognitive symptoms related to a whiplash neck injury
 

Could someone explain to me how it's possible for a whiplash neck injury to cause cognitive problems such as severe memory and thinking impairment?
What are the biological mechanisms that make it possible?

The most likely problem is reduced vertebral artery blood flow to the brain stem and part of the brain from inflammation. The sleep problems associated with whiplash injuries can be a big cause of those symptoms, too. Sleep apnea can be a cause. Chronic sleep and blood flow problems can cause atrophy of the brain cells over time.

Then there is the direct physiological damage to axons (diffuse axonal injury) that reduces the function of the communication structure in the brain. Think of wires that have poor insulation or are corroded or a leaking hose.

Mark, what is your recommendation for those of us who suffer from dizziness and brain/eye fatigue due to a whiplash car accident without head trauma? Is there anything we can do to speed up recovery? Anything that we shouldn't be doing?

- Eric

Thanks a lot for the answers, altough I have some more now:

-How can the inflammation of the nerves restrict the blood flow to the brain?

-What do you mean with Chronic sleep?
Also, the atrophy of the brain cells is reversible or its an irrepairable damage? And can it be seen on and MRI or other imaging exams?

-Do you mean the axons in the brain or in the nerves of the neck? And in either case it is possible for the axons to repair themselves?

It is not nerves that get inflamed although they can. It is the soft joint tissue around the traumatized joint. The inflamed joint tissue acts like a blood pressure cuff and squeezes the blood vessels.

I was meaning Chronic sleep problems. Lack of quality sleep, sleep apnea, and such limit the brains ability to detoxify and properly oxygenate.

Diffuse axonal injuries are to the axons between neurons and dendrites. The injury can be diffuse (throughout) the brain. The injury is believed to be to the myelin sheath that insulates the axons.

B-12, folic acid and other supplements can provide the best environment for the myelin sheath to heal.

When nerves in the neck get inflamed, they can cause muscle spasms that can also reduce blood flow.

On average, how long does it take for chronic sleep to cause brain atrophy?
And this atrophy can be reversible?

Also, the diffuse axonal injuries can be caused only by the impact of the brain inside the skull, or can they also be caused at the neck area by the acceleration/deceleration of the whiplash movement by shredding the axons?

[QUOTE=When nerves in the neck get inflamed, they can cause muscle spasms that can also reduce blood flow.[/QUOTE]

- What's the primary trigger for the inflammation and how is this treated?
- Would taking a blood thinner increase blood flow to the brain?
- What supplements or meds can be used to prevent inflammation?

SPNS,

There are plenty of anti-inflammatory substances. Fish oil, ibuprofen, aspirin. They also thin the blood.

For me, the inflammation was triggered by poor sleep posture. Too much head lift and tilt. My neck would respond with inflammation. The decreased blood flow would interrupt my breathing triggers and I would stop breathing as much as 16 times per hour. 20% of the treatment what physical therapy and chiropractic. The rest was my discipline to sleep in a good position, usually on my back with minimal pillow lift.

Chronic sleep problems like untreated sleep apnea can take decades to slowly atrophy the brain. There is no current way of rebuilding the lost brain tissue. The brain starts to naturally deteriorate at 25 with it accelerating at 40 to 45. Brain cells are always dying. They are not replaced fast enough to keep up with normal cell death.

Axonal injuries are within the brain tissue and are from the sheering forces as the brain bounces around inside the skull.

By definition, diffuse axonal injuries are throughout the brain. Look up diffuse. If there is focused damage in the neck, that would not be diffuse. There is a thing called a brain stem concussion where the impact forces bounce the brain stem around. It is not mentioned very often.

Brain atrophy can be diagnosed with imaging test? if so with which test?

Can brain stem concussion heal and if so, how long does it take?

Why do these details matter so much ?

Brain atrophy is impossible to image in the early stages. It is usually noted by comparison images taken a decade or more apart.

A DTI MRI can show evidence of trauma. Diffusion Tensor Imaging looks at the water flow in the brain and can indicate where that flow is abnormal. This usually indicate a response to trauma/injury.

As I said, Brain stem concussions are not mentioned much. They would likely heal like any other concussion.

Every brain injury is different. Extent of damage and length and completeness of recovery is different with each individual.

What type of pillow do you use? I had mri DTI scan done at Mayo Clinic and it came back clean. Dr. said that’s means I don’t have mTBJ but PCS and due to chemical changes in brain. 25% of people with PCS don’t recover and they dont know why. Also mentioned he thought I could possibly heal still as I’ve been incorrectly medicated.

If my vision was affected, I have post convergence insufficiency. Seems odd that if I didn’t have brain damage, my vision wouldn’t have been affected. I’m sure my neck plays a role in my headache pain but I want to solve the brain fog/head pressure more than my daily headaches.

I have question, how do we know that in some cases one of the causes of the cognitive problems after a whiplash injury is the reduced blood flow to the brain due to inflammation of the joint tissues?
What kind of tests or studies had discovered/showed that?

There is not definitive way to know. Poor sleep, depression, and other things can be the cause, too.

In my case, the only indication was when I had much better days cognitively when I slept with better posture.

Like so many issues with concussions, trying different treatments or behaviors for an extended period can effect improvements.

There are no direct diagnose and treat protocols. In much of medicine, the try this and see what happens protocol is a mainstay.

Yes, I understand that it is basically impossible to know for sure the cause of cognitive issues on a specific/singular case.
But generally speaking, how do we know that a whiplash injury can reduce the blood flow to the brain by inflammation of the soft joint tissues thus causing thinking and memory problems?
What kind of studies and/or exams have showed that it is possible?

There are no studies I have seen. A medical school professor who used to post his lectures online addressed these issues.

The anecdotal evidence suggests this to be a common issue. The medical industry is not completely behind this but the chiropractic and osteopath professions try to address these issues.

Common logical understandings of anatomy and physiology suggest this is the case. It is well known that excessive pressure in the brain can cause cognitive and memory problems. That is why the MMSE (Mini Mental Status Exam) is used to diagnose neurological condition.

A webinar put on by Headway Foundation addressed upper neck issues this past Thursday but I missed the presentation.

Why do you need to have such specific information?

Because I want to try to know and understand as much as possible about the possible causes, consequences, mechanisms and implications of what I am living through.

I started experiencong severe thinking, concentration and memory problems and numbness two days after the car accident during the first week of May, and then they worsened even more after I did a MMA match on the 17 June.
I did not take any hits to the head or other body parts, but I received a lot of pressure to the neck due to chokes and spinal compression techniques.

With that being said, I have been symptoms free since the half of August, but cognitive deficits (albeit less intense than previously) have gradually returned during this week, starting form November 1st.
I experienced an intense rage due to frustration, and in the process I grabbed, squeezed strongly and throwed around some objects.
Then I started to feel dizzy, groggy and "off", and that was followed by trouble thinking that became greater every day.
I was frustrated and angry in a similar way, many other times during this period, but I never experienced any setback. Hovewer, it was the first time that I physically grabbed and squeezed with much force objects in the process.

According to you, what is the most likely cause for this relapse?
And also, what should I do to avoid aggravating further my situation and improving the chance of a recovery?

I also specific that I have always taken Vitamin B and folic acid supplements during this period (I took them even before the accident to helm me stay focused when studying)

It is really not possible to accurately self-diagnose cognitive deficits. There are many causes, including anxiety, OCD (a form of anxiety), stress, school work load, diet, blood sugar levels, thyroid or other hormone imbalances, plus the issues due to injuries.

If you were symptom free from mid August to the end of October, what were you complaining about for the past few weeks?

It sounds to me like you need to slow down and take life a bit slower. Learn to let go of the little details.

btw, What doses of which B's are you taking? How about the other things like Omega 3, and other beneficial supplements.

Do you have access to a Neuro Psychological Assessment to properly quantify your symptoms? Most use an NPA to validate symptoms.

I used to think and speak in a very precise, quick, fluid and complex manner, while now I struggle to form one single coherent sentence in my mind and I cannot speak more than a few words without forgetting what I was tryng to say.
I'm also unable to perform simple cognitive tasks that I was capable of doing effortlessy previously.
Can a worsening of the situation of that level be cause by anxiety or stress?

I was complaining about having had severe cognitive symptoms for months (beetwen the end of June and July I would not have been able to post on this forum at all) and about the state of high anxiety and fear of my symptoms coming back that I was experiencing.
Also I had been imprecise in sayng that I have been symptoms free in that periodo, I'm sorry.
I meant that I was free from cognitive symptoms, but I still had some other issues like disturbed sleep patterns, sporadic shortness of breath and high levels of anxiety.

I'm taking a supplment called Be Total which include 2,1 mg of B6, 1,4 mg of B2, 1,1 mg of B1, 2,5 mcg of B12 and 200 mcg of folid acid

I have never heard about that, could you please elaborate further about it?

You are right but it's not easy, do you have some practical suggestions about that by the way?

Back in 1982, I was under high stress after being ripped off by a real estate developer for hundreds of thousands of dollars. My cognitive skills were a in seriously dysfunctional state. I could not finish sentences. I was walking around like a zombie. A psychiatrist diagnosed a serious depression. He got me started on the vitamin regimen with a focus on B-12 and mega dose anti-oxidants. I do not have any recollection of having suffered any kind of head trauma.

In 2002, after a head and neck injury in 2001 and over a year of cognitive struggles, a Neuro Psychologist did an assessment and found serious dysfunction in my cognitive skills. Because of my high scores in the WAIS-II adult intelligence assessment, he diagnosed my cognitive and memory problems as the result of depression. In this case, I scored very low on the depression scales. I researched depression and cognitive skills and found that depression/anxiety can cause a reduction in cognitive skills. I also found that there is a huge overlap between depression/anxiety caused and injury caused loss of cognitive skills.

All this to say there is no way to know the cause of your struggles until you are properly assessed by a professional.

Your accident and MMA neck strain could have triggered an increased anxiety and depression episode. Many with PCS start with injury caused struggles that become worse from the anxiety/depression symptoms. Your focus on details suggests an obsessive focus. This is a sign of anxiety. You are likely a very driven person with high achievement standards. People like that are impacted more severely by PCS so depression/anxiety is more prevalent.

The shortness of breath is a common symptom of anxiety. It comes from muscle rigidity. The anxiety causes people to tense up muscles to the point that they unconsciously hold or slow their breathing until their brain says, "Help, I'm not breathing." It is part of what is sometimes called postural rigidity where the muscles in the torso are held tense.

The dosages in the Be Total are very low. They are dosed to prevent malnutrition, not encourage healing and better stress tolerance. RI or RDA is an amount needed to prevent malnutrition, not to support an injured or stressed nervous system. The B-12 should be 500 to 1000 mcgs or more. The folic acid should be 400 to 500 mcgs. B-6 should be 20 mgs or more.

From a google search, Neuro Psychological Assessments are used in Italy (I think you said that is where you are). The MMSE, Mini Mental Status Exam is also used as an early stage screening tool. Both use tests of memory, motor function, executive functioning etc to diagnose brain and psychological dysfunctions. The MMSE is often done by a medical doctor. It only takes 10 to 20 minutes. The rest are done by neuro psychologists.

Could you please tell me the name of some reliable supplements that meet those standards?

I have visited three private neurologist and they did not any kind of cognitive test to me ( by the way, they also did not let me explain the majority of my symptoms or the mechanichs of the accident, and I was not able to tell them because of my cognitive problems made me barely able to start a slurred sentence and unable to understand very well what other said. They also were incompetent and negligent enough to say that it's impossible to suffer from neurological problems without hitting the head and losing consciousness and cleared me to do fighting sport) .
What should I do to have this kind of tests done to me?

Read the Vitamins sticky at the top.

The neuros who claim no injury unless loss of consciousness are ignorant. There are plenty of head injuries where the head never contacted anything.

The mechanics of the accident are not very important. Symptoms are.

Is there a teaching hospital near you? They usually have a medical school next to the hospital.

A physiatrist (Physical Medicine and Rehabilitation) or neuro psychologist that is affiliated with a neurological rehabilitation hospital or clinic is usually a good start. Do you have any concussion clinics?

Many patients want to tell the doctor too much information with too much anxiety. This tends to cause doctors to back away. Plus, there is not much a neuro can do for a concussion.

Starting a good vitamin regimen seven months or more after the initial injury is too late, or can it be still beneficial?

As far as I know there arent' any

Any time you start a brain focused Vitamin regimen is good. You would be wise to get started and stay with it for life because your brain has been compromised. It will never heal completely so taking good care of your brain will improve your long term experience.

Have you seriously looked for concussion programs? I can't search foreign language services but most areas that have soccer/futbol, boxing/MMA, rugby and such have athlete based programs. Auto accidents cause enough concussion that neuro rehab hospitals usually have some experience.

-How can you be sure that it will never heal completely?
Aren't there many cases of people who fully recovered from similar problems ?

-Yeah, unfortunately I can assure that in the area in which I live there are not any.

Studies have shown that even though day to day symptoms may resolve completely, when the brain is put under stress, symptoms will manifest. The reason to maintain a brain health nutrition regimen is to increase the brain's tolerance for such stress.

One expert has even gone so far as to recommend that the medical record reflect any head trauma regardless of symptoms so that if symptoms manifest at a later date, doctors can have an understanding as to a likely cause.

According to those studies, how likely is for symptoms caused by a stress induced relapse to resolve once again?

Once the stressor is gone, the stress caused symptoms will resolve. For some, it make take a day or two.

This is one of the more common problems with PCS. The person feels like they have recovered fully then they go to a concert or other event with high levels of stimulation and need a day or two to recover. We just plan on needing time after to get back to normal.

It's been more than a week since I have stressed myself, and my relapse symptoms not only aren't over yet, but they are progressively getting worse each day.
It's that common? How likely I'm to recover?

You are still in recovery from your original injury. Your self-induced stress of nit picking every detail means you do not yet know what your long term recovery level is. You need to find a way to let go of your need to define every little thing. This obsession with every detail is very stressful and indicates you have more recovery to achieve.

As I have said before, Many do not see a good recovery until they either learn to let go of their obsessions with every detail or maybe get professional help and maybe medication to lower their anxiety and obsession levels.

You sound very driven. Your combative hobby also suggests a self-medicating to give you release from your intense look at life. Competitive people tend to struggle to let go of the details.

If you tore up your knee in combat, would you expect to be able to return to combat sports without a need to moderate your level of intensity?

Knees and shoulders rarely recover fully so athletes know to protect them. The brain is less able to heal so you need to protect it.

The studies show that those who learn to accept their brain as injured and work within its limits will do much better. Those who constantly fight every little setback will live a life of misery.

But the fact that my brain was cognitive symptoms free and worked at 100% efficiency for almost 3 months should not mean that it recovered fully from the first injury (despite still being prone to relapses)?

Sorry, but due to my cognitive problems and my poor english knowledge I have not understand what do you mean, could you try to explain it please?

But I did moderate my level of intensity a lot, during this three months I have almost never left my home and I avoided watching tv and videos on the computer and any enovirment with a lot of noises out of fear of overloading my brain and having setback.

Were those 3 months of being cognitive symptom free during summer break and now you have returned to school and an intense study load?

If I remember, you said something about studying to class.

If you were doing nothing to trigger any symptoms and not taking on cognitively intense activities, it would make sense that you did not notice any cognitive struggles. That does not mean you were recovered. It sounds like you were 100% cognitively functioning doing almost nothing.

The recommended recovery protocol is to stay mentally active but in low intensity activities. Avoiding all stimulation tends to prolong recovery.

By self-medicating, I mean some people who have high stress levels and live intense lives use intense sports and activities to trigger adrenaline and other chemistries that result in a release of tension after the activity. Runners call it a runner's high.

No, I have dropped studies altogether after the initial symptoms in May.
I also have basically stopped doing anything else (including going out at night, playing sports, watching televions or computer videos etc...) after the recover in August out of fear of compromising the recovery/having a steback.
After the recover I did a lot of low-level cognitive tasks every day despite staying at home and not studiyng in order to monitor my cognitive level, I mean things such as posting on forum of various subject that I'm interested in, accurately describing in my mind simple concepts related to what I was doing,, tryng to find sinynounimos about certain words, making review and analisis about some books that I liked in my mind etc...they are all very simple and spontaneous, not stress-inducing, things that I was not able to do during the original symptomatic phase and that I'm not able to once again now.

There haven't been any difference whatsoever in my everyday level of both physical and cognitive activities and stress between the almost three months in which I have been fine and the current relapse, the only thing that I can think of is the fit of rage that I had on 1st november after which the symptoms slowly started to come back (I had a lot of similar fit of rages during the previous two months and they did not trigger any sympotms, but that was the only time in which I squeezed and lauched objects which I suppose may have strained my neck maybe?)

I have avoided any kind of adrenalinc or physical demanding activities in the last three months out of fear of having a setback.

By self-medication, I meant your previous activities of combat sports and such are often an indicator of an intense personality. I was not saying you have done them since.

The fits of rage suggests you had built up tension from not having your release activities or other accomplishments. The frustration of doing nothing when one is used to being productive is very stressful. It can cause depression that can cause cognitive struggles.

Your need to do even low level cognitive tasks to continually measure your function during your recovery supports my observation. It appears you demand and expect a lot of yourself. That personality style tends to make recovery difficult.

I've seen this many times. The more somebody demands of themselves and the more they try to define what has happened and is happening, the more and longer they struggle with PCS and the rougher the roller coaster ride.

When they finally give in to the need to let go of a need to understand everything and just go with the flow, they slowly start to see improvements.

As I said, some need medication to help them let go. The vitamin supplement regimen is a good start until you can find a doctor who understands these issues.

Yes, you are right.
My intellectual abilities are an huge part of my life and of my enjoyment for a multitude of reasons, and having them neglected is a huge toll for me that makes me very frustrated.

Actually I was not depressed, despite some acute fit of rage for some family issues I was extremely happy because I was symptoms free and I was dreaming and planning of living a normal life once again.
I was depressed both before the recover and currently, as a consequence of the cognitive symtpoms.

Do you mean that their symptoms actually improve, or that they learn to not being too bothered by their presence?

I have tried to read the vitamin thread, but it's too thick of information for my injured brain to process ad understand right now, it's pretty confusing and overwhelming.
Could you please tell me in this thread exactly what kind of doses of which vitamines and ingredients should I take?

Also, should I avoid to come back to watching tv or tv series on the computer according to you? Could it compromise my chance of recovery?

You don't need to read the whole vitamin thread. The first post has a link to post #101 with the updated information. NeuroTalk Support Groups - View Single Post - Vitamin and Supplements Regimen
Ignore the rest of the posts.

Here are the basics:

• B-12 (500 to 1000 mcgs daily or more) Methylcobalamin, taken on an empty stomach or sublingually (let it dissolve under your tongue).
• a B-50 complex, for all the other B's so you get a good balance of B's
• a high potency multi-vitamin for all of the trace amounts. If it has good B's, you can leave the B-50 Complex out.
• Niacin, 200 to 500 mgs
• Some extra anti-oxidants, Vit C (500 to 1000 mgs) and Vit E 400 IU's
• D3, plenty of this, 1000 to 5000 IU's
• Omega 3 fish oil, with a proper balance of DHA and EPA
• Calcium with magnesium, 500 mgs per day Magnesium needs to not be mag oxide. mag citrate is easy to find.
• Curcumin, concentrated curcumin with pepper extract.

There is depression that does not manifest as sadness. It just impacts cognitive function. It may manifest as frustration or apathy. It may also manifest as anxiety where one gets caught thinking about the same issues over and over. Think of it as like a car that is spinning its wheels. It is not going anywhere but it is putting wear and tear on the tires and drive train without the forward movement that normally helps air move into the fan to cool the engine.

You are used to achievement and productivity but are currently stuck in slow motion. It is frustrating and that frustration can build so a simple external stimuli (family issue or such) can cause an outburst.

[The studies show that those who learn to accept their brain as injured and work within its limits will do much better. Those who constantly fight every little setback will live a life of misery.]
[Do you mean that their symptoms actually improve, or that they learn to not being too bothered by their presence?]

They learn to or choose to not be bothered by their symptoms. They usually reinvent themselves, at least for the present time, so they can move ahead with their life. They let go of struggling parts of their lives and replace them with activities that are not a struggle.

Sometimes, one can just change how they perform a specific activity/task. Using pencil and paper to process ideas that previously were done in thought only.

The NO SCREENS is not as big of an issue for most people except for video games. If you can tolerate watching a TV show without becoming agitated or fatigued, it is OK. For me, I needed head phones to listen to the voices so they were not lost in the ambient sounds of the room.

I had to limit the types of reading I did. Fiction was too much struggle to keep track of the abstract details. Some writing styles were just too much work.

Are there any manual activities that you can spend time doing? Drawing, sketching, model building, playing a musical instrument, etc. can be activities that keep the mind and hands engaged without too much cognitive load.

First of all, I want to thank you a lot for your help and patience, it means truly a lot for me.

Thanks a lot, I will try to follow it as soon as possible.
Only thing, it's possible to have side effect from these supplements that will actually worsen my condition or compromise my chance of recovering?
Also, the fact that I'm pretty small (around 5'6 and 120 lbs) is going to affect the amount of dosage that is raccomended for me?

In the first phase of my recover (around mid August), when I was symptoms free, I played videogames for a week and it did not have any negative effect on my condition.
What do you think about that?

Also, now that I'm thinking about it, during the fit of rage after which I had the relapse, I also rubbed a small cutlery knife against the edge of a wooden chair cutting it slightly, and the sound of that made me quite unconfortable on the moment.
It's possible that this noise is the reason of my relapse? Event tough during this three months I have endured a lot of types of high-pitched sounds without problems?

Unfortunately there are no manual activities in which I'm halfway decent at, nor that I like/in which I am interested.
I have alredy tried to do them to spend time but it was nothing but frustrating.

Your light weight should not make a difference. They are not like drugs. They are all things you body already knows how to use.

Other than the fish oil and curcumin, the rest were all prescribed by a doctor many years ago. Fish oil and curcumin have been extensively studied.

I don't think the knife noise had anything negative. It was your outburst that demonstrated that your stress levels were high. That rage did not resolve your stress load. In fact, they usually add to the stress load.

It does not sound like the video games were an issue but you should limit them, especially when you are on edge.

You would be wise to find some manual activities that can take your mind of stressful thoughts. This is a lifelong need you will benefit from.

I do jig saw puzzles, both on my laptop and on a table with cardboard puzzles. There are thousands available online. I also so solitaire games on the computer. Mindsweeper, Freecell, Spider Solitaire, and others were I am just competing with the clock or other simple scoring systems. AOL Just Words is a Scrabble game. I don;t do any that have moving graphics. MSN Games. They can be taxing.

When you realize that having activities to past the time without your mind going wild, these 'boring' activities have a new value.

It's possible for those supplements to have side effects that will end up worsening my condition? Do you know any case of that happening by chance?

The return of sympomts caused by this stress load are likely to be permanent?
According to you, how likely I'm to come back to an asymptomatic phase, even if temporary?

The jigsaw puzzle sounds like a good idea by the way, I am.going to surely give it a try

No, the supplements will not risk making your condition worse. You are already consuming all of them except maybe the curcumin, just in less than optimum amounts.

As I said before, Symptoms caused by stress will go way once the stress is reduced. It may take a day or two. For some, it may take a week or two if the stress was intense.

You have more than simple stress to resolve. Your obsessive thinking needs to be managed.