[t97tab]

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!

[Jomar]

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

[nancys]

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.

[Mark in Idaho]

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.

[t97tab]

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!

[Jomar]

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

[melek]

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

[nancys]

Originally Posted by t97tab

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.

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.

Originally Posted by t97tab

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?

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.

Originally Posted by t97tab

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!

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!

[PCSLearner]

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.

[Mark in Idaho]

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.