Almost five months ago my 18 year old son was involved in a multiple rollover car accident. He suffered a serious concussion. CT showed no bleeds, swelling or skull fractures. He continues to struggle with cognitive functions, memory issues, brain fog, headaches. Requested an MRI that was done today and scan shows multiples areas with "old" blood. Up to this point we were lead to believe there had been no bleeding or "serious" brain damage. Neurologist last week stated that he felt the concussion was "all better" and that my son is now suffering from migraines. I am not opposed to the migraine idea, however felt strongly that we are far from over the concussion problems.
Not sure where to go from here with today's results . . . Old blood is seen on MRI after almost five months from accident, am I being a paranoid mother and needlessly worrying about this being a major concern? How long does blood remain visible on scan after there is no obvious signs of current bleeds? Is five months post accident considered a reasonable time frame for blood to still be detected? Does this increase the possibility that some of his current brain function deficits will always be present to some extent? I don't want him pushed in areas that will cause more damage, but I also do not want him to held back in areas that are safe. Is the old blood eventually absorbed and/or does the presence of it cause certain symptoms and/or increase his risk for further problems. I am feeling so helpless at this point. Any Neuro advice would be great!

MammaMia,

Welcome to NeuroTalk. I'm sorry to hear about your son.

The research I have read says that bleeds from the initial impact show up on CT Scans best at 72 hours post injury. This is enough time for a slow bleed to become large enough to be discernible and before it starts to be absorbed.

His neuro or a neuro-radiologist should be able to explain this for your son's situation.

Pushing him in rehab will not cause more damage. But, pushing too hard can be ineffective by causing stress that impedes progress. There is difference between rehabbing after a coma where brain functions become dormant and need effort to wake them up and the issues common to concussions. Coma based rehab is often considered successful when the patient reaches the level of function that concussion patients start at. From that point, further recovery will likely be much slower.

The migraines comment has been mentioned before. Some neuros do not believe concussions can have long term deficits and blame residual struggles on other causes.

So, how is your son doing ? What are his current struggles ? Has he had a Neuro Psychological Assessment done ?

Thanks Mark . . . I wish I had known about the CTScan being most beneficial when done a few days after the accident. His scan was done less than 2 hours after the accident. I am the one that requested the MRI last week and our Pediatrician agreed to order it. The neuron radiologist came out and explained the findings.

He actually called our neurologist to discuss what was found. Pretty sure the ego of our concussion specialist neuro was bruised a bit by the phone call. He did not know I had a MRI ordered. We have heard nothing from our neuro, guess he is fine to wait for our end of May appointment.
I have an appointmemt with my neurologist that follows me for MS. I will talk to them about my son's MRI. It makes me sick to read his report.

The foci "blood" found is within almost every area of the left side of his brain along with near the interpeduncular cistern of the midbrain in the midline, in the right thalamus and a whole lot more that I am still trying to understand. I do have him scheduled for two days this week being evaluated by our NeuroPsychologist. Hoping to have a better understanding and a plan put in place by the end of this week.

Also will be finding a new Neurologist for him. Just having a hard time understanding why his neuro never felt it necessary for further scans. My son continues to struggle cognitively and his memory recall is a mess. The kid with a 4.0+ with little effort is now doing everything he can to get B's for his final aymester of High School. We even put him on ADD meds in January to help him focus in class. It took him almost four hours to complete his college math placement test. We had to do it in small sections of time, with his sister who is currently in trig help him enough that his math knowledge was triggered due to his battle with memory recall. Hoping he can get a break soon . . . it has been a rough senior year.

The NeuroPsych Assessment will be very important toward understanding his capabilities. Personally, I disagree with pushing him just because he is about to graduate. I suggest he consider a reduced class load next year. He needs time to learn how to learn. He has never really had to work to learn. I understand that personally. I had the same experience. I had to relearn how to learn with my damaged brain. Learning to study when you never had to before is quite a challenge. I went from straight A's my freshman year to struggling for B's my sophomore year. I did much better my junior year but still struggled.

He may eventually recover his prior capabilities but until then, he needs to go slower and allow time for his brain to continue healing in a low stress environment. He should check out the disabilities office at his college and see what help they have for him.

As an inspiration, as a junior, I scored 650 on the math SAT. 6 months later, I took the SAT again and scored 700 on the math. I had not taken a math course since my sophomore year but improved 50 points. Back in 1972, there was no such thing as SAT prep courses. ( I was taking junior year honors Algebra II as a sophomore) At 43 years old, I almost aced the Math SAT (790). My son took it in a year where he received a copy of the test with the answer key with his score.

So, with time, he can improve but not necessarily at the speed expected by school and such.

I would not be concerned about the old blood. There is nothing that can be done now. I doubt there is any need to try to get it to absorb faster.

What were his symptoms in the first week or so after his injury ? Did he have bad head aches ?

I agree completely with the not pushing him, this has been my concern all along. Thankfully his school has been nothing but understanding and cooperative. Yes, he had bad headaches from the very beginning. He continues to have headaches as well as episodes if being in a fog. The neurologist he has been seeing is the most qualified in our direct area for concussion management, however his focus tends to be more for sports injury concussion and getting his patients back in to their game . . . we have been very clear with him that as much as my son wants to be on the ballfield this time of year, that is not our focus and truly is the least of our concerns. The Neuro Psychologist plans on contacting his college to make sure we are aware of all resources available for him.
Thank you for your suggestions and for sharing your experience with me. Hopefully we can get him on the right track and eventually more stable than he is at this point.