Hello everyone,

I have been lurking here for the past few weeks, reading old posts. They've been very helpful, but I wanted to post a thread to broach some of the issues that I'm personally dealing with.

I sustained a concussion in late March as the result of an assault. I was punched twice in the mouth and chopped twice in the jaw before falling over sideways (rightward). Initially, I didn't think that I lost consciousness. I was expecting to fall over the way I was being hit. I ‘opened’ my eyes after the fall, put on my glasses and leapt to my feet. I didn't feel dizzy, nauseous, or unstead on my feet. I did, however, have difficulty remembering my phone number when asked for it during the police report. I had to unlock my phone, look up my contact card, and read off my digits to the officer. After the report, I declined an ambulance, caught a city bus home and called my PCP, who told me to go to the ER. There I was diagnosed with a "jaw contusion," because the maxillofacial CT scan indicated no broken bones. My lip was swollen, but there wasn't even any bruising. The doctors didn't ask any questions that would enable to them to diagnose a concussion.

Following the assault, I experienced terrible insomnia and anxiety. The first few nights I couldn't sleep more than a few hours. Over time, I was able to get more and more sleep (~8h), but it continues to be fragmented. The anxiety first manifested itself through a fear of home invasion, which caused me to barricade my doors for the first few weeks. It then shifted to a fear of death-by-cancer and death-by-nuclear-annihilation. The doctors diagnosed me with acute stress disorder (ASD) when I went back to the ER. Now, three months out, my anxiety is much reduced. I continue to be wary of the strangers that I meet on the street but don't consider myself all that anxious otherwise.

Still, I spend a fair amount of time regretting the past (shoulda, woulda, coulda's) and worrying about the effects that the concussion has had and will have on my brain. I worry about how this injury will affect my intelligence since I am an academic. I worry about the accelerated brain aging that accompanies concussions (reduction in white matter). I worry about the possibility of dementia down the road. The worry of dementia is compounded by the fact that I have a close relative who suffered several brain injuries, including one severe brain injury in early adulthood (coma for 2 months) and another in middle age. This relative now has non-Alzheimer's dementia. The worry is further compounded by the fact that I have been struggling to get the necessary medical referrals.

At present, I "feel" normal for the most part. The headaches were never that bad and disappeared after the first week. The memory issues (retrieval) lasted maybe 2.5 months, but are mostly gone now. I never had nausea, double vision, or photophobia. My sleep continues to be fragmented with early morning wakings. But I go to bed when it gets dark and so, I don't really feel fatigued during the day. I guess the problem, though, is that I am not much comforted by being (mostly) asymptomatic. Whether I have symptoms or not, I know that I have sustained a life-changing brain injury. And it's hard to go forward...

Hey JumpingJehosephat,

Welcome to Neurotalk. Thanks for sharing your story. You write so well. It sounds truly awful. However you offer no evidence of a "life changing brain injury" merely the fear of having experienced one. They are separate entities. Stress and anxiety are natural after an assault. It may be helpful to discuss your concerns with a psychologist or psychiatrist who has experience in working with people who have experienced assault and ASD.

Best wishes,

Atty

JJ,

Welcome to Neurotalk.

My observation and opinion is you are suffering serious trauma related anxiety with minimal concussion related symptoms. Not remembering your phone number but being able to access and operate your phone suggests the phone number memory issue is not a big concern. Your ability to remember so many details prior to the 'opened my eyes' and after suggests you did not suffer pre or post traumatic amnesia. The emotional trauma and pain could easily make recalling your phone number difficult. [I didn't feel dizzy, nauseous, or unsteady on my feet.] are good signs of the lack of severity of the impacts.

Anxiety can mimic almost every symptom of a concussion.

Your sleep issues are more likely emotional trauma.

You list so many things that you think you should be worried about. You have no justification to worry after just one trauma. Your anxiety is already changing your life far more than any usual concussion does.

Nobody can say if you suffered a concussion at this point. But, your lack of concussion symptoms, both immediately and later on, suggests any concussion was minor.

You should focus your efforts on your anxiety issues and your worries about the long term effects of severe concussions.

You say: [but don't consider myself all that anxious otherwise.]

Then you state how anxious you are by saying:

[Still, I spend a fair amount of time regretting the past (shoulda, woulda, coulda's) and worrying about the effects that the concussion has had and will have on my brain. I worry about how this injury will affect my intelligence since I am an academic. I worry about the accelerated brain aging that accompanies concussions (reduction in white matter). I worry about the possibility of dementia down the road. The worry of dementia is compounded by the fact that I have a close relative who suffered several brain injuries, including one severe brain injury in early adulthood (coma for 2 months) and another in middle age. This relative now has non-Alzheimer's dementia. The worry is further compounded by the fact that I have been struggling to get the necessary medical referrals.]

The increased risks you face, if you face any increased risks, are 30 to 50 years down the road.

What medical referrals are you expecting or hoping to get?
There is nothing you need medically unless you have ongoing concussion symptoms like dizziness, vision disturbances, mental confusion, etc.

There is nothing to treat but your anxiety. You also need help with your irrational fears of your future.

The research suggests that you already were a bit either anxious or perfectionist or detail oriented prior to your assault. Your response fits with those studied who had a prior minor to major struggle with anxiety and details. That group's biggest struggle is with those traits being greatly magnified by the event. In essence, very minor anxiety issues become life controlling anxiety issues that delay the person from moving on with their life. They see every sensation and experience as a symptom of the trauma.

With enough complaints to doctors, they end up getting treated with anxiolytics and anti-depressant drugs like SSRIs and SNRIs. For some, a short term medication treatment helps them get free of the "I'm brain damaged and my life is ruined" repetitive thinking. I consider meds a last resort. Read the vitamins sticky at the top. Getting proper brain nutrition can help your brain endure the stresses.

You have a lot to contribute to how you move forward. As an academic, the data says you do not have a lot to worry about after just one minor trauma. If you can accept that and move forward, you will improve. If you can't, you will need help.

btw, There is no such thing as treating a concussion. You can only treat the individual symptoms. The idea that without 'concussion' treatment, the long term outcome is worse is totally false.

My best to you.

Welcome JumpingJehosephat.

Thanks for reading my thread and offering such a thoughtful reply, Mark! You're correct in observing that I continue to have anxiety issues. What I meant when I said that I didn't consider myself “all that anxious” was simply that my anxiety has returned to something approaching “normal levels.” Or at least normal for me.

I read through the vitamin thread and found it very instructive. I am taking a multivitamin (Men's One-A-Day), a B-12 supplement (1000 mcg), DHA + EPA (~4g), L-Acetyl-Carnitine (1g), CBD (25mg), and melatonin at night (~15mg). I'm also taking a powder supplement called Neuroshroom with Lion's Mane in it. I am thinking of adding a B-Complex as you recommend in the vitamin thread.

I don't know what sort of medical treatment I hope to get, since doctors can't really do anything for concussions (“There is no such thing as treatment for concussions. You can only treat individual symptoms.”) I think I would like help with my sleep as it is frustrating to not be able to sleep through the night. Apart from that, I would just like for a doctor with expertise in concussions / mTBI to listen to me, offer a diagnosis / prognosis, and maybe do some imaging. It just seems wrong that people sustain concussions and the doctors just send them on their way without any information or follow-up care. Concussions are a life-long injury after all.

Imaging would waste money, time, and radiation (CT Scan) and just feed your anxiety.

As I said, treat your anxiety. It has far more impact on your sleep.

Try taking magnesium citrate a couple hours before bed. Melatonin is known for not helping with sustained sleep.

Consider adding 200 mgs of L-Theanine and 200 mgs of 5-HTP daily. They can help with anxiety.

The CBD is likely only 5-10% CBD. The rest is hemp oil or something else.

I don't think a concussion expert doctor would have anything to offer, considering your complaints.

You sound like you want a sort of 'hand holding' relationship. "Yes, you suffered a concussion. I'm sorry you have experienced that."

Instead, you need somebody to help you get past the emotional assault trauma.

As one who lives with PTSD, I know the struggles such trauma can cause.