Case of persistent symptoms of post-concussive syndrome
Persistent post-concussive symptoms are collectively referred to as post-concussion syndrome. The symptoms are secondary to concussion symptoms lasting beyond the expected period of recovery after initial injury. The usual time it takes to recover can be from weeks to months, with symptoms including, headaches, problems with memory, concentration and dizziness. This article describes the case of a 19-year-old with a constellation of symptoms assumed to be triggered by post-concussion syndrome.
3 years ago James was accidentally hit by a soccer ball at the back of his head. Although his vision went black, he did not lose consciousness. Then his “bell was rung” and returned to playing after a few minutes. After a few days he began to feel foggy and some abnormal impulse sensations in the head. He habituated to the symptoms till he was accepted to Yale. In the last few months he developed neck and shoulder pain. He also experienced sensitivity to jumping up and down. Other symptoms included occipital headaches, causing him fogginess and loss of appetite with photophobia.
James had now become strangely sensitive to movement
Anytime he did something jostling in any way, he felt as though his brain was sloshing around. He would also feel fog roll into his brain, which lasted for hours and only went away with sleeping. He mentioned the incident to his mom and asked whether getting hit by a ball could have done this. She took him to his paediatrician, who examined him and found nothing wrong. The paediatrician further advised a CT scan. The findings of the CT scan were also normal, therefore, the paediatrician advised the mother and son to not worry.
Then James also started experiencing trouble sleeping. While he had no trouble going to sleep, there were nights where he felt short of breath. After searching his symptoms over the internet, he thought that he may have sleep apnoea. He went to a paediatrician who was uncertain and ordered a sleep study which came back normal.
He never felt the same after getting struck by a ball a year ago
His paediatrician referred him to a neurologist who advised an MRI of the head and neck. The test results came back normal, assuring that nothing was wrong with James. The doctor recommended for him to get more sleep. He later saw a second neurologist who ordered more testing, including an EEG and a second MRI. The doctor came to the same conclusion that his symptoms were consistent with post-concussive syndrome. And that he needed to rest more and avoid activities that worsened his symptoms.
However, as graduation approached, his symptoms worsened. However, yet again, all his test results came back normal. Concussion is a mild traumatic brain injury that can occur with violent shaking and movement of the head and body. In most people post-concussive syndrome is not associated with severity of the initial injury. In most people the symptoms occur within the first 10 days and go away after three months. But, they can persist for a year or more, as in James’ case.
The goal of treatment is to effectively manage the symptoms.
Do you recognise James’s symptoms? Offer your thoughts in the comments below!
Source: The New York Times Magazine