Unexplained Falls and Head Injuries: Neurological Concerns

Unexplained fall resulting in impact to the back of the head?

Hello Doctor: On the 25th of this month, after taking a break and using the restroom (urinating), I fell and hit the back of my head.
I have no memory of the fall or how I returned to the office.
The surveillance footage shows no abnormalities when I entered the restroom, but I appeared unsteady and was touching the back of my head when I came out.
After lying down for a moment in the office, I started to vomit.
A colleague took me to the emergency room, and they mentioned that I was shaking and short of breath in the car, while I only felt numbness in my limbs.
During transport, I vomited once or twice more.
The emergency physician noted swelling in my head, and a CT scan showed no bleeding.
Blood tests indicated no anemia, blood pressure was 134/87, and the ECG was normal.
I was semi-conscious for about two hours in the hospital, and upon waking, I experienced stiffness and soreness in my neck.
Additionally, I had a similar experience about a year ago (October 2015) after attending a gathering where I consumed alcohol; I fainted after using the restroom and hit the back of my head, but I did not lose consciousness.
Doctor, could you please advise if there is an issue I should be concerned about? Which specialty should I consult? Lastly, I wish you all the best!

Xiao Li, 30~39 year old female. Ask Date: 2016/11/26

Dr. Jiang Junyi reply Neurology

Based on your description, the symptoms you mentioned are more likely caused by syncope, which is typically due to a rapid drop in blood pressure or vasoconstriction leading to decreased cerebral blood flow, resulting in cerebral hypoxia.
Syncope is more likely to occur when a person is standing, as cerebral blood flow is at its lowest in this position.
When there is a decrease in cerebral blood flow, if the body cannot respond quickly enough, it can lead to fainting.
The likelihood of this occurring while sitting is lower, and it is almost nonexistent while lying down.
Prior to losing consciousness, symptoms such as nausea, yawning, dizziness, and a feeling of warmth may occur.
After fainting, the person may appear pale, have cold skin, relaxed muscles, and a weak pulse.
If you frequently experience these symptoms, do not force yourself to stand; it is advisable to sit down or squat quickly to avoid head injuries from falling.
I recommend discussing your condition with a neurologist or cardiologist for further evaluation and treatment.
Wishing you good health and peace.

Reply Date: 2016/11/26

More Info

It sounds like you are experiencing a very concerning situation with your health, particularly regarding your recent falls and head injuries. Based on your description, it is crucial to understand the potential neurological implications of your symptoms and the history of your falls.

First and foremost, the fact that you experienced a loss of memory during your fall is significant. This could indicate a concussion or other forms of traumatic brain injury (TBI). Even if your CT scan did not show any bleeding, the symptoms you described—such as confusion, vomiting, and neck stiffness—are concerning and warrant further investigation.
The neurological system is complex, and symptoms like dizziness, confusion, and memory loss can arise from various underlying issues. Given your history of similar incidents, it is essential to consider whether there might be a pattern or underlying condition contributing to these falls. Some potential causes could include:
1. Vestibular Disorders: These affect balance and spatial orientation, which could lead to falls. Conditions like benign paroxysmal positional vertigo (BPPV) or vestibular neuritis could be at play.

2. Neurological Conditions: Conditions such as epilepsy or other seizure disorders could cause sudden falls and loss of consciousness. It would be prudent to discuss this possibility with a neurologist.

3. Cardiovascular Issues: Situations like orthostatic hypotension (a drop in blood pressure when standing up) or arrhythmias can lead to fainting or dizziness, resulting in falls.

4. Medication Side Effects: If you are on any medications, it is essential to review them with your healthcare provider, as some can cause dizziness or affect balance.

5. Alcohol Consumption: Your previous incident involved alcohol, which can impair judgment and coordination, increasing the risk of falls. It’s important to consider how alcohol may play a role in your overall health and safety.

Given your symptoms and history, I recommend that you see a neurologist for a comprehensive evaluation. They may suggest further testing, such as an MRI, EEG, or balance assessments, to rule out any serious underlying conditions. Additionally, a thorough review of your medical history, including any medications and lifestyle factors, will be essential in determining the cause of your falls.

In the meantime, it is crucial to take precautions to prevent further injuries. This includes ensuring your living environment is safe, avoiding situations where you might fall, and possibly using assistive devices if necessary.
Lastly, if you experience any new symptoms, such as severe headaches, changes in vision, or increased confusion, seek medical attention immediately. Your health and safety are paramount, and addressing these issues early can help prevent more severe complications in the future.
Please take care of yourself, and I hope you find the answers and support you need to manage your health effectively.

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