Persistent Symptoms After Concussion: Seeking Answers for Ongoing Brain Disturbances

Symptoms such as brain movement and discomfort after a concussion lasting more than two months?

Dear Dr.
Jiang,
In June, I was rear-ended by a large truck while driving, and I hit the back of my head inside the car.
I did not lose consciousness or experience any bleeding at the time, but I had symptoms of dizziness, headache, and nausea.
The emergency diagnosis was a contusion to the occipital region along with a concussion.
Since then, I have been experiencing persistent and intense abnormal sensations in my brain, with a rapid shaking feeling that makes me feel very dizzy.
The frequency and duration of these symptoms have been variable; they decreased last week but have worsened again this week, even more so than after the initial accident.
Both the CT scan on the day of the accident and the MRI in August (without contrast) showed normal results.
I feel a pressure sensation in my eardrum and brain when I hear slightly louder sounds, which exacerbates the discomfort from the shaking.
I am easily startled and have ongoing nightmares, and I struggle with distance perception while driving.

This week, as my symptoms worsened, I felt a pressure in my brain, and the symptoms became more pronounced while walking, leading to nausea and difficulty maintaining balance, along with increased sensitivity to sound.
I have consulted with both ENT and neurology specialists, but the cause remains unidentified.
A neck ultrasound showed normal results; the ENT specialist noted a slight imbalance, but nothing severe.
In July, I experienced difficulties concentrating, slowed reactions, and trouble thinking, although there has been slight improvement since then.
What further tests could be done to potentially identify the cause? I am willing to pay out of pocket for tests, as I have had several unsatisfactory experiences with previous consultations.
Some doctors have dismissed further testing after reviewing the MRI, stating that dizziness is a subjective feeling and that it is normal not to find a cause.
However, the ongoing symptoms of brain shaking and imbalance continue to severely impact my work and daily life.
I would appreciate your recommendations for additional tests or treatment directions to help identify the issue as soon as possible.

Thank you.

Jiajia, 30~39 year old female. Ask Date: 2021/09/03

Dr. Jiang Junyi reply Neurology

Dear Miss Jia-Jia,
Your symptoms are likely indicative of post-concussion syndrome.
The symptoms following a concussion can be categorized into three main types:
1.
Physical symptoms: headache, fatigue, photophobia, neck pain, nausea, decreased balance, dizziness, etc.
2.
Emotional symptoms: anxiety, irritability, depression, personality changes, insomnia, etc.
3.
Cognitive symptoms: difficulty concentrating, memory decline, confusion, etc.
Among these, the symptoms that are often the most difficult to recover from or last the longest are headaches, difficulty concentrating, and fatigue.
If you recently underwent an MRI, it is likely that any significant structural abnormalities and bleeding have been ruled out.
I trust that you are ensuring adequate sleep, reducing central nervous system stimulants (excessive tea and coffee), minimizing tobacco and alcohol use, and taking vitamin B complex during the day.
If you are still experiencing considerable distress, you might consider self-paying for hyperbaric oxygen therapy.
There is a limited amount of literature suggesting it may assist in recovery from head injuries, and some patients have reported symptom improvement in clinical settings.
Relevant research can be found here: http://libir.tmu.edu.tw/bitstream/987654321/4400/3/tmu-96-M513094002-1.pdf
Thank you for your inquiry, and feel free to discuss any related questions further!
Wishing you good health, peace, and joy.
Dr.
Jiang Jun-Yi, Taoyuan Hospital

Reply Date: 2021/09/03

More Info

After experiencing a concussion, it is not uncommon for individuals to face persistent symptoms that can significantly impact their daily lives. Your situation, characterized by ongoing dizziness, a sensation of rapid movement in the brain, sensitivity to sound, and balance issues, is indicative of post-concussion syndrome (PCS). This condition can arise after a mild traumatic brain injury (TBI) and may manifest with a variety of symptoms, including cognitive difficulties, emotional disturbances, and physical complaints.

Given that your CT and MRI results have returned normal, it is essential to understand that imaging studies do not always capture the functional changes that may occur in the brain following a concussion. The symptoms you describe, such as the feeling of pressure in the brain, sensitivity to sound, and balance issues, can be attributed to several factors, including vestibular dysfunction, which affects balance and spatial orientation, and post-traumatic migraine, which can cause dizziness and sensitivity to stimuli.

Here are some recommendations for further evaluation and management:
1. Vestibular Rehabilitation Therapy (VRT): Since you are experiencing balance issues and dizziness, a referral to a physical therapist specializing in vestibular rehabilitation may be beneficial. VRT can help improve balance and reduce dizziness through targeted exercises.

2. Neuropsychological Evaluation: A comprehensive assessment by a neuropsychologist can help evaluate cognitive functions such as attention, memory, and processing speed. This evaluation can provide insights into any cognitive deficits that may be contributing to your symptoms.

3. Electrophysiological Studies: In some cases, tests like an electroencephalogram (EEG) may be warranted to assess brain activity, especially if there are concerns about seizures or abnormal brain electrical activity.

4. Further Imaging: While your initial MRI was normal, if symptoms persist or worsen, discussing the possibility of advanced imaging techniques, such as functional MRI (fMRI) or diffusion tensor imaging (DTI), with your neurologist may be worthwhile. These tests can sometimes reveal subtle changes in brain function or connectivity that standard imaging may miss.

5. Medication Management: If you are experiencing significant headaches or migraines, discussing medication options with your healthcare provider may help alleviate some of your symptoms. Medications such as beta-blockers, anticonvulsants, or tricyclic antidepressants can be effective for managing post-traumatic headaches.

6. Cognitive Behavioral Therapy (CBT): If you are experiencing anxiety, nightmares, or emotional disturbances related to your concussion, CBT can be an effective therapeutic approach to help manage these symptoms.

7. Lifestyle Modifications: Engaging in regular physical activity, maintaining a healthy diet, and ensuring adequate sleep can support overall brain health and recovery. Additionally, avoiding triggers such as bright lights and loud noises may help reduce symptom exacerbation.

8. Follow-Up Care: Regular follow-ups with your healthcare providers are crucial to monitor your symptoms and adjust your treatment plan as necessary. Keeping a symptom diary can also help track patterns and triggers, providing valuable information for your healthcare team.

In conclusion, while the path to recovery from a concussion can be challenging, a multidisciplinary approach involving physical therapy, neuropsychological support, and appropriate medical management can significantly improve your quality of life. It is essential to advocate for yourself and continue seeking answers until you find a treatment plan that works for you. Remember, recovery from a concussion can take time, and patience is key.

Similar Q&A

Post-Concussion Syndrome: Managing Persistent Dizziness and Headaches

Hello Doctor: Last year, I had a motorcycle accident that resulted in a head injury, during which I experienced about an hour of unconsciousness and cannot recall. I was taken to the emergency room where a CT scan showed no abnormalities. I subsequently received follow-up treatme...

Dr. Gao Chunde reply Neurology
Patients who experience a head injury but have normal imaging results are classified as having post-concussion syndrome. Symptoms may include dizziness, headaches, difficulty concentrating, decreased attention or cognitive function, and sleep disturbances. Literature indicates th...

Understanding Concussions: Symptoms, Treatment, and Long-Term Effects

Hello Doctor: On May 22, I was hit in the head by a basketball. At the moment of impact, I felt very dizzy and in pain. I immediately applied ice, and there was no visible swelling. However, an hour after the incident, I continued to experience dizziness and headaches. Initially,...

Dr. Ye Boshou reply Neurology
In the acute phase of head trauma, which typically occurs within the first 72 hours after the injury, if symptoms such as severe headache, persistent vomiting, limb weakness, unilateral paralysis, or slurred speech occur, medical attention should be sought immediately. If symptom...

Persistent Headaches After Concussion: Understanding Long-Term Effects

Dear Dr. Gao, The patient is my father. He fell from a height and hit the back of his head around November last year. He couldn't remember the events that occurred at that time. He was immediately taken to the hospital, where he was diagnosed with a concussion. After seeing...

Dr. Gao Chunde reply Neurology
If the neurology department of the medical center has assessed and found no issues, then this type of headache is classified as post-traumatic headache, which is a sequela. Some individuals may experience gradual resolution over time, while others may require long-term medication...

Understanding Concussions: Symptoms, Recovery, and Academic Challenges

I experienced a depressive episode and intentionally hit my head against the car door. After nearly an hour, I lost consciousness for a few minutes. The next day, I woke up with symptoms including headache, dizziness, nausea, and occasional difficulty focusing my vision. I went t...

Dr. Gao Chunde reply Neurology
Recovery from a concussion requires some time, and it is advisable to rest during this period, avoiding stress and excessive mental exertion. Attention issues and dizziness while walking should improve gradually as the nervous system heals itself.