Post-Injury Complications: Chest Trauma and Neurological Issues

Q: Post-Injury Complications: Chest Trauma and Neurological Issues

Hello： 1. <br>Your symptoms and condition sound quite complex, with many important internal organs affected! It is recommended that you have an in-person consultation and undergo physical and neurological examinations to determine the cause and provide targeted treatment. <br>2.

Post-injury complications of chest trauma..?

Dear Director Jiang,
I have experienced compression in my left chest and upper back due to gravitational force.
My chest was impacted by a mechanical device, specifically a screw with a diameter of 1.8 cm and a length of approximately 6 to 8 cm, which is pressing against my left chest (the center of the screw is located at a point 5 cm horizontally from the left nipple and 4.3 cm vertically upwards, possibly near the heart).
Additionally, my upper back was compressed by a horizontal beam from a fixed crane while in motion.
I am unsure of the depth of the compression, but I heard a cracking sound from my bones.
Currently, there is a slight indentation in my left anterior lower chest wall, and I have left costochondritis.
The circular scar from the screw is still present, and the rib above the scar appears slightly sunken.
When my body leans forward, the tissue above the scar protrudes about 2 cm, and there is a mass approximately 3 to 4 cm in size.
This mass only protrudes about 1 cm when I cough, with an underlying air pocket of about 5 cm.
Initially, I experienced significant pain.
After the injury, I developed rhabdomyolysis leading to acute renal failure and pulmonary edema (approximately 500 cc of fluid was drained).
I also had hypertension (with systolic blood pressure reaching nearly 200).
After about 20 days, a cardiologist diagnosed me with mitral valve disease and other malignant secondary hypertension, as well as left ventricular hypertrophy.
A kidney biopsy later revealed tubular damage, and a few months later, I experienced cardiac arrhythmias.
My right kidney has also atrophied.
Currently, my urine still has bubbles that take a long time to dissipate, and the cause remains undetermined.
Additionally, I have a symptom where I frequently feel soreness, tightness, and an uncomfortable pulsing sensation starting from the left posterior neck (about 6 cm below the left ear), which then spreads throughout my head.
Sometimes, even turning my head is difficult, and pressing on that point behind my ear exacerbates the discomfort.
Is this symptom related to cardiovascular or neurological issues? Are there any connections among the various symptoms I have described? What is the causal relationship, and what are the underlying pathologies? How should I be treated? Furthermore, what is the cause of the other malignant secondary hypertension?
I have consulted with Dr.
He from your hospital online, and he provided the following response: "I do not believe that trauma would cause heart damage unless the heart was directly injured at the time.
However, your various complications can easily stimulate the heart, leading to autonomic nervous system dysregulation, resulting in high blood pressure and arrhythmias.
I believe the issue in your left posterior neck is neurological and related to the sequelae of your injury.
We should first stabilize the sequelae to reduce stimulation to the heart, which may improve your cardiac condition."
I have a few more questions for you, Director Jiang.
Previously, I could sleep soundly until morning regardless of the time I went to bed, but since my injury, I have been unable to do so.
I find myself waking up between 3 and 6 AM to use the restroom, and after waking, I struggle to fall back asleep.
My eyes also tire more easily, and my vision has worsened.
Are these conditions also related to what Dr.
He mentioned?
I kindly ask you to provide comprehensive guidance regarding the issues discussed above.
Thank you very much for your patience in reading this lengthy account, and I hope it helps you better understand my situation.
Please help me!
I was injured in March 2009.

LUO SI, 40~49 year old female. Ask Date: 2010/10/18

Dr. Jiang Hezhou reply Neurology

Hello: 1.
Your symptoms and condition sound quite complex, with many important internal organs affected! It is recommended that you have an in-person consultation and undergo physical and neurological examinations to determine the cause and provide targeted treatment.
2.
Regarding the symptoms in your left shoulder and neck, post-traumatic myofascitis should be considered initially.
However, an in-person consultation and examination are still necessary to rule out other conditions! 3.
It is advisable to visit a medical facility for evaluation and examination.

Reply Date: 2010/10/18

More Info

Dear Patient,
Thank you for providing such a detailed account of your condition following the traumatic injury you sustained. It’s clear that you have been through a significant ordeal, and I appreciate your patience in seeking clarity about your symptoms and their potential implications.

From your description, it appears that you have experienced multiple complications following your chest trauma, including musculoskeletal injuries, acute kidney failure due to rhabdomyolysis, pulmonary issues, and cardiovascular concerns. Each of these conditions can be interconnected, and understanding their relationships is crucial for your ongoing care.

Chest Trauma and Musculoskeletal Issues
The initial injury to your left chest and upper back, particularly the presence of a screw impacting your chest wall, could lead to soft tissue damage, rib fractures, or costochondritis (inflammation of the cartilage connecting the ribs to the sternum). The slight depression in your chest wall and the pain you experience when coughing suggest that there may be ongoing inflammation or irritation in the area.

Rhabdomyolysis and Kidney Function
Rhabdomyolysis, which you mentioned, occurs when muscle tissue breaks down and releases myoglobin into the bloodstream, potentially leading to acute kidney injury. This can happen due to severe muscle compression or trauma, as in your case. The fact that you experienced acute kidney failure indicates that your kidneys were significantly affected, likely due to the myoglobin overload. Monitoring kidney function is essential, and any signs of persistent proteinuria (bubbles in urine) should be evaluated further.

Cardiovascular Complications
Your cardiovascular symptoms, including high blood pressure and arrhythmias, may be a result of several factors. The stress of the injury, pain, and potential autonomic nervous system dysregulation can all contribute to elevated blood pressure and heart rhythm disturbances. The connection between your neck pain and cardiovascular issues could suggest a neurological component, possibly related to nerve compression or irritation in the cervical spine region, which can affect heart rate and blood pressure regulation.

Neurological Symptoms
The discomfort radiating from the left side of your neck to your head may indicate a cervical spine issue or nerve involvement. This could be due to muscle tension or injury to the nerves that supply the neck and head. It is important to assess whether there is any cervical spine injury or nerve impingement that could be contributing to your symptoms.

Sleep Disturbances and Fatigue
Your difficulty sleeping and increased fatigue may also be linked to the stress of your injuries, pain, and possibly the medications you are taking. Sleep disturbances are common after traumatic injuries, and they can exacerbate feelings of fatigue and cognitive difficulties. It may be beneficial to explore sleep hygiene practices and discuss with your healthcare provider whether any adjustments to your medication regimen could help improve your sleep quality.

Recommendations for Treatment
1. Comprehensive Evaluation: It is crucial to have a thorough evaluation by a multidisciplinary team, including orthopedic specialists, nephrologists, cardiologists, and neurologists, to address each of your concerns systematically.

2. Pain Management: Effective pain management strategies should be employed to help improve your quality of life and facilitate better sleep.

3. Physical Therapy: Engaging in physical therapy may help improve your musculoskeletal function and alleviate some of the discomfort in your neck and chest.

4. Cardiovascular Monitoring: Regular monitoring of your blood pressure and heart rhythm is essential, especially given your history of hypertension and arrhythmias.

5. Kidney Function Monitoring: Continued assessment of your kidney function is necessary, particularly in light of your previous acute kidney injury.

6. Neurological Assessment: A neurological evaluation may be warranted to assess the source of your neck pain and any potential nerve involvement.

In conclusion, the interplay between your various symptoms suggests a complex recovery process. It is vital to maintain open communication with your healthcare providers and ensure that all aspects of your health are being monitored and managed appropriately. Please do not hesitate to reach out for further clarification or assistance regarding your treatment plan.

Wishing you a smooth recovery.

Best regards,
Doctor Q&A Teams

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