ABSTRACT: CASE REPORT OF MULTIPLE SYNCOPIC EVENTS WITH RESULTANT CONCUSSIONS, VERTIGO, DYSAUTONOMIA, MIGRAINES, APHASIA AND PARALYSIS IN A 28 YEAR-OLD FEMALE AFTER TRAUMATIC BRAIN INJURY.
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1
Delmarva Chiropractic PC, United States
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2
Carrick Institute, United States
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3
Holy Cross Hospital, Epilepsy Monitoring Unit and EEG Laboratory, United States
Background: A 28 year-old, healthy and active female who was gainfully employed and fully functional suffered a traumatic brain injury (TBI) secondary to a fall on the occipital aspect of her skull in 2013. The patient suffered with a host of symptoms—the most severe including migraines, photophobia, vertigo and dysautonomia. In addition, she was further afflicted with sporadic episodes of syncope which led to multiple further concussive events and a severe exacerbation of her symptoms. With her syncopic events she would experience, paralysis, aphasia and severe diplopia which would last for hours.
The patient demonstrated significant aberrations in basal ganglionic and mesencephalic function, with severe dysautonomia and resultant transient ischemia and hypoxia. In addition, findings included alterations in arm swing and circumduction with gait on posturographic analysis, slight facial paresis, and decreased sensory perception of the left lower extremity. Further to this was dysfunction in cerebellar aspects such as coordination and balance, ocular motor aberrancies in saccadic velocity, decreased optokinetic responses, deficiencies in pursuit mechanisms and express saccades, ocular flutter, nystagmus, ocular jerks, and a decreased vestibular ocular reflex (VOR). Additional findings included alterations in convergence and excessive blepharoclonus. She also demonstrated right sided facial tremors with myokymia, and spasticity of cervical musculature.
Methods: A treatment regimen of daily intervention was initiated for several weeks combined with similar home protocols to be performed three to four times daily. This was supplemented with a week-long intensive protocol of three to four sessions per day with a duration of approximately forty-five minutes per session for five days. The patient’s treatment was then gradually tapered off over the next several months at approximately one or two treatments per week of similar duration. Neuromuscular re-education, vestibular rehabilitation exercises, ocular motor exercises, electrical somatosensory stimulation, cold laser therapy, off-axis vertical rotation and a pharmaceutical paradigm were utilized. Prescriptions included propranolol, amitriptyline, topiramate, verapamil and florinef.
Results: At the end of treatment there was an improvement of many of her clinical findings. The patient no longer suffered with syncopic events, nor the paralysis and aphasia associated with them. She had a dramatic decrease in migraines, no facial paresis, and improvements in balance based on posturography. Her dysautonomia had stabilized, and she had a resolution of ocular jerks and nystagmus. In addition, many of her ocular motor findings had improved including express saccades, saccadic velocity, pursuit mechanisms and optokinetics based on visual nystagmography and saccadometry. The patient’s prescriptions were also altered, and the administration of verapamil and florinef were initiated as the other medications were eliminated due to the patient’s recovery.
Currently, the patient continues to be co-managed by the authors, and is experiencing greater stability regarding her subset of symptoms, with an increase in function and resumption of her normal daily activities. She continues to be withheld from employment and the use of an automobile. Continued multi-disciplinary care is required and the patient continues to progress in her activities of daily living as she experiences stability in cortical function.
Conclusions: Functional neurological, multi-modal applications including ocular motor, vestibular and other therapeutic interventions, combined with appropriate prescription medication may be a viable treatment protocol to improve neurological function and assist in the recovery of syncope and other cortical phenomena secondary to TBI and concussion. The authors further suggest investigation and application of multi-modal, multi-disciplinary, and functional neurological applications into case presentations of this type.
Conflict of Interest: The authors declare that the research conducted was done so in the absence of any financial relationships that could be construed as a potential conflict of interest.
Acknowledgements
A special thanks to the support personnel and treating clinicians and physicians in the co-management of this patient's care.
Keywords:
Traumatic brain injury (TBI),
Concussions,
Syncope,
Aphasia,
Migraine,
Ocular Motility Disorders,
dysautonomia,
Nystagmus, Pathologic,
Nystagmus, Optokinetic,
Diplopia,
Photophobia,
Myokymia,
Saccades,
pursuit eye movements,
Balance control,
Tremor,
Paralysis
Conference:
International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015.
Presentation Type:
Poster Presentation
Topic:
Case Reports for Poster Presentation
Citation:
Lane
DG,
Carrick
FR and
Mathews
GC
(2015). ABSTRACT: CASE REPORT OF MULTIPLE SYNCOPIC EVENTS WITH RESULTANT CONCUSSIONS, VERTIGO, DYSAUTONOMIA, MIGRAINES, APHASIA AND PARALYSIS IN A 28 YEAR-OLD FEMALE AFTER TRAUMATIC BRAIN INJURY..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: TBI and Neurodegeneration.
doi: 10.3389/conf.fneur.2015.58.00072
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Received:
05 Oct 2015;
Published Online:
02 Nov 2015.
*
Correspondence:
Dr. Daniel G Lane, Delmarva Chiropractic PC, Salisbury, MD, United States, drdanlane@hotmail.com