Post-concussive cervical dystonia and chronic frontal headache: A diagnostic and treatment perspective.
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1
Carrick Institute, United States
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2
Innova Brain Rehabilitation, United States
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3
Symmetry Wellness, Canada
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4
Woodbine Chiropractic Clinic, Canada
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5
Balance Health and Sports Therapy, Canada
Clinical Features: An 18-year-old male hockey player presented to a chiropractic neurology clinic with post-concussive symptoms following a fall backwards on the ice without striking his head. After resting for the better part of the season, he returned to play and was subsequently cross-checked from behind which re-aggravated his symptoms of stiff neck, supraorbital headache, fogginess, fatigue, dizziness, akathisia, and “drunk feeling” that had persisted for over 12 months.
Methods: Videonystagmography (VNG) was employed to quantitatively measure oculomotor strategies. Findings included mild upward drift with vision occluded. Upward vertical pursuits were contaminated with square wave jerks to the right. Increased latencies measured in horizontal and vertical saccades. Optokinetic responses (OKR) in the horizontal plane were variable in frequency and amplitude to the left. Vertical OPK were adequate, but with mild convergence in the upward direction. Mild bilateral postural tremor noted in the upper limbs. Mild hyperalgesia noted in the left trigeminal nerve distribution. Loss of associated arm swing in the right upper limb during casual and dual-tasking gait.
A case specific intensive multi-modal neurorehabilitation protocol was designed including vestibular rehabilitation, oculomotor training and visual therapy, over a three-day period.
Results: Post-treatment findings revealed attenuation of tremor, equalization of sensation in the trigeminal distribution, decreased headache, increased cervical range of motion, and normalization of gait. VNG testing measured normalization of gaze, pursuits, saccades, and OKR in horizontal and vertical planes. Complaints of stiff neck, supraorbital headache, fogginess, fatigue, dizziness, akathisia, and disequilibrium showed improvement on subjective assessment.
Conclusions: Utilizing findings from a functional neurological exam, an individual protocol of intensive multi-modal neurorehabilitation was devised and implemented. Following the execution of the protocol the subject had an improvement in symptomatology and neurological findings. With further investigation, it may provide a therapeutic approach for other individuals with cervical dystonia and chronic frontal headache.
Keywords:
concussion,
akathisia,
Cervical dystonia,
frontal headache,
Vestibular Rehabilitation
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Keiser
ND,
Scarborough
D,
Kwok
W,
Lee-Ying
I and
Nardella
A
(2016). Post-concussive cervical dystonia and chronic frontal headache: A diagnostic and treatment perspective..
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00081
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Received:
02 Sep 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Nathan D Keiser, Carrick Institute, Cape Canaveral, FL, United States, dockeiser@gmail.com