Postural orthostatic tachycardia syndrome secondary to mild traumatic brain injury
-
1
Carrick Institute, United States
-
2
Innova Brain rehabilitation, United States
-
3
Symmetry Wellness, Canada
-
4
Woodbine Chiropractic Clinic, United States
-
5
Balance Health and Sports Therapy, Canada
Objective: Symptom resolution in an individual with postural orthostatic tachycardia syndrome (POTs) sustained from a mild traumatic brain injury.
Clinical Features: The patient is an 14-year-old Female Soccer player who presented with a 16 month history of post-concussive symptoms she sustained from hitting her head after tripping on a soccer ball. Positive symptoms included brain fog, fatigue, irritability, lethargy, neck discomfort, difficulty with reading, concentration, difficulty with falling asleep, poor appetite and headache.
On examination the following were observed: Grade 3 hypomimia with a decrease in affect. Blood pressure(BP) seated 81/60 with a heart rate of 86 bpm to a standing BP of 80/63 with heart rate of 118 bpm. Dysmetria was observed with finger-nose-finger testing, rapid pronation and supination and heel to shin on the left side. Videonystagmography (VNG) testing revealed large amplitude left beating nystagmus and poor tracking with upward pursuits. Increased latencies were noted in vertical saccades. Optokinetic responses (OKR) in the horizontal plane were variable to the right and showed elongated slow phases to the downward stimulus. Computerized dynamic posturography (CDP) revealed a 77.5% stability score with eyes open on a perturbed surface and 65.7% stability score with eyes closed on a perturbed surface.
Interventions and Outcomes: A case specific intensive multi-modal neurorehabilitation protocol was designed including tilt table rehabilitation, oculomotor therapy, exertion training and vestibular therapy, over a five day period. Post-treatment findings were decreased headache intensity and frequency, normalization of affect and hypomimia, coordination of upper and lower extremities, and resolution of POTS phenomenology. VNG revealed normal vertical pursuits, saccades and OKR in horizontal and vertical planes. CDP stability scores increased to a 78.8% stability score with eyes closed on a perturbed surface.
Conclusions: Intensive rehabilitation addressed signs and symptoms in a patient with POTS secondary to post concussion syndrome. The subject demonstrated significant improvements subjectively and objectively after five days of therapy. Further investigation may establish a therapeutic approach for other individuals with POTS and/or Post Concussion Syndrome.
Keywords:
mild traumatic brain injury,
MTBI,
Postural Orthostatic Tachycardia Syndrome,
POTS,
Vestibular Rehabilitation,
Neurorehabilitation
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). Postural orthostatic tachycardia syndrome secondary to mild traumatic brain injury.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00090
Copyright:
The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers.
They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.
The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.
Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.
For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.
Received:
02 Sep 2016;
Published Online:
07 Sep 2016.
*
Correspondence:
Dr. Nathan D Keiser, Carrick Institute, Cape Canaveral, FL, United States, dockeiser@gmail.com