Resolution of post-concussion derived dysautonomia, lower extremity weakness and subsequent falls in a 36-year-old female following 3 days of chiropractic neurological treatments
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1
Georgia Chiropractic Neurology Center, United States
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2
Life University, United States
Background
A 36-year-old female presented to a chiropractic neurology clinic with dysautonomia associated with post-concussive syndrome. The patient reported experiencing three separate concussions of her left temporal/occipital area that occurred over a 15-year time span. Her chief complaint was bilateral lower extremity numbness, coldness and muscle weakness that caused her legs to collapse while walking approximately 2-3 times per week. The resultant falls would occasionally cause bodily injury. The patient reported that if she warmed up her legs when they started feeling cold and numb, she would not collapse. Her lower extremity symptoms had increased in frequency and duration over time. Since the third impact in 2015, her numbness, coldness and weakness had become a common occurrence and she reported waking up without the ability to move her lower limbs on several occasions. The patient additionally reported that she experienced “violent neck jerks” and isolated twitches over different areas of her body that would occur an average of 5-7 times daily. She also reported experiencing intense migraines for many days following each head trauma that coincided with palpable edema over the site of impact. The patient reported a continual decrease in auditory sensitivity in her right ear and photophobia, which required her to wear transitional prescription sunglasses even indoors. Auditory senses were reported as “muffled”, despite the findings of her latest auditory examination, which showed her tympanic membrane to be intact with auditory receptors functioning at optimal levels in both ears.
Methods
Upon neurological examination, the patient exhibited cervical myoclonic jerks usually in the leftward direction and isolated twitches over different areas of her body. Her reflexes were graded 3+ for the biceps and brachioradialis bilaterally with concomitant spreading. Patellar reflex testing was pendular, having 8-9 leg swings bilaterally. She has a Babinski response bilaterally to plantar reflex testing. She revealed multiple hesitations on alternating palms up/palms down testing bilaterally. She was unable to distinguish between sharp and dull on any point on her skin. Point localization was 2” off target on the left side of her body and .5” off target on the right. Vibration sense was absent in her lower extremity and reduced in her upper extremity. She was allodynic to touch on all skin locations. During gait, her legs would swing out laterally prior to moving anteriorly with each step bilaterally. She was unable to distinguish the location of a sound with her eyes closed.
The patient’s treatment plan included bilateral Repetitive Peripheral Sensory Stimulation (RPSS) over the trigeminal areas V1, V2, and V3. Also included were modified Epley maneuvers, passive complex movements of the left arm, as well as saccadic and anti-saccadic eye exercises.
Results
After 3 days of treatment, the lower extremity coldness, numbness and falls had completely resolved. The patient was able to distinguish sharp vs. dull, and regained the ability to normally perceive vibration sensations. The intensity and frequency of the myoclonic jerks and twitches had decreased.
Conclusion: Chiropractic functional neurological rehabilitation strategies were used to restore autonomic function and consequently create positive outcomes in this case of lower extremity dysfunction, as well as improvements hyperkinetic movement disorders and sensory perception. Further research in of the use of these strategies is suggested.
Keywords:
dysautonomia,
falls,
chiropractic neurology,
Neurorehabilitation,
Traumatic brain injury (TBI)
Conference:
International Symposium on Clinical Neuroscience 2018, Orlando, Florida, United States, 24 May - 26 May, 2018.
Presentation Type:
Poster
Topic:
Clinical Applications in health, disease, and injury to the nervous system
Citation:
Arkin
JE,
Suarez
MM and
Esposito
SE
(2018). Resolution of post-concussion derived dysautonomia, lower extremity weakness and subsequent falls in a 36-year-old female following 3 days of chiropractic neurological treatments
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Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience 2018.
doi: 10.3389/conf.fneur.2018.60.00128
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Received:
08 Apr 2018;
Published Online:
14 Dec 2018.
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Correspondence:
Dr. Susan E Esposito, Life University, Marietta, United States, susanesposito@gmail.com