Long-term effects of head injury
September 8, 2016 9:48 AM   Subscribe

I had a head injury when I was 7 that included loss of consciousness. I did not receive any medical attention for this injury. Could any of my current issues be traced back?

When I was 7, I tripped inside our house and put a hole in the wall of our extremely sturdy Queen Anne house with my head. The baseboard lip hit the bridge of my nose, directly between my eyes. I lost consciousness for a short period of time, but my parents didn't take me to the hospital or a doctor (awesome). I had two black eyes for a few days but I don't remember any other effects at that time.

Fast forwarding 30ish years: I am full of problems. When I started having headaches about 5 years ago, I had an MRI, which showed several white matter lesions in my frontal lobe. They were considered nonspecific and attributed to migraines. My official headache diagnosis is chronic migraine though I don't believe I fit the parameters. I also experience issues with my vision, specifically being able to focus my eyes; it's like the Magic Eye phenomenon where my eyes are automatically focusing just past an object rather than on it and it takes effort to focus on the object itself. My most recent eye exam was with a new provider, and when I explained the situation, he asked whether I had had a head injury. When I said I had, he said a common long-term effect of concussion is this particular difficulty in focusing. I haven't found any information to that effect, though.

I have multiple other health issues (both mental and physical) but my questions are: could the above issues have stemmed from an untreated concussion? What are other possible long-term effects of untreated concussion/head injury?
posted by altopower to Health & Fitness (6 answers total) 1 user marked this as a favorite
I have a friend with a seizure disorder due to a childhood concussion, and another with chronic migraines that started after one concussion and got worse after the next (she's a martial arts teacher, it's something of a professional hazard.) So yeah, long-term sequelae are certainly possible.
posted by restless_nomad at 10:08 AM on September 8, 2016 [2 favorites]

There are no real 'treatments' for a concussion that has no brain bleeding, if that helps you feel better. My fiance recently had a concussion, with memory loss (with extremely minor bleeding, outside of brain but inside skull, visible in CT scan) that knocked him out of work for 3 months, and has persistent post-concussion syndrome even today, and the only course of treatment was 'take it easy'. Hopefully that makes you feel better about this concussion.

The long-term effects of concussions are very poorly known (even short-term effects are poorly known enough that predicting symptoms is not commonly thought possible; the current Canadian/Ontarian recommendation is to read a pamphlet explaining every possible symptom to the injured party, so they know the full gamut of symptoms). There are frequent-enough long-term effects that there is a name for it: post-concussion syndrome. Even then, PCS is usually something that begins in the first year after injury and refers to persistent symptoms. Your symptoms appeared to begin 25 years after the concussion.

I will note that focusing problems, especially with small objects, are one commonly-mentioned symptom of migraines.

I don't think you'll be able to definitely 'trace it back' even if you find a doctor who specializes in the long-term effects of concussions; there's too much that you don't know about concussions in general, the concussion itself (which part of your head did you hit?), and your brain state then, 20 years ago, and 10 years ago (when did those lesions appear?). For instance, the immediately-post-concussion CT scan of my fiance found a subarachnoid cyst. Maybe from birth, maybe from a childhood concussion, maybe something else, but definitely not from the same-day concussion. They couldn't definitively identify its cause given his available medical history, so it was noted as being an incidental finding of 'unknown' origin.

Sometimes, you just can't know. It's theoretically possible that your problems are concussion-related, but concussions can also cause migraines which can then cause problems of their own.

Good luck!
posted by flibbertigibbet at 10:27 AM on September 8, 2016 [3 favorites]

Yes, it’s certainly possible for there to be long term problems associated with head injuries, but on the other hand I’m not aware of any treatment you could have been given 30 years ago that would have made any difference - in hospital you would probably have been observed over night & then sent home with your black eyes. There’s nothing else the hospital could have done for you.

What would have been really bad is if you’d received a second or multiple head injuries shortly after the first one - it’s this that’s believed to be behind the long term damage done to American Football players and the like.
posted by pharm at 10:29 AM on September 8, 2016 [6 favorites]

I have chronic daily headache, and my doctors are also very interested in the time I fell off my bike when I was 10 and knocked myself unconscious. It's tricky to know—a prior head injury could certainly contribute to headaches later, but how can you know for sure? My daily headache manifested something like 17 years after that fall, after I had done other potentially headache-induding things like falling down stairs and working in a perfume factory.

I also have white-matter lesions. They really don't know much about these things, do they?

I've had many different diagnoses for my headache over the years: atypical migraine; chronic daily headache with migraine features, migraine disease. I don't think they really know what to call them, and different doctors call them different things.
posted by not that girl at 10:54 AM on September 8, 2016 [1 favorite]

I am not a (medical) doctor, this is not medical advice. I do know a few things about neuroanatomy and neurophysiology, though.

As far as I know, it is certainly possible for a head injury like you describe to cause some of your symptoms. However, brain injuries are extremely difficult to treat, and there may not have been anything to do once you were injured. Anti-inflammatory drugs like steroids can help limit additional damage due to swelling in some cases, but I don't know how or in what cases they're used in medical practice.

In particular, the difficulty with focusing your eyes does seem very consistent to me with the type of trauma you describe. The ability to focus the eyes on a near object is carried by the oculomotor nerve, which is a cranial nerve which passes through small openings in the skull. Sudden blunt trauma to the front of the head can compress and damage this nerve, producing a variety of symptoms. You might experience either or both of two distinct issues with focusing your eyes on near objects: difficulty or inability to converge your eyes together, resulting in the "magic eye" -like double vision; and difficulty or inability to "accommodate" the lens of your eyes to focus on near objects, resulting in blurred vision. You might also have a weak or absent pupillary light reflex, the automatic constriction of the pupils in response to bright light; if this is the case, an optometrist or ophthalmologist should definitely have noticed this.

As for your headaches, I am definitely not an expert in this, but as far as I know the causes of migraines are still poorly understood. I wouldn't rule out a link to your childhood head injury, but neither is it a smoking gun. White matter lesions in your frontal lobe are also possibly consistent with the type of injury you sustained, but could have had another cause. I described what I know about some of the more subtle effects of this type of brain injury in a previous answer on AskMe, in case that's useful. But since you were 7 when the injury occurred, your brain was still very plastic, particularly your prefrontal lobe, and so I would expect it to be much more resilient to this type of damage.

If you haven't discussed the possible link between your childhood head injury, the lesions in your frontal white matter, and your current headache and vision problems with your neurologist, I'd recommend trying to get an appointment to do so. If you have raised it but didn't think your neurologist adequately addressed the link, you might want to bring it up again as a point you'd specifically like to discuss, or find a neurologist who is more open to discussing your history with you.
posted by biogeo at 1:25 PM on September 8, 2016

One of my friends was accidentally dropped on his head as a baby (no, really!) and has a lazy eye related to that. His parents did take him to the doctor, but the doctor basically told them they could treat the lazy eye, but it was basically there to stay. So yup, totally possible.

I had a really bad fall at 8 months or so (I fell straight from the 2nd floor to the 1st) and my mom didn't take me to the doctor either because "you were crying, so I figured you were OK". I don't think I have major lasting brain effects, but WTF, take your kids to the doctor, people.
posted by Nibbly Fang at 2:43 PM on September 8, 2016 [1 favorite]

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