A 49-year-old male elementary school teacher was originally referred to the CBIP with a history of PPCS (vision changes, headaches, confusion, slowed thinking, difficulty with multitasking, poor balance, postural dizziness, nausea, emotional lability, fatigue) following a motor vehicle accident. He had a past medical history of a mild TBI (with loss of consciousness) at 19 years old, as well as remote history of lower extremity orthopedic injuries.
The patient was involved in a motor vehicle accident, which occurred at ~50 km/h. The air-bags deployed and his car started on fire. He was unable to remove himself from the vehicle. He did not report amnesia or loss of consciousness, but did experience a sensation of nausea, vision changes, headache, dizziness, and fatigue following the event. He was diagnosed with a concussion by his family doctor in accordance with the World Health Organization Criteria, based on alteration in mental state and neurological deficits following the event. He tried to go back to work 3 days after the injury, however reported word-finding difficulties, problems concentrating, poor memory, and confusion. Treatment prior to assessment in the CBIP included acetaminophen, ibuprofen, physiotherapy, massage, and hyperbaric oxygen chamber therapy without significant benefit. The patient was on short-term disability from work as a Grade 5 teacher. He was previously active in Iron Man Triathlons but was unable to train since his accident.
Initial physical exam demonstrated convergence insufficiency. He became symptomatic with eye movement. The rest of his neurologic exam was normal. Investigations, including an MRI of the brain and neuroendocrine testing (CBC, electrolytes, glucose, TSH, free T4, IGF-1, a.m. cortisol, and urine electrolytes) were within normal limits.
He was seen five times at CBIP over the course of 8 months with ongoing treatment for vision, headaches, dizziness, mood, return to exercise, and general rehabilitation (occupational and physical therapy, social work, psychology, and productivity consultant). He was treated with oral medications (sertraline, rizatriptan), prism glasses, vestibular physiotherapy, vision therapy, and personal exercise training with ongoing post-concussion symptoms.