Brain-based Clinical Approach to a Patient with Post Concussive Syndrome and Dysautonmia

Abstract

Event Abstract Back to Event Brain-based Clinical Approach to a Patient with Post Concussive Syndrome and Dysautonmia Matthew M. Antonucci1, 2, Chris M. Sass1, 2* and Brian J. Sass1, 2 1 Plasticity Brain Centers, United States 2 Carrick Institute for Graduate Studies, United States Presentation A 22 year old female visited our clinic in Atlanta, GA from 8/22/2015 to 8/25/2015. She presented with the main complaint of severe exhaustion/fatigue, anxiety, fogginess, visual disturbances, sound sensitivity, dizziness, and headaches. Assessment The main physical exam findings were as follows: Her blood pressure increased from 106bpm to 122bpm from supine to standing, with an exacerbation of symptoms upon standing as well. The right eye developed a down beating nystagmus during passive head rolls, and fundiscopical exam revealed an ocular bobbing response (2 Hz) in the vertical plane in darkenss. The patient had a right efferent pupillary defect, observed only during the indirect light response. A small amplitude tremor was observed on the left side with the arms in a wing beating position. Pinwheel responses were increased on the right face and left body distributions. Sound lateralized to the right ear during Weber’s test. During vertical pursuit activity with the eyes, saccadic intrusions were present. Right finger tap testing was given a grade III with hesitations. The patient elicited exaggerated plantar responses with a withdrawal response on the right. Otoscope exam revealed vegetation on both tympanic membranes. During gait, the patient had a decreased right arm swing with left UE cantilever response that switched to the right side during dual tasking. CAPS balance scores with eyes closed and on a perturbed surface had a stability score of 48%. She fell with her eyes closed and head extended. Impression She exhibited the signs and symptoms associated with a post concussive syndrome complicated with a centrally maintained vestibulopathy and dysautonomia. Intervention Based on the above findings, we started a course of treatment including tilt table therapy, vestibular rehabilitation, eye exercises, and repetitive peripheral somatosensory stimulation. The treatment comprised of chair rotations, gaze stability with head movements, and iPad exercises. Outcome At the end of our 4 day treatment, she had complete resolution of her dysautonomia symptomatology, normal finger tapping bilaterally, improved gait, as well as improvements energy, balance, independent activities. She did not fall during CAPS testing and her stability score with eyes closed on a perturbed surface improved to 72%. Acknowledgements The authors would like to thank Dr. Frederick Carrick and the Carrick Institute of Graduate Studies for the training and clinical neuroscience. The authors would like to also thank Dr. Marc Ellis for the temporary utilization of his facilities for which this patient was seen and treated. The authors would also like to thank Dr. Kelsey Brenner, Dr. Stuart Rutledge, Dr. Lon Kalapp, Dr. Eduardo Fontana, Dr. Ben Berendt for their assistance in patient treatment References N/A Keywords: TBI, Vestibular rehabilitation therapy, posturography, Brain Injury, neurological rehabilitation, dysautonomia, POTS Conference: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration, Orlando, Florida, United States, 10 Dec - 14 Dec, 2015. Presentation Type: Poster Presentation Topic: Clinical aspects of TBI and Neurodegeneration Citation: Antonucci MM, Sass CM and Sass BJ (2015). Brain-based Clinical Approach to a Patient with Post Concussive Syndrome and Dysautonmia. Front. Neurol. Conference Abstract: International Symposium on Clinical Neuroscience: TBI and Neurodegeneration. doi: 10.3389/conf.fneur.2015.58.00085 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: 10 Sep 2015; Published Online: 02 Nov 2015. * Correspondence: Dr. Chris M Sass, Plasticity Brain Centers, Orlando, United States, sasschr1@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Matthew M Antonucci Chris M Sass Brian J Sass Google Matthew M Antonucci Chris M Sass Brian J Sass Google Scholar Matthew M Antonucci Chris M Sass Brian J Sass PubMed Matthew M Antonucci Chris M Sass Brian J Sass Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.