Residuals (almost a decade post) mTBI

[itsnotmeitsyou]

I was told that my low-t (263) was caused from my mTBI.

I also have some mild memory issues attributed to the mTBI.

Could balance problems be caused by residuals of mTBI?

(I was checked by audiology and neurology. Neurologist thought it was medication (topamax, pregablin) and not the mTBI.)

Caveat: since the initial mTBI, I have lost consciousness on one other occasion from falling. This would also be categorized as a mTBI, but I didn't experience new problems.

[Wise Young]

Originally Posted by itsnotmeitsyou

I was told that my low-t (263) was caused from my mTBI.

I also have some mild memory issues attributed to the mTBI.

Could balance problems be caused by residuals of mTBI?

(I was checked by audiology and neurology. Neurologist thought it was medication (topamax, pregablin) and not the mTBI.)

Caveat: since the initial mTBI, I have lost consciousness on one other occasion from falling. This would also be categorized as a mTBI, but I didn't experience new problems.

itnotmeitsyou,

Balance problems can result from mild TBI that may have damaged your vestibular organs. However, if an audiologist finds that your hearing and vestibular senses are fine, it is likely to be due to medication. In any case, it does not matter since there is no good treatment for balance problems, other than to reduce the doses of drugs that may contribute to balance. By the way, aging alone can be associated with balance problems.

Wise.

P.S. I don't know what low-t (263) is referring to.

[SCI-Nurse]

Originally Posted by Wise Young

itnotmeitsyou,

P.S. I don't know what low-t (263) is referring to.

I suspect he is talking about his serum testosterone levels. Low normal is usually considered to be 300. I have seen nothing that relates this to balance or vestibular problems. It can be associated with both TBI and SCI.

A good PT or OT can work on balance exercises that can be effective. Many hospitals and clinics have added such therapies to their programs for fall prevention therapy in the elderly.

(KLD)

[itsnotmeitsyou]

Yes, I was referring to the low testosterone levels. I wasn't correlating the low-t with balance problem, just mentioning one of the residuals that has been attributed to the mTBI. I was tested because of the mTBI.

I am working with PT on the balance issues, but the problem remains.

My medical provider has reduced the medications to the lowest point where they still remain somewhat effective.

I guess I will chalk the balance problems up to a combination of things. The problem is I become less mobile the more I fall. It is a cycle: fall, use wheelchair more, lose more strength, get going again and fall.

I am only 27 and have had significant balance problems since my injury. I know having the left leg junked contributes to the balance issue. But 19 is very young and 27 is sorta young, so age --I don't think is the problem, but I do not know if this is the types of ages you're thinking about Dr. Wise-- may not be the problem.

I greatly appreciate Dr. Wise and Sci-Nurse Kathy's time in answering and positing an answer. I know you both are busy.

[Wise Young]

Originally Posted by itsnotmeitsyou

Yes, I was referring to the low testosterone levels. I wasn't correlating the low-t with balance problem, just mentioning one of the residuals that has been attributed to the mTBI. I was tested because of the mTBI.

I am working with PT on the balance issues, but the problem remains.

My medical provider has reduced the medications to the lowest point where they still remain somewhat effective.

I guess I will chalk the balance problems up to a combination of things. The problem is I become less mobile the more I fall. It is a cycle: fall, use wheelchair more, lose more strength, get going again and fall.

I am only 27 and have had significant balance problems since my injury. I know having the left leg junked contributes to the balance issue. But 19 is very young and 27 is sorta young, so age --I don't think is the problem, but I do not know if this is the types of ages you're thinking about Dr. Wise-- may not be the problem.

I greatly appreciate Dr. Wise and Sci-Nurse Kathy's time in answering and positing an answer. I know you both are busy.

27 is young. I was referring to people over age 70. There are many non-TBI causes of balance problems, even in your people. For example, ear infections can cause problems with the vestibular system. There may also have been injuries to your cerebellum. Were you injured at age 19 and that is why you are referring to that age? What do you mean by "having the left leg junked"?

Wise.

[itsnotmeitsyou]

Dr. Wise,

Yes, I was injured at 19. I injured a bunch of things, but I ended up with paralysis in the left leg and a neurogenic bladder --flaccid, and I have CPRS type 1 in the upper left leg --coupled with weakness--and the lower left leg is complete --no movement, no sensory.

Audiology has checked my ears, and they are good, for the most part.
Neurology is blaming it on the drugs, but they said I could come back every year and have it checked --do not know what that means.

I have had the balance problems since I was injured, which has led to the cycle of wheelchair use --my right leg keeps getting weaker --3/5, and it was 4/5 post-injury, and I am told it may have to do with the initial injury.

My initial injury involved a 20 minute LOC --hence mTBI, and I working with OT and PT on the issues still.

I hit the back of my head (occipital lobe). I do not know where the cerebellum is. I only know the occipital lobe, because I was told.

[Wise Young]

Originally Posted by itsnotmeitsyou

Dr. Wise,

Yes, I was injured at 19. I injured a bunch of things, but I ended up with paralysis in the left leg and a neurogenic bladder --flaccid, and I have CPRS type 1 in the upper left leg --coupled with weakness--and the lower left leg is complete --no movement, no sensory.

Audiology has checked my ears, and they are good, for the most part.
Neurology is blaming it on the drugs, but they said I could come back every year and have it checked --do not know what that means.

I have had the balance problems since I was injured, which has led to the cycle of wheelchair use --my right leg keeps getting weaker --3/5, and it was 4/5 post-injury, and I am told it may have to do with the initial injury.

My initial injury involved a 20 minute LOC --hence mTBI, and I working with OT and PT on the issues still.

I hit the back of my head (occipital lobe). I do not know where the cerebellum is. I only know the occipital lobe, because I was told.

I see. From your description, I would not be surprised if you have had spinal cord injury. The reason that I say this is because of your neurogenic bladder. A neurogenic bladder would an unusual sequelae of brain injury (mild or otherwise). It suggests that you have had a lumbosacral plexus or cauda equina injury. This might explain why your left leg is weak. If I were you, I would get an MRI of your lower spinal cord.

The cerebellum can be injured and may cause a variety of motor coordination problems, including balance. The classic manifestation of cerebellar damage is called ataxia, which manifests as unsteady or clumsy limb movements. If the injury is in the middle part of the cerebellum, called the vermis, the clumsiness usually involve the trunk and legs. If it involves the lateral hemispheres, the arms may be involved. However, cerebellar damage is often associated with eye movement problems as well.

Wise.

[itsnotmeitsyou]

Dr. Wise,

I have had a MRI. I was medically retired from the military because of the injury, and it was called a bunch of different things. Ultimately, it was termed diagnosed as a lesion at the spinal cord roots at the L4-L5, sciatic neuropathy, neurogenic bladder --flaccid, and complex regional syndrome (along with several other things, but they had no impact on the bladder nor leg). Some doctors haven't liked these diagnoses, so I get to play the whole diagnosis game again. I have been told it is cauda equina, sciatic avulsion, and one doctor thought I had MS.

The VA runs with the military diagnosis. Essentially life goes on, and I deal. I am told this is a spinal cord injury, but I don't like calling my injury spinal cord. I prefer a PNS injury, because people recover from those. (honestly, I haven't adjusted to my injuries, and I have done crazy things to try and get fixed.)

Right now, my biggest issues are the CPRS and the dizziness. The dizziness is a problem, because it interferes with the way I live. The more dizzy I am the more I have to utilize the chair. I have a nice chair, but nobody wants to use a chair. I don't.

I follow up with the neurologist every year (for the leg and bladder and migraines). PCP manages my care. Because I refuse to go to the spinal cord clinic.

[Wise Young]

Originally Posted by itsnotmeitsyou

Dr. Wise,

I have had a MRI. I was medically retired from the military because of the injury, and it was called a bunch of different things. Ultimately, it was termed diagnosed as a lesion at the spinal cord roots at the L4-L5, sciatic neuropathy, neurogenic bladder --flaccid, and complex regional syndrome (along with several other things, but they had no impact on the bladder nor leg). Some doctors haven't liked these diagnoses, so I get to play the whole diagnosis game again. I have been told it is cauda equina, sciatic avulsion, and one doctor thought I had MS.

The VA runs with the military diagnosis. Essentially life goes on, and I deal. I am told this is a spinal cord injury, but I don't like calling my injury spinal cord. I prefer a PNS injury, because people recover from those. (honestly, I haven't adjusted to my injuries, and I have done crazy things to try and get fixed.)

Right now, my biggest issues are the CPRS and the dizziness. The dizziness is a problem, because it interferes with the way I live. The more dizzy I am the more I have to utilize the chair. I have a nice chair, but nobody wants to use a chair. I don't.

I follow up with the neurologist every year (for the leg and bladder and migraines). PCP manages my care. Because I refuse to go to the spinal cord clinic.

I see. I guess that it doesn't matter what name your condition has as long as it leads to appropriate treatment. Wise.

[SCI-Nurse]

Originally Posted by itsnotmeitsyou

The VA runs with the military diagnosis. Essentially life goes on, and I deal. I am told this is a spinal cord injury, but I don't like calling my injury spinal cord. I prefer a PNS injury, because people recover from those. (honestly, I haven't adjusted to my injuries, and I have done crazy things to try and get fixed.)

That is not true. It only applies for determination of service connection, and even that can be appealed. The VA makes their own examinations of you to determine your diagnosis for treatment. You are doing yourself a disservice by not seeking SCI care through the VA, esp. at at major VA SCI Center.

(KLD)