Here is a scenario that is repeated thousand times per day in doctor’s offices across this country:
Patient: “Doctor, I am having headaches, dizziness, sensitivity to light and noise. My ears are ringing, and I am having a lot of cognitive symptoms.”
Doctor: “I am sorry to hear that. When did this begin?”
P: “Just recently. I (was in a car crash / had a sports injury / fell down / etc).”
D: “That’s easy. You have a concussion. Most concussions resolve within 6 months. Get lots of rest and avoid stimuli.”
That sounds easy, right? After all, everyone knows what a concussion is. It’s a brain injury that can occur after a direct blow to the head, and sometimes in the absence of direct head trauma. Even the CDC has a checklist that will help us diagnose this.
But what if we ask ourselves a different question:
“Are there any other medical conditions that can cause the same symptoms as a concussion?”
The reality is that there are several medical conditions that can cause some combination of headaches or migraines, tinnitus, sensitivity to light or noise, brain fog, nausea, and can affect are emotional well-being and sleep cycle.
When we lose our certainty of the concussion diagnosis, it opens up a differential diagnosis for the other conditions that can cause these symptoms, such as:
- Craniocervical instability (upper neck instability, atlanto-axial instability, occipito-atlantal instability, cervicomedullary syndrome)
- Spinal fluid leaks (traumatic spinal CSF leaks)
- Lower neck instability (angular or translational)
- Venous compression syndromes
- Chiari malformation (ectopic cerebellar tonsils)
- Eagle’s syndrome
Each condition comes with its unique properties and subtleties. Working through the differential diagnosis requires familiarity with each of these conditions, their nuances, and the trail of crumbs that may have been missed by others. Other clues may come in the form of underlying hereditary connective tissue disorders (HCTD) such as Ehlers-Danlos syndrome (EDS), hypermobility spectrum disorder (HSD), Marfan syndrome, or short stature syndromes. There may be anatomical variants that also contribute to some of these atypical presentations.
Over the following weeks and months, I will be posting cases that were initially diagnosed as concussions, but the symptoms resolved upon getting the diagnosis (and treatment) right.
If you’ve been injured in a crash and are suffering from headaches, neck, back pain, or think you’ve been misdiagnosed, please give our clinic a call at 503-774-3778.
