Question
I have had some very strange (to me) symptoms after a neck injury from a car wreck.  2 years ago I was struck by a person running a stop sign.  I was hit in the passenger door. He was moving in excess of 60 mph.  For a number of months I had problems with fine and gross motor control.  I could not walk without assistance.  I could not write.  I suffered extreme headaches, blurred vision, dizziness, nausea, very tense muscles, swelling, and lack of full range of motion in my neck, arms, and upper back. MRI results showed spinal stenosis, and two herniated discs at c 5/6 and c 6/7.  I was also told after the first year of the injury that it looked like degeneration of the bone in the area and that it appeared that I had a bruise on my spinal cord.

I have several symptoms that I don't fully understand.
1) When I do physical labor my hands shake alot.
2) When I go to bed I get strange sensations in my arms and hands.  I loose control of one or both arms.  I get shooting pain from my hands up.  I often get a strange tingling sensation in my pinkies, thumbs, and the back of my elbows.
3) My blood pressure has gone nuts.  Sometimes it is fine, others it is very high.  If I take lisinopril, the pressure drops to the low 60s (diastolic).  A diastolic count of 62 is normal while medicated.  When I don't take meds the BP often jumps very high.  A diastolic count in the high 100s is common.  I often get pounding headaches and an upset stomach.
4) Bed time is fun.  I get pounding headaches, stay cold, yet wake up with a sweat soaked pillow.  For the first year after the wreck I had to get up urinate every few hours.  That has backed off to once a night generally.

Do these symptoms make any sense?

Chris

Answer
Dear Chris,

The complaints you have all indicate nervous system dysfunction, and actually do make some sense.  The fact that you have spinal stenosis can account for many of these symptoms due to the fact that stenosis implies that there is increased pressure on the spinal cord.  Moreover, the disk bulges can cause strange symptoms as well, depending on what neurological structures have been compromised from their normal position.

The tingling and numbness in your hands, and back of the elbow indicates pathology/inflammation/compression of the median and ulnar nerves (often diagnosed as carpal tunnel syndrome even when it does not fit that diagnostic criteria).  Both of these nerves arise in the neck and travel all the way to the fingers, you can have compression or irritation at any course of the nerve therefore accounting for the problem.  *(true diagnosis of nerve function needs to be documented with a nerve conduction velocity test above and below the joints of the wrist, elbow, and shoulder, and then correlated with neurological tests of the sensation and heat to assess function)*  It is also, likely that you have substantial scar formation in the soft tissues of the neck that may aggravate these symptoms, and restrict blood flow into the hands

The urinary symptoms can be linked to higher brain tracts that control those functions (called a long track sign), or the lower spinal nerves that exit in the low back. If you had any compression of the nerves in the lumbar or sacral plexus (lower back areas) this can lead to urinary and bowel troubles, as well as loss of sensation to the skin areas of the genitals and perineum.

Unfortunately, many times brain injury after car crashes cannot be picked up by conventional imaging techniques (and we know they occur).  There is an injury called a diffuse axonal injury where the axon of the nerve is injured by acceleration forces called shear currents (inertial injuries), but this can only be found with brain biopsy...which will not likely be performed.  We know about these injuries through research performed on monkeys and baboons...their brains were dissected after crash sequences and multiple injury sites were found that could not be documented with MRI or Spect scans. These diagnoses are mostly made from clinical examination and observation, and many doctors are not aware of the diffuse axonal injury.

Listen Chris.  Cases like yours are often more complicated than many doctors realize, and many often do not have the training to understand why and what structures are damaged or inflamed.  For a better understanding of crash related symptoms, check out the Spine Research Institute of San Diego's website:  www.srisd.com

Good Luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net