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Compressed the cartoid artery in neck. Feeling light headed and nauseous. Have I damaged my nerve?

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Hi

I am a 31 year old fit male. Weight 80kg. Height 5 foot 11 inches.

Last Monday I was practicing Judo and had a choke hold applied to me which compressed the cartoid artery in my neck. I did not pass out but stopped and felt very faint for a few seconds. In a few seconds I felt well again. I got dressed and walked to get my bus and did not feel any side effects but when waiting to get my bus (about 20 mins later) I felt lightheaded like I might feint.

That night I felt 'cloudy and confused' and nauseous and had a headache on one side of my head. I saw a doctor who said that the head ache was normal and that my heart sounded fine and that the symptoms should pass within a few days. He also said I appeared to be panicking a bit.

That night I had an ECG on my heart and had my blood pressure checked and these tests came back normal.

I felt lightheaded and nauseous for a day or two afterwards and so went to my doctor again who did not think there was anything to worry about. He sent me for an MRI scan on my head / brain area to allay my concerns (I went for this last night but have not gotten the results back yet).

Symptoms (slight head ache, feeling nauseous etc.) have cleared up however I had blocked ears yesterday ad today and have a slight ringing in my head / ears. It is only very slight and is similar to 'white noise' i.e. when a television is on but there is no reception. Could this be as a result of nerve damage in my neck?

The other point I was concerned about is that my vagus nerve may have been damaged which could interfere with my heart rate but I understand that this is a risk in the seconds after the choke hold is applied only and that given that the ECG came back normal - my heart should be fine. Would you agree with this assessment? I dont have any significant pain in my neck.

Do you think there is anything else I need to be concerned about? I have felt feint and felt like my heart is racing one or two times in the past few days but I think this was down to panic type attacks. I understand that if my heart felt like it is racing - this is the opposite of vagus nerve interference with my heart (which I understand would tend to slow a persons heart beat) I will of course mention these to my doctor but you might let me have your opinions as to whether or not I should have any other concerns / watch out for anything else and what you think might be the case of the slight ringing in my ears.

Thank you
Posted Thu, 15 Nov 2012 in Brain and Spine
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your query.

1. Since this happened almost a week ago, the worst is probably over.

2. The type of strangle hold and the direction of the force, struggle and your own body weight would have been the factors responsible for your symptoms.

3. A force as little as 2.5 kg can obstruct blood flow through the carotid arteries and the jugular veins. Another possibility is that the carotid body (sinus) was stimulated leading to a fall in blood pressure and heart rate at that times of feeling faint. It would quickly recover between episodes. You may also have a sensitive carotid sinus.

4. To complete the list of possible causes and not necessarily in your case, there may be a slight damage to the delicate inner ling (intima) of the carotids or a small plaque or clot may be released from the vessel wall. The cervical spine may be injured leading to muscle spasm and dizziness. (However, you have no pain).

5. If your MRI is normal, there is no cause for worry. If you are now prone to anxiety, get a color doppler study of the neck vessels done.

6. Get a PTA (Pure Tone Audiogram) and an Tympanogram (Impedance Audiometry) done to investigate the ear blockage. The noise that you hear is known as Tinnitus an it is very common. The exact cause is unknown and it can only be controlled (not cured). It is not XXXXXXX in 99% cases. It has great nuisance value. Either your attention has been drawn to an preexisting Tinnitus or changes in blood pressure/ small clot may be responsible.

7. Permanent vagal damage is unlikely. You are most likely experiencing panic and hyperventilation attacks. Stop any contact sports training for some time till you recover completely.

8. I must emphasize that the chance of a serious permanent problem at your age is rare. Tinnitus can be treated once middle ear pressure is normal in the ear tests.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Compressed the cartoid artery in neck. Feeling light headed and nauseous. Have I damaged my nerve? 1 hour later
Thank you for your response.

1. As I have practiced Judo and other martial arts for over 2 years (which would have involved such choke holds being applied during competition etc) and I did not experience adverse reactions before do you think it is reasonable to rule out a hyper sensitive vagus nerve?

2. Is it possible that my vagus nerve has become sensitive as a result of this recent choke hold. If so do you think this will 'reset itelf' so that the sensitivity goes away?

3. If possible would you still think this unlikely?

4. When you state that there may be slight damage to the delicate inner lining of the cartoids or a small plaque or clot may be released from the vessel wall - will such damage usually heal naturally in the normal course?

5. Would a color doppler study of the neck vessels be carried out purely to detect such damage?

6. Will a clot 'dissolve' in due course or otherwise be dealt with by the body? I would like to know if such damage is 'permanent'

7. I note your advice about stopping contact sports which I intend to do. Do you think I could engage in non contact sports for example running or weight lifting so as to relieve and control anxiety and satisfy myself that I have not suffered any significant damage.

8. Do you think I should take another week or so off or engage in light exercise next week if I feel up to it. I strongly suspect it will help with anxiety.

9. With regard to the ear blockage - this comes and goes (similar to being in an airplane) for the past 2 days. I cant seem to make it go away by 'popping' my ears by breathing out or yawning although the pressure is stronger at times than others. I have had problems with my sinus in the past and I may have a slight sinus infection at the moment (I suspect this as the pressure in my ears has definitely only appeared in the past 2 days and I had one blocked nostril for part of yesterday). Also I was on a I was on a 9 hour plane flight last week which may have upset my sinus. I would hope the ear pressure and tinnitus are related to my sinuses (although it only appeared 2 days after I experienced the choke hold).

In view of the above do you think it more or less likely that the tinnitus is related to my sinus or to the choke hold (if it is possible to express an opinion).

10. IF the tinnitus is related to changes in blood pressure / small clot as a result of the choke hold being applied - is it possible or even likely that it may disappear in a few weeks as the body heals itself (assuming that the change in blood pressure / small clot can heal itself).

11. If I had any sort of a cervical spine injury I assume it is likely I would feel significant or at least noticeable pain or discomfort so that it is reasonable to rule this out?

12. Also although I know this is probably a stupid question - I assume any sort of brain damage / minor stroke / blood clot in brain / brain bleed is a fairly remote possibility and this would show up on the MRI scan in any event?

13. Finally it would seem that if my symptoms do not go away in a week or so - visiting an ENT doctor may be the best approach - would you agree or would you think I should first have a color doppler study of the neck vessels carried out.

Thank you for your response which is greatly appreciated.




 
 
Answered by Dr. Sumit Bhatti 12 hours later
Hi,

Thank you for your writing back.

1. Vagal nerve, Glossopharyngeal Nerve and Carotid Sinus sensitivity increases with age, though your current argument is fine.

2. This problem should be temporary.

3. There is no way of predicting the outcome.

4. Damage to the carotid lining (intima) was, as mentioned, an example to compete the list of injuries possible by a stranglehold and not in particular to your case. It would heal quickly at your age.

5. The Neck Color Doppler Study will pick up only substantial damage, areas of atherosclerosis and plaques. Extremely small lacerations cannot be picked up on any type of imaging.

6. Small cots will dissolve. There is no evidence that this has happened in your case.

7. You should avoid contact sports.

8. You should avoid all sporting activity and exercises for a few weeks.

9. It appears that now that your ear blockage and tinnitus is due to the air travel during an attack of sinusitis. The timing may, as mentioned earlier, be more of a sudden awareness of a pre-existing tinnitus.

10. The tinnitus will lessen either due to the blood pressure, clot or Tinnitus Retraining Therapy (TRT).

11. Yes, a cervical spine injury would cause significant pain due to muscle spasm and pressure on the spinal nerves.

12. An MRI will pick up anything significant. Conversely, if it is normal, you should believe that everything is in order and that the changes are temporary.

13. Get a Neck Color Doppler done if this persists after a week before visiting an ENT Specialist and let a Neurologist decide the need for an MRI.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Compressed the cartoid artery in neck. Feeling light headed and nauseous. Have I damaged my nerve? 1 hour later
Thank you Doctor.

A final question I have is that I had a headache last night when I woke up. This did go away after a while and was not there this morning when I woke up. I felt a slight head ache for 20 min earlier today and pressure above my ears.

Again I assume that the MRI should pick up anything of concern. Would you think - even if the MRI does does not pick up anything of concern - it would not be unusual to have slight headaches at times for the next week or so?
Also Doctor - I have at times felt like my balance was a little off - again I assume that any issues (including whether or not this is sinus related) should be picked up by the MRI.

Thanks
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for your writing back.

1. If your MRI is normal, the slight headache may be related to the changes in blood pressure, the blocked ears or stress induced.

2. You may then decide to take a mild painkiller or not.

3. A normal MRI will rule out any serious cause for imbalance. Scans and imaging detect physical from not function. Hence minor, temporary causes will not be picked up on the MRI. Sinus pathology will be picked up on an MRI screening though a plain CT PNS (Para Nasal Sinuses) is the imaging of choice for sinusitis.

4. If you do plan to go in for an MRI, a 3 Tesla machine is preferable.

5. Does your imbalance occur in any particular position? Does it occur while walking? Is it intermittent or last all day? Is there any photophobia or aversion to bright lights? Get a Neurotologist to check for signs and test for imbalance.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Compressed the cartoid artery in neck. Feeling light headed and nauseous. Have I damaged my nerve? 5 hours later
Hi Doctor


1. if the headache is related to changes in blood pressure or blocked ears - then is it likely this will clear up. can you give a rough estimate as to how long it would take to clear up in the normal course? should it only take a few days?

2. is it unusual that i still experience these symptoms after nearly a week (although my symptoms have definitely improved some)?

3. would it be very unusual if i still experience slight head ache / pressure in ears or head in one weeks time?

4. I went to the shop today and carried home a bag of shopping which on reflection was probably a bit too heavy. while i was walking it put pressure on my neck near where it meets the torso (on the left side which i think is the same side that the choke was applied to) and i have had a pain - not terrible pain but noticeable pain - in my left lower neck at the point where it meets the torso. i took a mild pain killer (2 paracetamol) which seems to have lessened most of the pain and it is not so bad now. i also seem to have a slight headache / pressure at the back of my head along with this pain in the neck and a slight pain on the top of my head on the left side - although these pains are not very bad after 2 paracetamol and are not causing major discomfort.

do you think i may have some sort of nerve damage in my neck as a result of the choke hold and that my symptoms might relate to this? the left side of my neck does seem to be a bit tenser than the right side and there seems to be a very slight difference in the range of motion when i turn my head.

5. if the pain in my neck is only minor and is not there is the morning when i wake up - do you still think that nerve damage is a likely reason for the symptoms?

6. if there was nerve damage - do you think in view of the lack of serious pain it should be minor and should clear up in a few days? i have been putting a heat pack on my neck which seems to alleviate most if not all of the pain (while the heat pack is applied).

7. again - i assume that if i had any sort of significant damage to the neck / spine i would be in alot more pain (I only experienced this pain today after carrying the bag of shopping home).


8. with regard to the imbalance - this is very intermittent and is only a type of feeling rather than actual imbalance. it does not occur while walking it is just that once or twice i have noticed both when walking and standing and generally moving about the house - for a few seconds only - that my balance seemed to be a bit off. it was not a serious loss of balance and did not cause me to fall over or anything. i can stand and hop on one leg etc.

what sort of aversion to bright lights would be an issue? would this mean that i experience mild discomfort when i look at a bright light and want to look away? what other symptoms would there be?

what would such symptoms be an indication of and is it serious?

9. if i still have these symptoms in one week - should i then get the colour doppler done and go to an ENT doctor or do you think i should give 2 or 3 weeks for the symptoms to clear?

10. if the pain in my neck persists would a colour doppler be appropriate to investigate this?

11. as the air travel was over a week ago and my ears only seemed to have blocked up in the past 2 - 3 days - do you still think it is likely that the air travel caused sinusitis and thus the ear blocking or do you think it is more likely related to the choke hold.

thank you
 
 
Answered by Dr. Sumit Bhatti 29 minutes later
Hi,

Thank you for your writing back.

1. Headache due to changes in blood pressure will clear up within two to three days from the last major fluctuation of blood pressure. Headaches due to blocked ears will respond only after the block is relieved. Your Tympanogram (Impedance Audiogram) and treating any nasal and sinus problem is important here.

2. It is fine as long as these symptoms are improving.

3. It is not very unusual to still experience slight head ache / pressure in ears or head after a week.

4. The pain in the neck probably means that you may have sprained your neck during the stranglehold. There should be no permanent nerve damage and the slight stiffness and slight difference in the range of movement is supportive of the same.

5. Permanent nerve damage is not likely.

6. The spasm is minor, temporary and you should believe in the healing power of the body. You may use a local pain relieving gel and an infra red heat source, if available.

7. With significant damage to the neck / spine you would not be able to move your neck or lift any weight. A simple catch in the neck is far worse, and it mostly improves without treatment.

8. Minor imbalance may be due to gastritis or stress. Photophobia would be more in favor of a migraine type headache or meningeal irritation. That would require a different set of medications.

9. II you still have these symptoms after a week, get the Neck Color Doppler done and go to an ENT Specialist.

10. If the pain in my neck persists, an MRI of the neck would be ideal.

11. The sinusitis induced eustachian tube dysfunction had probably progressed during your air travel and then worsened during the struggle associated with a stranglehold.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Compressed the cartoid artery in neck. Feeling light headed and nauseous. Have I damaged my nerve? 3 days later
Hi Doctor

On Tuesday I got the results of the MRI scan and it was clear. My symptoms improved greatly once I got the result.

However, yesterday and today there has been alot of pressure in my ears. it is not constant pressure, rather it is pressure in my ears that comes and goes. on a few occasions the pressure was really great for a minute or two to the extent that it hurt and then it would ease off


in addition the pain in my neck - on the lower side near the neck muscle that sits on top of the shoulder has been much worse. worst of all the tinnitus has been worse and it seems as if there is a bit of pain in my left ear (it also seems like the tinnitus is more in my left ear than my right (but it is hard to say).

i will go to my local doctor tomorrow and book an appointment with an ent doctor. have you any advice for me - in particular do you think there is anything they will be able to do to improve the tinnitus as that is what is worrying me most now.

also - sometimes at work i use soft foam in ear ear plugs to block out noise. i have also been putting them in one ear to try and confuse my senses and drown out the tinnitus. do you think it is ok to do this? one other point i would mention doctor is that i seem to have two types of tinnitus in my ear - a constant high pitched white noise type tinnitus and also every so often there is faint beeping or pulsing like the noise an industrial machine makes when it is reversing (so people will know it is reversing).


thanks

 
 
Answered by Dr. Sumit Bhatti 1 hour later
Hi,

Thank you for writing back.

1. It is good to hear that your MRI is normal and that your symptoms have reduced.

2. Get a PTA (Pure Tone Audiogram) and an Tympanogram (Impedance Audiometry) done to investigate the ear blockage.

3. Your ear pain may be a referred pain due to common nerve supply. The ear is supplied sensation by many nerves that supply many other regions of the head, neck, chest and abdomen.

4. You may try and ease the Tinnitus by taking steam inhalation through the nose and mouth and taking an anti-allergic decongestant till you see the ENT Specialist.

5. Using ear plugs will increase the awareness of the Tinnitus (you will be able to hear it better in silence). Ambient or environmental sounds tend to drown it out.

6. Various people hear various and multiple kinds of sounds. As ;ong as you do not hear voices, it is normal.

7. Do you use ear plugs at work because there is a lot of exposure to noise? Exposure to noise can cause Tinnitus.

8. You may follow up here with your examination and test results.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Compressed the cartoid artery in neck. Feeling light headed and nauseous. Have I damaged my nerve? 10 hours later
Hi Doctor

I use ear plugs at work because i work in an open plan office. I am a lawyer and work in an open plan office so that there are a lot of people on the phone and talking etc. at the same time and it can be hard to concentrate.

i use ear plugs to help concentrate. do you think this could be a cause of tinnitus? i had thought it is only loud noises (such as if one works in a factory) that could cause tinnitus.

seeing as i have only gotten the tinnitus after i hurt my neck (and it seems to get worse when my neck is tensing etc.) do you think it could be vascular tinnitus. i have detected a pulsing at times and it seems to be mostly in my left ear (i.e. the same side as the neck injury).

if it is related to the injury in my neck i.e. perhaps a pinched nerve - do you think it will be possible to treat it?

if i am finding it hard to sleep at night - do you think it is ok to leave head phones in my ears which play music or play 'white noise' so as to help mask the tinnitus.

also sometimes at work i put an ear plug in one ear only. this causes me to focus on the background sounds more and seems to help drown out the tinnitus a bit. do you think this is ok for the moment?

thanks

 
 
Answered by Dr. Sumit Bhatti 12 hours later
Hi,

Thank you for writing back.

1. Everyone experiences tinnitus sometime during their lives, even when their hearing is normal, especially when the surroundings are quiet. Kindly get your ears examined to rule out blockage due to ear wax (cerumen) build-up, which is the most common cause for tinnitus. Get you blood pressure and hemoglobin levels checked. You may also get a Pure Tone Audiogram (PTA) done after that to rule out any age related hearing loss. You may also get your middle ear pressure checked (Impedance Audiometry). Can you post your Audiograms? What is your Speech Discrimination Score?

2. Exposure to loud noise is only one of the many causes postulated for Tinnitus. The exact cause remains unknown. Decreased hearing also makes one more aware of tinnitus. Hence the use of earplugs will make you more aware of any underlying Tinnitus.

3. How severe is your tinnitus on a scale of 1 to 10? Is it pulsatile (matching with the heartbeat)? If your Tinnitus gets worse with tensing the neck, it is more likely to be Somatic Tinnitus rather than Vascular Tinnitus.

4. One option is to mask the tinnitus by using hearing aids. White noise or unpredictable XXXXXXX Music will help mask the Tinnitus. Common tinnitus therapy includes ginkgo biloba, multivitamins and antioxidants. Transtympanic steroids (dexmethasone) are of help in half the patients I treat. Tinnex (Caroverine) is a newly launched treatment.

There is no cure for tinnitus however in certain cases, it can be controlled.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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