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What Causes Exhaustion And Speech Disorder Post Head Injury?
Question: On XXXXXXX 3 I fell and slammed my head against the wall of a building. I had an EEG and MRI and I did not have a stroke. I may fallen bc of a seizure but that is not at all sure. It seemed that I tripped and fell. The question is this. In the aftermath I was exhausted and for several weeks I did not have control of my speech. I thought I was speaking clearly and people should understand what I said and they did not. Could you speculate about what was going on here?
Brief Answer:
Diffuse axonal damage possible.
Detailed Answer:
I read your question carefully and I understand your concern.
Regarding on whether it was a seizure or not that is hard to assess from a single episode without any detailed description of the episode from external witnesses as well as you. Generally a seizure in the adult has a cause such as stroke, tumor, infection etc, so since none was detected on MRI and EEG was normal even if it was a seizure it most probably won't evolve into epilepsy. It wouldn't cause the exhaustion in the following weeks anyway.
The most probable explanation for those weeks could be either brain damage or a psychological component.
At times even when there is no lesion on MRI it is possible to have happened diffuse changes of the nerve fibers due to the extreme stretching due to the trauma, it is a reversible phenomena leading to a transitory dysfunction of a percentage of the nerve fibers which eventually heal. Because it's not a lesion involving a group of cells but isolated nerve fibers (axonal injury) in a widespread manner MRI might miss it. Whether this type of phenomena was alone responsible or there was some psychological components like depression which you mention that is at times hard to completely differentiate, often both components are present.
I remain at your disposal for further questions.
Diffuse axonal damage possible.
Detailed Answer:
I read your question carefully and I understand your concern.
Regarding on whether it was a seizure or not that is hard to assess from a single episode without any detailed description of the episode from external witnesses as well as you. Generally a seizure in the adult has a cause such as stroke, tumor, infection etc, so since none was detected on MRI and EEG was normal even if it was a seizure it most probably won't evolve into epilepsy. It wouldn't cause the exhaustion in the following weeks anyway.
The most probable explanation for those weeks could be either brain damage or a psychological component.
At times even when there is no lesion on MRI it is possible to have happened diffuse changes of the nerve fibers due to the extreme stretching due to the trauma, it is a reversible phenomena leading to a transitory dysfunction of a percentage of the nerve fibers which eventually heal. Because it's not a lesion involving a group of cells but isolated nerve fibers (axonal injury) in a widespread manner MRI might miss it. Whether this type of phenomena was alone responsible or there was some psychological components like depression which you mention that is at times hard to completely differentiate, often both components are present.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Taka, Thank you for your clear answer. I was so dramatically impacted by this event that I believe both the transitory dysfunction of nerve fibers and depression were at work.
Something else I have wondered about is whether an EEG can detect a seizure that has taken place several hours before the test, such as 12 hours before? The same question applies to the MRI, which was given nearly a week after the fall. If you could address this, I would appreciate your understanding. Many thanks. XXXXX
Something else I have wondered about is whether an EEG can detect a seizure that has taken place several hours before the test, such as 12 hours before? The same question applies to the MRI, which was given nearly a week after the fall. If you could address this, I would appreciate your understanding. Many thanks. XXXXX
Brief Answer:
Read below
Detailed Answer:
Of course I will gladly address your question.
A seizure means the presence of abnormal electrical discharges in the brain. During a seizure the EEG detects this abnormal electrical activity with certainty.
Outside of the seizure it can still detect at times some abnormalities, some abnormal waves coming from the hyper-excitable area where the seizure originates. That is not always the case though and it could well be for an EEG to result normal in a patient with epilepsy. In terms of percentages, outside of the seizure episode the EEG is abnormal in 50% of the cases. So the EEG never makes the diagnosis by itself, only supports it.
As for the MRI, it doesn't detect a seizure at all. You have to understand that at your age epilepsy doesn't come out of the blue. There has to be a cause to suddenly start it by causing focal damage like a stroke, tumor, traumatic brain injury, infection etc. So the MRI is done to detect such a potential lesion which could cause a seizure, not for the seizure itself.
When one evaluates a patient for a seizure it is very rare that we have the luxury of the patient having the seizure under EEG, so we have to take all three components into account: seizure observation/description, EEG outside of seizure and MRI for potential cause. Since the last two in your case do not provide any data to support a seizure hypothesis and without much available information on the episode there is no reason to call the episode a seizure. Even if it was a seizure, since as I said at your age there is usually an underlying cause which is excluded by MRI, a metabolic or circulation issue would be more probable than a brain lesion.
I hope to have been of help.
Read below
Detailed Answer:
Of course I will gladly address your question.
A seizure means the presence of abnormal electrical discharges in the brain. During a seizure the EEG detects this abnormal electrical activity with certainty.
Outside of the seizure it can still detect at times some abnormalities, some abnormal waves coming from the hyper-excitable area where the seizure originates. That is not always the case though and it could well be for an EEG to result normal in a patient with epilepsy. In terms of percentages, outside of the seizure episode the EEG is abnormal in 50% of the cases. So the EEG never makes the diagnosis by itself, only supports it.
As for the MRI, it doesn't detect a seizure at all. You have to understand that at your age epilepsy doesn't come out of the blue. There has to be a cause to suddenly start it by causing focal damage like a stroke, tumor, traumatic brain injury, infection etc. So the MRI is done to detect such a potential lesion which could cause a seizure, not for the seizure itself.
When one evaluates a patient for a seizure it is very rare that we have the luxury of the patient having the seizure under EEG, so we have to take all three components into account: seizure observation/description, EEG outside of seizure and MRI for potential cause. Since the last two in your case do not provide any data to support a seizure hypothesis and without much available information on the episode there is no reason to call the episode a seizure. Even if it was a seizure, since as I said at your age there is usually an underlying cause which is excluded by MRI, a metabolic or circulation issue would be more probable than a brain lesion.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr Taka, Thank you so much for this explanation. It is EXACTLY what I need to know.
Brief Answer:
You're welcome.
Detailed Answer:
You're welcome. I wish you good health.
You're welcome.
Detailed Answer:
You're welcome. I wish you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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