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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I hit my head on April 15th of this year. I had some blood

Resolved Question:

I hit my head on April 15th of this year. I had some blood that came out of my ear the very next morning. I was evaluated by a doctor 1 week later who said the neurology exam he performed was normal. Two weeks after that I felt worse and went for a CT scan. The CT was normal. Since this time I have improved up until a week ago. I have some blurred vision, my right pupil is larger than the left when my eyes are adjusting to light and I have burning feet again. What should I do?
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

neuromd2012 :

Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.

neuromd2012 :

Hello

neuromd2012 :

waiting for you to come online

neuromd2012 :

April 15th, you hit your head, could you explain that in more detail?

neuromd2012 :

did you have a loss of consciousness, or change in consciousness?

neuromd2012 :

blood came out of your ear? did you have a laceration of the external ear canal? or a ruptured tympanic membrane?

neuromd2012 :

did you have a change in hearing?

Customer:

yes, I hit my head on a pointed corner at peer level on my bathroom vanity. I did not lose conciousness.

neuromd2012 :

which ear? right or left?

Customer:

No change of hearing

Customer:

right i think

Customer:

i hit my head on the op right side

neuromd2012 :

so the bleeding was from the sharp corner?

Customer:

the blood i found on my pillow the next morning so i believe it came out of ear

Customer:

just a tiny bit like 1/16 tsp

neuromd2012 :

so it could have just as well been your scalp? you had cut?

Customer:

but i noticed it because i had fresh white pillow cases

Customer:

no there was no cut

neuromd2012 :

ok

neuromd2012 :

the issue is I am trying to see how serious the ear was damaged.

neuromd2012 :

without any change in hearing or balance

neuromd2012 :

then it is unlikely that the blood is from a serious injury to the ear

Customer:

when the family dr eauated me 1 week after incident he said my ears looked fine

neuromd2012 :

right

neuromd2012 :

tell me about the pupil change

neuromd2012 :

there is a common finding called anisocoria

neuromd2012 :

which is a difference in pupil size

Customer:

ok

neuromd2012 :

the key is that the difference remains the same

Customer:

it wasnt like thisbefore

neuromd2012 :

in any light condition

neuromd2012 :

ok

Customer:

heres my situation with the pupil

Customer:

when first exposed to light, the right pupil gets larger than the left pupil

Customer:

then after a few moments they become the same size,

neuromd2012 :

ok

neuromd2012 :

the thing is that pupils constrict to light exposure,

neuromd2012 :

so are you saying that the right pupil constricts less?

Customer:

less slowly correct

neuromd2012 :

there is a condition called an Adies' pupil

neuromd2012 :

hang on ok?

Customer:

ok

neuromd2012 :

http://vision.about.com/od/sportsvision/a/Adies-Pupil.htm

neuromd2012 :

here is a webpage on Adies pupil

neuromd2012 :

so this can be as a result of even mild head trauma

neuromd2012 :

we don't really know why this happens

neuromd2012 :

it is an effect on the parasympathetic fibers to the eye

neuromd2012 :

the way you diagnose this condition

neuromd2012 :

is to go to the eye doctor

neuromd2012 :

and he will use different eye drops to dilate

neuromd2012 :

and constrict your pupil

neuromd2012 :

and will be able to see if you have an abnormal pupillary response to suggest Adies pupil

neuromd2012 :

now the burning feel

neuromd2012 :

feet

neuromd2012 :

have you had this before, before the head trauma?

Customer:

???

neuromd2012 :

what is the situation with your lower back? do you have spinal stenosis, or some disc issue in your back?

neuromd2012 :

you mentioned burning feet?

Customer:

I have occasionally had burning feet. but was worse after hea trauma then went away then came back

Customer:

no problem with my back

Customer:

that I know of...

neuromd2012 :

I have no way to link the burning feet problem with the head trauma , in the setting of a normal CT scan of the brain

neuromd2012 :

to diagnose that problem, you need a neurologist to examen your feet, and look at your deep tendon reflexes

neuromd2012 :

you could have small fiber neuropathy

neuromd2012 :

I will attach a webpage on that condition

neuromd2012 :

http://www.hopkinsmedicine.org/neurology_neurosurgery/specialty_areas/peripheral_nerve/conditions/small_fiber_sensory_neuropathy.html

neuromd2012 :

this is a problem most commonly seen in diabetics.

neuromd2012 :

but you don't have to have diabetes

neuromd2012 :

it is diagnosed by skin biopsy

Customer:

my blood work is text book perfect and i eat lots of good nutrients

Customer:

ok

neuromd2012 :

well if you read that webpage,

neuromd2012 :

you can have this problem and be very healthy

Customer:

ok so the dialited pupils are not of concern to you?

Customer:

ok i will take a look thnk u

neuromd2012 :

we don't have all the reasons for you to suffer from small fiber, but 40 million americans have this problem, and they are not all diabetics

neuromd2012 :

the dilated pupil is a tough issue

Customer:

interesting

neuromd2012 :

there is no treatment for adies

neuromd2012 :

it usually gets better with time

Customer:

i am mostly concerned if you were to think I could have a slow bleen in my head

neuromd2012 :

you shook up the internal brain connections to the pupil

neuromd2012 :

when you hit your head

neuromd2012 :

and they have to reorganize and reprogram themselves

neuromd2012 :

that is the best way to describe it

neuromd2012 :

but there is no real treatment, just time

neuromd2012 :

I understand

neuromd2012 :

well you could have had a retinal hemmorhage

neuromd2012 :

but I assume someone looked in your eye?

neuromd2012 :

with the CT scan

Customer:

no

neuromd2012 :

it is hard to have a bleed

neuromd2012 :

like a subarachnoid or subdural hemmorhage

neuromd2012 :

you need someone to seriously look at your eyes

Customer:

ok so do you think that i just have post concussion syndrome

neuromd2012 :

part of that is a fundiscopic exam

neuromd2012 :

well the adies would say yes to that

neuromd2012 :

but I cannot explain burning feet

neuromd2012 :

post concussion is headache

neuromd2012 :

dizziness, nausea

neuromd2012 :

photophobia or light bothering your eyes

Customer:

diziness yes naseua no

neuromd2012 :

change in mood

Customer:

not so much now,

neuromd2012 :

well a neurologist will look at your eye closely as well

Customer:

but it still feel deep in my brain where I hit that something is definitely off

neuromd2012 :

you maybe should see a neurologist if you feel you have a post concussion

Customer:

and what will they do

neuromd2012 :

look at your eye

neuromd2012 :

do a neurological exam for your dizziness

neuromd2012 :

to see if you have a vestibular disorder

neuromd2012 :

from a brain injury

neuromd2012 :

and then an MRI scan of your brain'

neuromd2012 :

which is more sensitive than a CT for looking at PTS,

neuromd2012 :

and maybe an EEG

neuromd2012 :

looking if there is a change in brain function (brain waves)

neuromd2012 :

as a result of this head trauma

Customer:

ok and if there is ...

neuromd2012 :

you can only treat symptoms of head trauma

neuromd2012 :

it is treated symptomatically

Customer:

do you thik with time i will improve more?

neuromd2012 :

it usually does, yes

neuromd2012 :

that you are doing your activities of daily living currently

Customer:

so just to guess, how long do you think?

neuromd2012 :

it should resolve

neuromd2012 :

within the next few months, if you are 2 months out now

Customer:

I Am doing most of my daily activities

Customer:

ok, and would you advise of no excercise and or alcohol?

neuromd2012 :

I think exercise in moderation is always a good idea

neuromd2012 :

as you are 2.5 months out, I would encourage you

neuromd2012 :

alcohol, if taken to excess, is always a bad idea

neuromd2012 :

and could make your dizziness, worse, it could also effect the burning in your feet

Customer:

ok because i jogged just 1 mile a week ago and it made me a little bit worse

neuromd2012 :

I see

neuromd2012 :

well if you have significant head trauma, you do not want to go into anaerobic metabolism

neuromd2012 :

so I would say walk and don't run

Customer:

ok got it. so if I stay away from any excess alocohol and excercie in moderation ike jog is ok Ill improve?

Customer:

ok

neuromd2012 :

try not to raise your heart rate too much

neuromd2012 :

start slowly

Customer:

am i safe to fly an airplane?

neuromd2012 :

sure

Customer:

the alcohol set me back i had too many wines friday and now am disappointed in the way i feel

neuromd2012 :

if you function day to day, and only have problems with running, you can fly

neuromd2012 :

I see

neuromd2012 :

well use moderation. ok?

Customer:

so that in fact could be he culprit

Customer:

ok thank you very very much. i will do my best. last question

Customer:

so you do i think I will be ok correct, not to worry about internal bleed?

neuromd2012 :

very unlikely to be an internal bleed with a normal CT

neuromd2012 :

it is very sensitive to small amounts of bleeding

neuromd2012 :

you should improve day by day

neuromd2012 :

good luck to you

neuromd2012 :

Dr Frank T

Customer:

thank you kindly, the best to u 2

neuromd2012 :

bye

Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 7201
Experience: Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
Dr. Frank and other Neurology Specialists are ready to help you
Expert:  Dr. Frank replied 1 year ago.
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