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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 8999
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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hi, my husband had a fall in oct 2012 resulting in a severe

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hi, my husband had a fall in oct 2012 resulting in a severe concussion. the mri shows one t2 hyperintensity is noted within the left dorsal aspof the pons. there were 5 small white matter hyperintensities for which are noted with the deep and subcortic al white matter of the cerebral hemispheres more so on the right. Can you explain what this means. Also I and other family members have noticed a change in his personality, he gets nasty with me and finds fault with all that I do, he will argue with family members over issues that are in the past, he was not like this before, he was kind, considerate and caring of others, but no longer is, seems only concerned with himself and his needs.

neuromd2012 :

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

neuromd2012 :

hello, I am waiting for you to come into chat

Customer:

hi, am here

neuromd2012 :

hi

neuromd2012 :

did he lose consciousness with the fall?

Customer:

yes, and a cut to the right side of the head that required stitches. he was unconsciousness with eyes open of a few minutes, I woke his as quickly as I could. did not let him move, he hit the cement on the right side of the head, then right shoulder and the rest of his body, he fell 5 feet from the trailer, backwards doing a complete flip

neuromd2012 :

I see.

neuromd2012 :

well the changes in the right hemisphere, in the subcortical area, if there is a linear character to them especially, could be the result of the concussion, with a contusion or bruise in the brain at that time

Customer:

he was taken by ambulance to a hospital. hi has progressed pretty good but it is the mood swings that are bad

neuromd2012 :

the small white matter change in the dorsal pons, also could be a result

neuromd2012 :

these changes can also be non-specific, as from diabetes, hypertension, smoking, high cholesterol, migraine headaches etc.

neuromd2012 :

but from the history, I would suspect the right hemisphere changes are from the fall

Customer:

he didn't remember falling or hitting the ground. he does not have diabetes, or headaches nor smoke. he has had bigh blood pressure for about 10 years

neuromd2012 :

so with the mood swings, it is most likely that his temporal lobe connections on the right side were effected as well. Did he get an EEG ?

neuromd2012 :

in high blood pressure, you would expect these changes to be symmetric

Customer:

yes, at the hospital in Kansas city and all reports were sent to our doctor here in ontario

neuromd2012 :

it may be a combination of both processes

Customer:

will it improve? what can I and other members of the family do to help

neuromd2012 :

but when there is a change in personality, this is a type of cognitive loss

neuromd2012 :

would he be open to an evaluation?

neuromd2012 :

you would start with a neurocognitive assessment

neuromd2012 :

often people change their personality because of a change in their abilities

Customer:

no, his brother and mother have both tried to talk to him about going back to the doctor but he refuses, saying there is nothing wrong with him, we have the problem

neuromd2012 :

he may be upset internally because he is still having problems doing thing, or still having headaches, etc.

neuromd2012 :

this can become a difficult problem as the patient can go into denial

Customer:

he says no headaches, but gets frustrated with little things that used to be so easy for him

neuromd2012 :

right

neuromd2012 :

so I would approach him in that context

neuromd2012 :

tell him that he should get tested for his abilities to do things

neuromd2012 :

he needs neuropsychometric testing to see if he has focal cognitive deficits

neuromd2012 :

and then there is CBT, computer based training, that focuses on doing

neuromd2012 :

rehab for the specific findings, to try and re train his brain to do better

neuromd2012 :

by forming new connections in the brain.

neuromd2012 :

as he progresses, his mood and affect might also improve

neuromd2012 :

there is also medications if he is willing to try them

neuromd2012 :

to improve his ability to do certain tasks

Customer:

we can try that, I will talk to our family doctor and ask his to set up an appointment

neuromd2012 :

but as a truck driver, there may be some limitations as to what he can take

neuromd2012 :

yes

neuromd2012 :

tell you family doc

neuromd2012 :

he needs a cognitive evaluation, neuropsychometric testing

neuromd2012 :

by a cognitive psychologist

neuromd2012 :

also if you can get him an EEG

neuromd2012 :

he could have temporal lobe spikes on his eeg, from the trauma

Customer:

yes, as a truck driver the company you work for does random tests for drugs

neuromd2012 :

and that may be changing his personality

neuromd2012 :

right

neuromd2012 :

well this is not opiates

neuromd2012 :

but anti depressants usually

Customer:

I

neuromd2012 :

or he needs meds like modafinil, to improve his attention

neuromd2012 :

but with the CDL people, many meds are excluded

neuromd2012 :

like adderall

Customer:

ok, I thank you and will take this info to the doctor with me, is there anything specific I can do here at home so that he is not so nasty with me

neuromd2012 :

try to keep his world simple

neuromd2012 :

day to day

neuromd2012 :

no stress

neuromd2012 :

that is really all you can do, you cannot push him as he will not respond and will be defensive

Customer:

am trying to do that,

neuromd2012 :

think of him as a little boy

neuromd2012 :

but he needs the evaluation , and try to encourage him to at least try it

Customer:

that is basically what I have been doing, I will do my best to get him to go for an evaluation

neuromd2012 :

maybe his family doc can get the ball rolling

Customer:

I certainly will take this info the family doctor

neuromd2012 :

it is tough for family members to get this to happen

neuromd2012 :

ok

neuromd2012 :

good luck

neuromd2012 :

get back to me anytime if I can help

neuromd2012 :

if you get test results

neuromd2012 :

I can explain them to you

Customer:

it has been a tough road....a gain, thankyou

neuromd2012 :

Dr Frank T

neuromd2012 :

you are welcome bye

Customer:

wonderful....

Customer:

bye

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