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Welcome to Just Answer. I am an Adult Neurologist and was contacted to answer your question.
hello, I am waiting for you to come into chat
hi, am here
did he lose consciousness with the fall?
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
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
he was taken by ambulance to a hospital. hi has progressed pretty good but it is the mood swings that are bad
the small white matter change in the dorsal pons, also could be a result
these changes can also be non-specific, as from diabetes, hypertension, smoking, high cholesterol, migraine headaches etc.
but from the history, I would suspect the right hemisphere changes are from the fall
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
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 ?
in high blood pressure, you would expect these changes to be symmetric
yes, at the hospital in Kansas city and all reports were sent to our doctor here in ontario
it may be a combination of both processes
will it improve? what can I and other members of the family do to help
but when there is a change in personality, this is a type of cognitive loss
would he be open to an evaluation?
you would start with a neurocognitive assessment
often people change their personality because of a change in their abilities
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
he may be upset internally because he is still having problems doing thing, or still having headaches, etc.
this can become a difficult problem as the patient can go into denial
he says no headaches, but gets frustrated with little things that used to be so easy for him
so I would approach him in that context
tell him that he should get tested for his abilities to do things
he needs neuropsychometric testing to see if he has focal cognitive deficits
and then there is CBT, computer based training, that focuses on doing
rehab for the specific findings, to try and re train his brain to do better
by forming new connections in the brain.
as he progresses, his mood and affect might also improve
there is also medications if he is willing to try them
to improve his ability to do certain tasks
we can try that, I will talk to our family doctor and ask his to set up an appointment
but as a truck driver, there may be some limitations as to what he can take
tell you family doc
he needs a cognitive evaluation, neuropsychometric testing
by a cognitive psychologist
also if you can get him an EEG
he could have temporal lobe spikes on his eeg, from the trauma
yes, as a truck driver the company you work for does random tests for drugs
and that may be changing his personality
well this is not opiates
but anti depressants usually
or he needs meds like modafinil, to improve his attention
but with the CDL people, many meds are excluded
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
try to keep his world simple
day to day
that is really all you can do, you cannot push him as he will not respond and will be defensive
am trying to do that,
think of him as a little boy
but he needs the evaluation , and try to encourage him to at least try it
that is basically what I have been doing, I will do my best to get him to go for an evaluation
maybe his family doc can get the ball rolling
I certainly will take this info the family doctor
it is tough for family members to get this to happen
get back to me anytime if I can help
if you get test results
I can explain them to you
it has been a tough road....a gain, thankyou
Dr Frank T
you are welcome bye