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Dr. Caplan
Dr. Caplan, Physician
Category: Neurology
Satisfied Customers: 71
Experience:  A family doctor, with medical and residency training in Boston, MA, patients of all ages and wide range of illnesses.
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Can you have a delayed paresthesia ( I am having symptoms of

Resolved Question:

Can you have a delayed paresthesia ( I am having symptoms of radial neuritis in my right arm) after a grade 2 concussion? I sustained the concussion last Monday 11/11 and began getting the interment feeling of my arm being " alseep" which continue now. It is usaually in the morning but have it at night at times. My muscles are fine but I struggle with fine motor skills like writing when the nerves are acting up. Of note, I did sustain the concussion by falling backwards so I am also wondering if I could have did something to my spine which is causing it.  I am confused because it was delayed by about 5 days. 

Submitted: 4 months ago.
Category: Neurology
Expert:  Dr. Caplan replied 4 months ago.

Dr. Caplan :

Hello - Welcome to JA

Dr. Caplan :

I am a board certified Family Medicine doctor, with certification in Internal medicine, Pediatrics, Obstetrics and Gynecology, as well as Integrative medicine, with advanced training in Neurology, Cardiovascular Medicine, Gastroenterology, Endocrinology, and Psychiatry. I am also well-trained in naturopathy and Functional Medicine, and perhaps most importantly, a patient listener.

Dr. Caplan :

Would you prefer a summary answer to your question, or would you prefer more back-and-forth, where there will be a series of more questions and more details clarified?

Either way, I’ll do my best to take the appropriate time to help you.

Customer:

Hi Doctor, you could just do a summary and if I have a question I will follow up?

Customer:

How does that sound

Dr. Caplan :

certainly! That sounds good to me.

Dr. Caplan :

The goal with JustAnswer is excellent patient satisfaction, so this really gets to be your ship to run as you see fit.

Customer:

ok i will wait for your response then.

Dr. Caplan :

great!

Dr. Caplan :

I'll do some research and get right back to you

Customer:

ok

Dr. Caplan :

I'm sorry to hear about your concussion. From the language you use to describe the event, it seems that either you were seen in an ER and given those diagnoses, or you are familiar with the terms yourself from research or experience. Either way, it's great to hear that you're being proactive. The short answer to the question about delayed paresthesia from a concussion is "yes, neuritis is possible with any minor brain trauma, but it would very unlikely." Some of the likelihood that the arm symptoms are related would depend on the degree of injury you sustained, but truthfully, it is much more likely that they are not related. For example, it's more likely that you were resting your body weight on some of the nerves in your shoulder or arm, and caused a temporary neuritis that way, rather than secondarily due to the brain trauma

Customer:

Right, that's what I was told, I am just concerned because it is coming and going throughout the day. I also went back to work for the first time today and began to get it in my leg on the same side and also radially

Dr. Caplan :

If, however, the concussion was severe, and your brain was jostled significantly during the event, it is theoretically possible (though again, unlikely) that you either impacted areas of your arm nervous control, or alternatively, endeavored into a state of autoregulation and anti-inflammation that could irritate the nerves in your arm

Dr. Caplan :

I see.. That is helpful information.

Dr. Caplan :

the coming and going, as opposed to being continuous and unprovoked, is a good sign. That should be reassuring to you

Customer:

either way, is it at least temporary? I don't mind to much as long as I know it isn't long term

Customer:

yes it is.

Customer:

I did suffer temporary amensia ( bout 3 hours) I don't know if that helps contextualize the concussion or not

Dr. Caplan :

There are fewer injuries on the concerning spectrum that come and go as you describe

Customer:

ok, so the basic answer is, most likely not but possible... wait and see?

Dr. Caplan :

that is a useful symptom, helps me understand a little more yes.

Dr. Caplan :

I would say it is very very unlikely this symptom would be long-term.

Dr. Caplan :

this is for 2 reasons.

Dr. Caplan :

one, the mechanism of injury,as you describe it, does not suggest that there was damage to the arm nerves

Dr. Caplan :

(is this a fair assumption?)

Customer:

yes

Customer:

right its not like it would do damage a week later, if there was damage there would be damage right off the bat

Dr. Caplan :

secondly, as a 28 year old male, your body is still quite young, and adaptable, and even if there were an injury to the arm nerve, more than likely, you would be able to adapt easily, and your brain would essentially learn to ignore the bothersome signals.

Dr. Caplan :

correct.

Customer:

o that makes sense

Dr. Caplan :

there would be no further damage, only repair.

Customer:

one last question while I have you

Dr. Caplan :

surely, please :)

Customer:

. last night I started to develop a significant pain in my left temple. It was bad enough I was beginning to get concern. I woke up with no pain and went to work ( half day) and the pain is coming back in the same spot. I would imagine 8 days later than there would be no bleeding to worry about, would it be safe to say this is just part of the normal on and off headaches I have had?

Customer:

it's been the worst head pain I have had so far ( heaches with this have been very mild it is more dizziness)

Customer:

very localized in the left temple

Dr. Caplan :

I see. How does it relate to what caused your concussion? did you hit your head in that area?

Customer:

no i hit the back of my head I fell backwards

Dr. Caplan :

Ah. That is reassuring.

Customer:

it really does not make sense that it should relate at all except that i've never had the pain before in my life and its close to after the concussion

Dr. Caplan :

There are some blood vessels in your temple area that are concerning for emergent issues, if there were impact. But as I understand it here, that is not the case

Dr. Caplan :

the nerves in your brain are delicate, and the skull very hard. This makes for a lousy combination if you hit your head hard.

Dr. Caplan :

you can get what is called "diffuse axonal injury" which is something like a pulled leg muscle if you stretch your leg more than it is used to.

Dr. Caplan :

for some, that evolves into headaches.

Customer:

No it is not there was no impact there but there was significant whiplash as my head hit the ground and back up again, actually strained my jaw muscle up by my ear as a result of the impact

Dr. Caplan :

Ah.. is that the side where the temple is bothering you?

Customer:

so even say I did hit my head there, if there was damage to those blood vessel, I would have know about before now right?

Customer:

no other side

Dr. Caplan :

Most likely, yes... this is very late in the game, but it's serious enough that it's worth considering

Dr. Caplan :

Do you know if you grind your teeth at night?

Customer:

no i don't plus the pain started before i went to bed last night

Customer:

also the pain was gone this morning I don't know if that helps

Customer:

and came back

Dr. Caplan :

that is reassuring for most things related to the concussion.

Dr. Caplan :

the most likely causes for those headaches include TMJ concerns (your jaw, grinding, teeth issues), caffeine withdrawal, and dehydration

Customer:

if it was that emergency situation you spoke of , it would most likely not have gone away ?

Dr. Caplan :

do you drink a lot of caffeine?

Dr. Caplan :

not necessarily.

Customer:

a good amount

Dr. Caplan :

the timing suggests caffeine more than anything concerning

Customer:

Would you say then maybe the temple thing would be a good idea to at least put a follow up call in to the doc?

Customer:

oo

Customer:

ok

Dr. Caplan :

I don't think it's worth contacting them at this point.

Customer:

ok

Dr. Caplan :

if you have any symptoms of fading consciousness, or feel lightheaded, that might be a different story

Customer:

well i do have the lightheadness but thats been since I hit my head

Dr. Caplan :

but if you can bear it, I would recommend tapering down your coffee use

Customer:

long before the concussion

Customer:

I can

Dr. Caplan :

yeah, I mean, woozy that you'd need to sit down

Customer:

gotcha

Dr. Caplan :

and, while you taper the coffee, see if you can't get yourself to drink water (or electrolyte drinks) enough so your pee turns clear throughout hte day

Dr. Caplan :

the first urine of the morning you get some yellow free, but hte rest of the day, urine should be clear. That's a good indication you're well hydrated

Customer:

ok thats good advice

Dr. Caplan :

you're welcome.

Customer:

ok well that should do it then

Customer:

thanks for the advice and the peace of mind

Dr. Caplan :

Was I able to address your question to your satisfaction? CanI answer any other questions for you today?

Customer:

you certainly did, that will be all. Thanks for the help

Dr. Caplan :

You're welcome. If you have any follow up questions, don’t hesitate to ask.
Please click on EXCELLENT
Thank you.

Customer:

Thanks bye now

Dr. Caplan, Physician
Category: Neurology
Satisfied Customers: 71
Experience: A family doctor, with medical and residency training in Boston, MA, patients of all ages and wide range of illnesses.
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