Body Types Figure into Olympic Champions
Ever wonder how much body type plays into being an Olympic champion?
Michael Phelps has a strange body type: Phelps’ arm span exceeds his 6-4 height by three inches. (more…)
Can Slurred Speech Have a Benign Cause or Is It Always Serious?
Most causes of slurred speech are life-threatening, but there’s also a small number of benign causes. (more…)
Can You Get Serious Brain Injury Banging Head on Car Door ?
Whether or not a serious injury can result hitting your head on a car door depends on your age.
We’re talking about casually getting in and out of the vehicle, rather than having one’s head shoved into it by an angry mugger.
It also depends on how you define “serious.” Bleeding in the brain sounds like a very serious injury.
However, when an injury is corrected with a 15-20 minute bedside procedure, it doesn’t sound so “serious.”
How serious can getting hit in the head by the car door ever be?
In elderly people, it can cause bleeding in the brain—a condition called chronic subdural hematoma.
This condition can sometimes spontaneously resolve, and in other cases, is treated with a 15-20 minute draining procedure.
Chronic subdural hematoma. Credit: Lucien Monfils
“CSDHs often occur in the elderly after a trivial injury without any damage to the underlying brain,” says a report in the Postgraduate Medical Journal (2002).
An acute subdural hematoma “generally occur in younger adults, after a major trauma,” says the PMJ.
Examples: vehicular accident, skiing accident, being thrown from a horse.
So for a person under 50, hitting one’s head against the car door frame while getting into the vehicle or exiting it does not constitute a major trauma.
Sure, it hurts, but did anything ever come of it? Not if you’re young.
For younger people, “You would have to hit yourself REALLY hard to do enough damage to cause serious brain injury, and most of us — even when we do hit ourselves in that way — only have a minor blow to the head,” explains Susan L. Besser, MD, with Mercy Medical Center, Baltimore, and Diplomate American Board of Obesity Medicine and board certified by the American Board of Family Medicine.
So why can getting one’s head bonked by the car door frame be more serious for an elderly person?
• The brain shrinks with age.
• This creates more space between the brain and skull.
• “This causes stretching of the bridging veins, and the greater movement of the brain within the cranium makes these veins vulnerable to trauma,” says the PMJ.
• Tiny tears occur to the veins.
• The tears are so small that the bleeding is very slow (chronic), and symptoms typically take several weeks to a few months to begin appearing.
With an acute subdural hematoma, such as that caused by getting one’s head slammed through the windshield in a car accident, or repeatedly pummeled in a boxing match, the bleeding occurs within 72 hours and is very life-threatening.
The bigger size of a younger adult’s brain provides a tight fit against the skull, better protecting the bridging veins from tears resulting from trivial bangs to the head.
NOTE: A young person with a pre-existing aneurysm can sustain what appears to be a minor bang to the head — but it may be enough to cause the aneurysm to rupture, requiring immediate medical intervention.
This article pertains to the typical individual and subdural hematomas, which involve torn veins, not arteries.
ER doctors are not surprised when a CT scan of an elderly person shows a chronic subdural hematoma.
When asked if they’d hit their head in the past several weeks, 50-70% report yes, says the PMJ.
“About half the patients have a history of fall but without hitting their head on the ground.”
The whiplash movement of an elderly person’s head from a fall, even though the head never strikes the ground, is enough to jar the brain and tear the veins.
Also, an actual hit to the head may have been so trite that the patient can’t even remember that it ever happened, such as hitting their head against the car door frame seven weeks ago.
What makes an incident like this even more potentially serious to senior citizens is that many are on blood thinners.
Up to 24 percent of cSDH patients are on the blood thinner Warfarin (coumadin) or some other antiplatelet drug.
Middle aged or younger adults, after hitting their head hard on the car door, may become quite unnerved over the possibility of a brain bleed.
They don’t know about chronic subdural hematoma, and perhaps ONLY know about acute subdural hematoma.
When I was 21 I was flipped to the floor (hard mat) in a judo class, getting the back of my head slammed pretty good.
For the next few weeks I feared a “subdural hematoma.” I didn’t know about acute vs. chronic.
Even after three weeks, I was still fearful that any moment blood would start gushing out somewhere in my brain.
After three weeks without incident, I decided that if something bad were going to happen, it would have happened already.
What I didn’t know was that when bleeding begins occurring during the “chronic” phase (three+ weeks out from the incident), you have time to get to the hospital – it’s not one of those screaming ambulance emergencies.
In fact, when my mother in her 80s passed out in the bathroom and slammed her head on the porcelain bathtub, her CT scan later that day was normal. She was fine for six weeks.
Then she awakened with the worst headache ever and weakness in both legs. A new CT scan showed a chronic subdural hematoma.
However…the brief drainage procedure was scheduled for the next morning!
Summary
Non-elderly adults are at much lower risk for a brain bleed from minor bangs to the head; in typical younger adults they are extremely rare.
As much as getting hit by the car door frame hurts…it’s minor when compared to getting one’s head slammed into a tree while skiing, or slammed to concrete from a skateboard trick gone wrong, or falling off a ladder.
Dr. Besser provides comprehensive family care, treating common and acute primary conditions like diabetes and hypertension. Her ongoing approach allows her the opportunity to provide accurate and critical diagnoses of more complex conditions and disorders.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/wavebreakmedia
Source: pmj.bmj.com/content/postgradmedj/78/916/71.full.pdf
Normal CT Scan After Hitting Head: Brain Bleed Can Still Occur
Can Chronic Subdural Hematoma with Symptoms Go Away on Its Own?
Slip & Fall, Hit Head Hard on Concrete: Brain Bleed Prevention
Hit Head? Bleeding in Brain Symptoms Can Occur Six Weeks Later
How Often Is ALS Misdiagnosed As Benign Fasciculation Syndrome?
There are cases in which someone with ALS was misdiagnosed with BFS.
Imagine the devastation when the patient finally receives the correct diagnosis.
From a clinical standpoint, early ALS can resemble benign fasciculation syndrome – at least from the subjective reporting of the patient.
How often is ALS mistaken for BFS by a doctor?
“Although ALS can be misdiagnosed as BFS, this is not common,” says Bonnie Gerecke, MD, director of the Neurology Center at Mercy in Baltimore.
There is no data on how often ALS is misdiagnosed as BFS.
Now it happens that initially, the patient may be told that their symptoms seem to be related to a number of conditions, one of which is benign fasciculation syndrome.
But this is not a diagnosis; it’s an initial assessment.
Dr. Gerecke explains, “The hallmark of BFS is muscle twitching in the absence of other pathological signs and symptoms.
“If a patient presents with muscle twitching and no other symptoms and has a normal examination other than for twitching, it is usually not difficult to recognize this syndrome.
EMG test. Paul Anthony Steward, CreativeCommons
“ALS is associated with weakness and muscle wasting and not just isolated muscle twitching.”
A neurologist will have the patient perform some tests in the office to measure for weakness, and of course, the EMG will be very telling about whether or not nerve conduction is normal.
BFS is not progressive, but ALS is – and sometimes rapidly – and the associated weakness as it progresses is significant.
The bottom line is that it is rare for a person with ALS to be diagnosed with benign fasciculation syndrome.
But to learn just how this can happen, read this interview with Michael Cartwright, MD, a board certified neurologist at Wake Forest Baptist Medical Center in Winston Salem, NC. You will be very surprised by how he says ALS is diagnosed.
Dr. Gerecke has a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
ALS Muscle Twitching vs. BFS Muscle Twitches: Key Differences?
The term “twitching” is ambiguous; there are different kinds.
Certainly, there are variations between ALS muscle twitching and that of BFS.
What are the differences between the twitching muscles of ALS and those of BFS?
“In benign fasciculation syndrome, the muscle twitching is often widespread throughout the body,” says Bonnie Gerecke, MD, director of the Neurology Center at Mercy in Baltimore.
“For example, one can experience twitching in an arm, eyelid, torso or foot,” continues Dr. Gerecke, referring to BFS.
“The twitches in benign fasciculation syndrome are brief and can be frequent.”
You may feel these as very short-lived creepy-crawly sensations, or squiggly worm sensations, right under your skin.
These are especially apparent while you’re sitting still at a computer, while reading or watching TV, and can occur seemingly relentlessly.
With BFS, the twitching will stop the second you begin moving the affected area.
So if the twitching keeps recurring in a hamstring or quad muscle while you’re at the computer, it will stop when you get up and walk, march in place, or even remain seated but bounce the leg up and down.
With benign fasciculation syndrome, you may notice a predictable trigger, namely, whenever your calve muscle twitches, it’s always after you’ve run on a treadmill or used a stationary bike.
Or the twitching that runs rampant in your upper legs and butt always occurs after a rigorous hike. However, benign fasciculations can also occur randomly.
“In ALS, the muscle twitching often starts in one region and spreads locally,” says Dr. Gerecke.
“For example, there can be twitching isolated to the right hand and then it may spread to the right arm and then the left hand and the left arm.
“Also, in BFS, the twitching is not associated with other signs or symptoms.
“In ALS, when a patient experiences muscle twitching, there is almost always associated muscle atrophy (shrinkage of muscles) and muscle weakness.”
Dr. Gerecke has a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Alexander Raths
Muscle Twitching: Is It ALS, Anxiety or BFS? Best Information!
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Bulbar Onset Symptoms vs. Laryngeal Cancer: Symptom Comparison
Laryngeal cancer is one of the scariest diseases, but it would be appealing to someone who’s just been diagnosed with bulbar onset ALS.
Symptoms overlap in these two conditions.
“Both conditions can be associated with hoarseness,” says Bonnie Gerecke, MD, director of the Neurology Center at Mercy in Baltimore with a special interest in neuromuscular disorders, ALS and EMG.
So if you’ve had an unexplained, persistent hoarse voice lately … and no other symptoms with it … it’s understandable how you can be in a state of panic.
Bulbar Onset Symptoms
“There are many different bulbar onset symptoms,” says Dr. Gerecke.
“These include the following: dysarthria (slurred speech), dysphagia (trouble swallowing), trouble chewing, drooling, moving the tongue in the mouth and hoarseness.”
Difficulty speaking (dysphonia) is also a symptom, and this may occur without slurring. The tongue will also shrink due to eventual atrophy.
And of course, there’s the tongue fasciculations, but these are not the same “twitches,” tremoring or quivering that a healthy person sees when they stick out their tongue and inspect it.
It’s impossible to keep the tongue perfectly still when inspecting it, especially if you’re scared of what you’ll see.
The tongue is not designed for meticulous control of movement. It’s not like a finger that you can hold perfectly still.
The tongue twitches of bulbar onset ALS are undulating and wormlike.
Laryngeal Cancer Symptoms
Dr. Gerecke says, “In contrast to bulbar symptoms due to ALS, patients with laryngeal cancer often experience pain when swallowing. They may also experience sore throat, a lump in the neck and cough.”
Bulbar Onset Symptoms that Laryngeal Cancer Will Never Cause
• Speech characterized by “effortful, slow productions with short phrases, inappropriate pauses, imprecise consonants,” says a report in the BMC Ear, Nose, and Throat Disorders (Nov. 2001).
• Slurred speech
• Breathy speech
• Trouble chewing, a feeling of weakness when doing so
• Difficulty moving the tongue within the mouth
• There may be lip involvement very early on, affecting swallowing.
• Saliva control when eating. There is excess saliva regardless of eating as the ALS progresses.
• Tongue atrophy
• Tongue fasciculations
Laryngeal Cancer Symptoms that Bulbar Onset ALS will Never Cause
• Sore throat
• Constant coughing
• Pain when swallowing, though there is no mechanical difficulty.
• Ear pain
• Lump in the neck
• Weight loss
Symptoms Shared by Bulbar Onset ALS and Laryngeal Cancer
• Hoarse voice, though not all laryngeal cancers cause this.
• Trouble swallowing
• Trouble breathing (ALS causes this via a vocal cord spasm)
Benign conditions such as LPR can cause some of the symptoms listed here.
Laryngeal cancer is a very uncommon disease, and bulbar onset ALS affects about one in 300,000 people.
Dr. Gerecke has a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/ShotPrime Studio
Sources:
ncbi.nlm.nih.gov/pmc/articles/PMC60006/
cancer.org/cancer/laryngealandhypopharyngealcancer/detailedguide/laryngeal-and-hypopharyngeal-cancer-signs-symptoms
als.ca/sites/default/files/files/Bulbar%2520ALS.pdf
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