Most GPs and specialist consultants can't distinguish whether mTBI symptoms are neurological, physiological or psychological following a clear CT scan. These are cyclic domains and act on each other.
Whiplash and impact injuries damage the neck, face and head. Nerves in the cervical spine get impinged and tissue damage causes inflammation that compress nerves, both cause tremors in the body and affect signalling to the vestibular system and facial muscles causing balance and visual issues.
The vestibular system comprises fluid filled canals in the inner ear and temperomandibular (jaw) joint. There are crystals in the canals that trigger motion sensors. Following an injury these crystals get displaced and no longer trigger the motion sensors properly, causing confusion in body stability. The vestibular system is also linked to motor control in the eyes which lose horizontal and vertical axis control.
Eyes and eye regions also get damaged in accidents affecting muscles that control movement and eye components such as the retina that affects sensory signalling to the brain.
All the sensory signals go to the thalamus, which is a junction box in the brain. If the signals are not normal, the thalamus triggers a stress response that increases cortisol, blood pressure and flow, increases breathing, and affects the gastric system by increasing acid production. This response is automatic, pre-perceptual, pre-congitive, ie you haven't thought about it, it's not psychological or of the mind.
This stress response that acts within 100 milliseconds and within 200 milliseconds it triggers a change in mood (this all occurs in the right brain hemisphere). The left brain hemisphere is triggered via signals across the corpus collosum and initiates an emotional response followed by language based thoughts, objective reasoning, (what the fuck is going on!) within 300 milliseconds. This is the psychological element. (Visual based 'thoughts' are linked to PTSD in the right hemisphere). If the events that trigger the stress response continue the effects become hard wired in the brain.
None of what I have described so far is due to neurological damage. They are psychosomatic and psychological.
If a CT brain scan is clear then what I have described are the symptoms seen by GPs and consultants.
If you have visual, vestibular treatment many of the causes of the stress response can be solved and remaining psychological effects can be overcome.
Only after this, if symptoms persist, a neurological condition can be investigated.
The problem is that most health authorities in the UK have no, or inadequate visual and vestibular services. Which means the causation of stress response continues and the psychological effects persist resulting in depression. The psychological effects can't be solved until the causation is treated. The neurological effects of brain damage are hardly ever found.
New brain imaging techniques, diffusion tensor imaging, can identify neurological damage traumatic axonal injury, after an accident, but this imaging technology is not available in mainstream healthcare hospitals.
So until there are proper vision and vestibular screening and treatments and also modern imaging technology, particular types of brain injury, the most common, mTBI/PCS will not be dealt with.
Well I have to say pink yet another brilliant post full of factual information I saw a physio for my disfibibular distribution months ago wich helped a little with dizziness it makes sence to me about right sided damage and impact of the effects of this but it does seem there is a lot less known about the brain than the rest of the working body
Thanks Janet, just thought I'd share info that may be of interest to people. I wish I knew most of this in my first two years post BI. The info I'm sharing is to do with axonal injury but there will be crossovers that may join a few dots for other BI's. I have noticed you have always seemed outward focused and getting on with activities. Keep the gym work up and you'll be running the doors in the Manchester club scene soon. Wishing you well, take care.
Interesting PV. Makes sense in the light of the rehab I got, certainly. Loads of ( fairily painful) neck manipulation and neck exercises, alongside all the vestibular and oculomotor exercises.Have you come across the work by John Leddy at Buffalo university in States - no-one here seems to have come across it except me in my rehab - where my inability to exercise was very marked - but it's interesting they regard autonomic dysfunction as one of the various outcomes of TBI.
This isn't a paper, but there are a few on the web.
Interesting - how do you define psychosomatic by the way - because I think most of us would probably think of psychosomatic as just meaning 'all in the mind' which I don't think is the way you're using it here? Ta!
Excellent information thank you, I find it shocking that in the year 2022 almost 90% of the medical profession have no knowledge of a condition called cervical myelopathy, which can also be caused by whiplash or any trauma to the cervical spine, and also by degenerative changes, this can also prevent the messages from your brain getting to almost any part of your body to function. I now have this condition and mine was originally caused by the trauma to my cervical spine when I had my TBI
Yep have only just had my cervical spine results, five and a half years post injury, cervical spine damage blocks the median and ulnar nerve function in my left arm. My brain is sorted though so that's ok with me.
I am genuinely pleased for you, but my cervical myelopathy is from c3 thru to c7 and my spinal cord is compressed so much that surgery is not a option for me, I recently moved in to a care home because of it,
I really gave vestibular therapy a good shot just after the mtbi I had, and could get nothing out if it - all it did was make my symptoms worse.
With your explanation, I think I can understand why.
The therapst I saw didn't think it found be the mtbi because she had earned in out patient at the hospital - though I could not go anywhere near ehete the program was, I would end up on the floor - so, she never would have seen those with the same symptoms as me - none if them would gave seen her there, either.
I also had the crystals reset - expectation I would be all better. Nope.
The vestibular person had a machine she did some tests with and said I had down beating nystagmus, but the doctor merely pooh pooh 'd it. I also had a test by an ENT ... the machine had lights that moved back and forth - you were supposed to keep your head still and look, but I couldn't do it - I got really dizzy and nauseous. I thought, well maybe now I will get some answers. No. I found out later the GP I had at the time was calling all these people up and telling them I was faking or crazy, not sure...and then I found out from someone else he was being sued for malpractice - which must have been bad because that just doesnt happen here in Canada.The same test group showed I had some issues when they put water in my right ear - I also lost quite a bit hearing in that ear.
The ENT offered no explanation, and when I asked he told me to get out of his office and stop wasting his time. There was only the one where I live, at the time.
I don't know what that test was... it is now 15 ish years out - worth asking for it again do you think? (The queue is about 18 to 24 months for non urgent stuff.)
More recently I went to someone who looks at how the brain and eyes work together. He said vision therapy would help, and that I didn't need prisms in my eye glasses. There is no standard protocol for neurovisual therapy here - some people I've talked to thought it helped a lot, though they were useless at anything else while going through it, and others said they got no benefit - and, there is no coverage for it, and it's 4k . So I didn't go for it. ( I'm also not in a position to be useless for the months it takes to go through.)
Do these sound like what you mean , PV, or was there something else?
Ah that sounds like a nightmare runaround, those vision tests sound a bit hit and miss depending on the experience of the provider. It's best to ask if they have neuro rehab experience beforehand, 15 years is a long time ago in that industry. Not sure where you are in Canada but Ontario State seems to be ahead of the game with neurorehab, but again it's finding the right people. Here's a link to a hospital that does provide rehab sjhc.london.on.ca/
Ontario is a 6 hour jet ride from BC, where I live - for perspective it's 9 to the Uk (over the polar cap ) from here. Another thing is, if I travel to another province I have to buy travel insurance - I am not necessarily covered - medical services are offered by province, not federally. I am not sure if some arrangement can be made, I will have to ask.
At some point they might consult with a specialist , or gp, from here - if I had either of those. I don't. The specialist I was seeing is no longer practicing. There are no other neuro psych's in the area. And, I have only limited access to a random gp through a walk in clinic. Never seems to be the same one twice. (They are trying to make it better.)
Yes, it's a hot mess over here.
Never any harm in getting info, though, so I do very much appreciate the reference.
I put a call in to their out patent unit and left a message asking.
They have a lot if good stuff on their website about coping strategies so I'll have a look through that. I think I 've got a lot of those down, but never hurts to check more info out. You pick up different things.
I've asked around here for a neuro psychiatrist who does appointments online - you would think this would be easy to find. Nope.
I suffer with tbi and osteoporosis developed in 1998. The NHS took me from the car accident, then to get correct treatment urgently I went private for 22 years,I now receive some of my treatment through NHS, I still pay for physiotherapy, had to go privately initially to receive appropriate treatment.
Thank you for posting this, it helped me to understand why I have experienced all these symptoms. Although my GP always listened and took me seriously, referring me to several consultants (balance, vestibular, neurology), none of them could explain why I was feeling how I did, and all dismissed me because my CT and MRI scans were clear.
Neuro psychiatrists are the ones that can diagnose based on clinical observation. That's who gave me my diagnosis and did paperwork for those needing it. They also can recommend things to do for it, medications, etc.
Your PV posts have really meant a lot to me, I'm really grateful. I had a crainiotomy to remove a Menigioma (baseball sized, left temple and optic canal, and gamma knife to stop it's growth-all seemed to heal, but I haven't been the same since. I understand it's not as bad as horror of a car accident (or IED, good God), Im lucky yoga/meditation healthy diet has been part of my life for most of it. But damn. I have learned more about the system wide effects of a crainotomy (and a titanium mesh patch) from your posts, than my primary, neurologist, plastic surgeon, oncologist, radiologist, et al. Many, many thanks!!
Thanks, tell me more about your yoga and meditation practices. A lot of the work I'm doing relates to meditative/yoga techniques and I'd be interested to get your take on how it's helpful, ie do you follow a routine? is it your own routine? or is it a set routine from a particular meditative tradition? and anything else you think interesting. I know the wheel of the dhamma and the eight limbs of yoga so go as deep as you like.
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The NICE guidelines for diagnosis and rehabilitation of TBI of all types have been updated. Good news and bad news.
Still coming to terms...
Mild Traumatic Brain Injury (MTBI/Concussion) Treatment
"Tonics" 
