Recurrent Neurological Episodes Following Minor Head Trauma

Case at a Glance

A 33-year-old female presents with three episodes of neurological symptoms following minor head trauma to the same occipital region over 5 years, with two episodes occurring within 6 months.

Patient's Story

The patient is a 33-year-old female (5'4", 165 lbs) with a medical history of focal seizures managed with lamotrigine, depression treated with bupropion, and hypertension controlled with beta blockers. She reports three distinct episodes over the past 5 years where minor trauma to the lower occipital region resulted in significant neurological symptoms. The most recent episode occurred when she struck her head on a soft plastic drawer of a t-shirt press. She emphasizes that the impacts were always gentle and did not cause immediate pain. The patient denies participation in contact sports and has no history of other head injuries.

Initial Assessment

Each episode follows a consistent pattern: approximately 20 minutes post-trauma, the patient develops diplopia, severe disorientation, bradylalia, and cognitive impairment including inability to recall basic information such as the current president's name. She experiences severe photophobia requiring 3+ days of bed rest in a darkened room. Notably, she maintains consciousness throughout all episodes. Multiple emergency department evaluations have yielded normal findings, with physicians attributing symptoms to aging.

The Diagnostic Journey

The patient has presented to emergency departments on multiple occasions, with standard neurological assessments reportedly normal. The consistent location of trauma (lower occipital region) and the disproportionate neurological response to minor trauma raises questions about the underlying pathophysiology. The patient's existing seizure disorder and current anticonvulsant therapy add complexity to the clinical picture.

Final Diagnosis

Pending neurological evaluation. Differential diagnosis includes post-traumatic migraine, seizure-related phenomena, or other neurological conditions rather than true traumatic brain injury given the minimal mechanism of injury.

Treatment Plan

Referral to neurology for comprehensive evaluation of recurrent post-traumatic neurological episodes. Consideration of imaging studies and EEG monitoring. Review of current seizure management and potential relationship to presenting symptoms.

Outcome and Follow-up

Patient advised to follow up with neurology specialist for further evaluation. Given the atypical presentation with minimal trauma causing significant symptoms, alternative neurological etiologies are being considered rather than traumatic brain injury.