Pre-Syncope and Ataxia After Spinning Whiplash

Abstract

This is a 46-year old female presenting to her Primary Care Physician on Day #2 post-motor vehicle accident. She was the driver of a large suburban truck that was suddenly T-boned into her left drivers' rear wheel, whirling 360 degrees to face oncoming traffic. She and her daughter went home. But over time, the patient slept more and more. She experienced ataxia and pre-syncope. Dozens of presentations to the Emergency Department (ED) ensued. Eventually, she could not stand up without vertigo, ataxia, pre-syncope, and vomiting. After 2 months, the patient still had severe nausea and vomiting 12 times/day, was weak, ataxic, confused, and had short-term memory loss, and developed tinnitus and an expressive aphasia. She still had pre-syncope on standing. She was diagnosed with a traumatic brain injury (TBI).After 3 months, the patient underwent an MRI of head and neck without contrast, and it was negative. Ten ED visits later, the doctor ordered a spiral CAT scan that detected an extra cranial 3 cm left vertebral artery dissection (VAD). Angiogram confirmed the VAD at C4-5, with a 2 cm aneurysm at the base. Medical management failed to correct pre-syncope, so the patient kept "doctor shopping" until led to Electrophysiology Cardiologist, Dr. David Cannom, MD. She underwent the Tilt Table Test (TTT), passing out for 22 seconds. The diagnosis of Dysautonomia was made. This was aggravated by polydypsea and polyuria, so she was diagnosed with diabetes insipidus (DI) and placed on a PICC line for almost four years.After 7 years and a nearly full recovery with a return to work as an anesthesiologist in sight, a neurologist allowed her fall to the hard wood floor during his "close your eyes and touch your nose" exam while standing; the patient sustained another TBI with DI and remains disabled.

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“…[11][12][13] She also presented multiple Poster Presentations and was a leader in her field, Hyperpolarized 3 He-MRI of the porcine lung, having internationally lectured on V/Q mismatch and 3 He-MRI of the lungs. 14,15 She collaborated with other anesthesiologists, radiologists, internal medicine physicians, and physicists on projects [11][12][13] and helped write $3 million in successful NIH Research Grants at the University of Pennsylvania.…”