Snowflakes And The Aftermath

“Concussions are like snowflakes.” I’ve heard a couple of doctors use this explanation. I think they’re right.

We’re used to hearing the expression in the context of every snowflake being a little bit different. But ultimately snowflakes are more alike than they are different.

And one of the unifying things about concussion—and particularly post-concussive syndrome—is just how difficult it is for both patients and doctors to clearly describe symptoms and identify causes.

That sounds funny. Because symptoms associated with most injuries are usually pretty obvious. And the challenge is usually determining what’s causing them.

But with post-concussive syndrome the symptoms overlap and are intertwined. Let me give you an example.

I’ve been having challenges with reading and depth perception. I thought my prescription changed in one eye following the wreck. So I went into the optometrist.

I found out that my prescription had changed. But that the big problem was there was a significant convergence insufficiency.

Convergence insufficiency is an eye neuromuscular coordination issue. It’s common after concussion.

As a result of the concussion the neuromuscular connection stops working properly. That means the muscles lose efficiency, endurance and strength. Greater effort is required to move the eyes medially, which causes eye strain and pain, just like with any other muscle injury.

Symptoms typically worsen with reading, computer use, or a visually demanding environment.

Common symptoms of convergence insufficiency include blurred vision, diplopia (double vision), near-sighted discomfort, frontal headaches, pulling sensation in eyes, sleepiness, loss of concentration, nausea, eye discomfort, and general fatigue.

Also interesting: The injury that causes the convergence insufficiency happens right away. But it typically won’t be noticed for a while because of distraction injuries/symptoms and also because it takes time for the loss of efficiency, endurance and strength to result in symptoms.

So looping back to the original point—it’s hard to sort out symptoms and causes. Following a concussion most people would associate problems with reading comprehension, headaches and fatigue with the seminal injury to the brain. But another cause could be one eye not working with the other.

A couple of observations:

It’s important for people who have suffered concussions to treat with a doctor who is experienced in managing concussions and isn’t seeing these issues for the first time. Neurologists understand concussions. But I think physical medicine and rehabilitation doctors are better in terms of managing treatment and providing longitudinal care.

Resist the temptation to either rule in or rule out the cause of symptoms. Or even get too tied to a particular description of the symptom. Keep an open mind.

I’ve been asking defense doctors whether they’ve been concussed and suffered post-concussion syndrome. Surprisingly, a lot have never been concussed. I think it would be extremely hard to understand a lot of things associated with the concussion itself or working through the symptoms if you hadn’t experienced them for yourself. It would be a little like an “expert” giving parenting advice having never had kids of their own.