The question
About three years ago my wife slipped on some ice, fell backward and hit her head quite hard. We got her up, waited for any signs of dizziness, confusion, problems with her sight and unusual thought activity. She seemed fine. However, lately, we have noticed her ability to concentrate has lessened and her memory is worse. [She is working on a master's degree]. How should we present the case to our doctor?
The answer
Losing consciousness is not required to sustain a concussion. So, your wife may have suffered a concussion, which is a brain injury. It would have been ideal for her to see the family doctor soon after the fall.
"We want every concussed person to see a medical doctor," according to renowned concussion expert Charles Tator, professor of neurosurgery at University of Toronto.
With athletes, there are six steps to return to play. With students, like your wife, it is more complicated but generally, it involves monitoring, a plan to go slow and to not dive right back into her normal activities.
"We want people to rest cognitively and physically after a concussion," added Dr. Tator, founder of ThinkFirst Canada. "We feel you get the best recovery if you follow a graduated program, after a concussion."
Experts are now seeing patients, such as your wife, who can pinpoint a decline in mental function to a specific event. Some have not just one but several head injuries and a subsequent mental decline. Although such a decline can happen after a single concussion, it is more frequent after multiple ones, said Dr. Tator.
"We are more vigorous now in wanting to investigate people who have experienced mental decline," he said.
Some mental decline is normal as people age and it can vary for each person. Some experience decline in their 50s and 60s, while others not until their 80s or 90s.
You mentioned your wife was in school. Learning new material and trying to commit it to memory are two functions that a concussion can affect years down the road.
The go-to specialist for this is a neurologist, who typically works as part of a team. For people like your wife, a series of neuropsychological tests that look at memory, concentration, and speed of mental process would likely be ordered, that would be performed and interpreted by a neuropsychologist. In addition, the neurologist would probably want to take a picture of your wife's brain with an MRI scanner, according to Dr. Tator.
While concussions are not visible on an MRI, it may be important to have the scan to diagnose other conditions that could potentially be giving your wife these symptoms.
It's for that reason, I suggest your wife go to her family doctor and request – even insist, if need be – on being referred to a neurologist.
The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to patient@globeandmail.com.