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Dr. Richard Spitzer, M.D.
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Dr. Richard Spitzer is a distinguished Neurologist in Pasadena, CA. Dr. Spitzer specializes in diagnosing, treating, and managing disorders of the brain and nervous system. With expertise in handling complex conditions like epilepsy, multiple sclerosis, and migraines, Dr. Spitzer employs advanced techniques and personalized treatment plans to improve patient outcomes. As a neurologist, Dr. Spitzer is committed to staying abreast of the latest developments in neurological research and therapies.
56 years
Experience
Dr. Richard Spitzer, M.D.
- Pasadena, CA
- Albert Einstein College of Medicine - Yeshiva University
- Accepting new patients
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What is the best test for a concussion?
There's really no such thing as a "a test for a concussion." Put another way, a diagnosis of concussion is a so-called "clinical diagnosis" meaning a diagnosis made "at the bedside" READ MORE
There's really no such thing as a "a test for a concussion." Put another way, a diagnosis of concussion is a so-called "clinical diagnosis" meaning a diagnosis made "at the bedside" [or in an office] based on the history of the event(s) ie the signs symptomos as they started and evolved over time, and the bedside (or office) physical examionation of the patient. The key features that lead toa diagnosis of concussion are (1) a closed head injury, and (2) a sudden and transient loss of consciousness, which may be followed by a period of confusion.
There are certainly tests that may be done in those circumstances, either in an ER or subsequently in a neurologist's office, that may show there's more going on than a mere concussion. For example, a CT study demonstrate bleeding inside the cranial cavity might indica that in addition to a concussdion the patient has suffered, for example, a subdural or epidural hematoma (a blood clot which exerts inward pressure on the brain, and which has to be removed either emergently or less-urgently), or a cerebral "contusion" which indicates actual bruising of the cerebral cortex.
In a "typical" concussion the CT and/or MRI are usually normal, and show no such additional pathology, and the exam usually shows little except confusion which gradually (sometimes quickly; sometimes not) clears up.
Thereno specific treatment for a concussion either, other than the passage of time, i.e. waiting out the expected improvement of the confusional phase.
Some people have a lengthy, delayed recovery after a concussion, a so-called post-concussive syndrome, w/ persisting headache, dizzyness, "brainfog", difficulty concentrating, etc. Usually this too resolves fully, though sometimes takes weeks-months.
There are certainly tests that may be done in those circumstances, either in an ER or subsequently in a neurologist's office, that may show there's more going on than a mere concussion. For example, a CT study demonstrate bleeding inside the cranial cavity might indica that in addition to a concussdion the patient has suffered, for example, a subdural or epidural hematoma (a blood clot which exerts inward pressure on the brain, and which has to be removed either emergently or less-urgently), or a cerebral "contusion" which indicates actual bruising of the cerebral cortex.
In a "typical" concussion the CT and/or MRI are usually normal, and show no such additional pathology, and the exam usually shows little except confusion which gradually (sometimes quickly; sometimes not) clears up.
Thereno specific treatment for a concussion either, other than the passage of time, i.e. waiting out the expected improvement of the confusional phase.
Some people have a lengthy, delayed recovery after a concussion, a so-called post-concussive syndrome, w/ persisting headache, dizzyness, "brainfog", difficulty concentrating, etc. Usually this too resolves fully, though sometimes takes weeks-months.
Nerve damage?
This is a very unusual scenario. I believe there are two problems, one of which sounds like it's a true constellatiion of neurologic symptoms; and the other a psychophysiological READ MORE
This is a very unusual scenario.
I believe there are two problems, one of which sounds like it's a true constellatiion of neurologic symptoms; and the other a psychophysiological respopnse to those symptoms.
What I refer to as "true...neurologic symptoms" includes the discomfort and hypersensitivity in the mid-back; and the longstanding (since childhood) shock-like sensation felt through the entire body with certain head or neck movements, and which may indeed be a Lhermitte sign (or symptom" though it's extraordinarily rare to experience that on a decades-long basis. A Lhermitte sign is often an indicator of some sort of intraspinal parthology, and has been described in MS affecting the spinal cord, but also in many other types of problems involving the spinal cord inside the spinal canal. All of that requires a thorough workup including a very careful clinical exam, and imaging (preferably MRI) of the spine. Neither MS nor a tumor are likely answers here -- MS doesn't usually begin at such an early age and produce only a single persisting symptom; and spinal tumors also are rare so early in life, and get larger and symptoms worsen oiver months-years as they grow. So something, perhaps congenital and structural involving the spine and/or spinal cord, but not likely MS nor a tumor. Something else --- to be determined.
What I refer to as a "psychophysiologic response" is the group of events set off by the massage, including first a general feeling of discomfort and uneaase; then nausea, lightheadedness, pallor, and fainting, succeeded by fear, confusion, and exhaustion. This is the onset and evolution of an episode of so-called "vaso-vagal syncope" which is a physiologic response to pain, fear, etc, and which is not a specific disease but a reaction -- both psychological and physical -- to pain and/or fear of almost any sort. It can be as straightforward as a normal but anxious person fainting at the sight of blood or an injection of medication or a minor but painful injury. It's basically a fainting spell. It's not a stroke, nor an epileptic seizure, or anything truly serious.
The possibly and potentially serious aspect of this case is the first group of symptoms described above, which warrant a search for a real problem of some sort affecting the spine and/or spinal cord.
I believe there are two problems, one of which sounds like it's a true constellatiion of neurologic symptoms; and the other a psychophysiological respopnse to those symptoms.
What I refer to as "true...neurologic symptoms" includes the discomfort and hypersensitivity in the mid-back; and the longstanding (since childhood) shock-like sensation felt through the entire body with certain head or neck movements, and which may indeed be a Lhermitte sign (or symptom" though it's extraordinarily rare to experience that on a decades-long basis. A Lhermitte sign is often an indicator of some sort of intraspinal parthology, and has been described in MS affecting the spinal cord, but also in many other types of problems involving the spinal cord inside the spinal canal. All of that requires a thorough workup including a very careful clinical exam, and imaging (preferably MRI) of the spine. Neither MS nor a tumor are likely answers here -- MS doesn't usually begin at such an early age and produce only a single persisting symptom; and spinal tumors also are rare so early in life, and get larger and symptoms worsen oiver months-years as they grow. So something, perhaps congenital and structural involving the spine and/or spinal cord, but not likely MS nor a tumor. Something else --- to be determined.
What I refer to as a "psychophysiologic response" is the group of events set off by the massage, including first a general feeling of discomfort and uneaase; then nausea, lightheadedness, pallor, and fainting, succeeded by fear, confusion, and exhaustion. This is the onset and evolution of an episode of so-called "vaso-vagal syncope" which is a physiologic response to pain, fear, etc, and which is not a specific disease but a reaction -- both psychological and physical -- to pain and/or fear of almost any sort. It can be as straightforward as a normal but anxious person fainting at the sight of blood or an injection of medication or a minor but painful injury. It's basically a fainting spell. It's not a stroke, nor an epileptic seizure, or anything truly serious.
The possibly and potentially serious aspect of this case is the first group of symptoms described above, which warrant a search for a real problem of some sort affecting the spine and/or spinal cord.
