A case history of a 12 year-old with depersonalization-derealization disorder

This is the case of a once normal, happy 12-year-old boy who suffered a tailbone injury and whiplash-like injury. The case is presented to help parents who may be lost in searching for answers for a child suffering from dozens of new-onset post-injury symptoms. Immediately following this impact injury, this boy lost his vision and hearing, which would eventually return with impairments. Symptoms of headache and coccyx pain persisted for a couple of weeks, but he showed no sign of a concussion. Three weeks following the injury, he started experiencing a rapid heart rate and visual disturbances, which prompted an emergency room visit. They concluded he has a mild concussion, and he was sent home. He began to have anxiety and an irregular racing heartbeat. His mother took him to a concussion center, which then referred the boy to cardiology and a blind and visually impaired eye center for his visual disturbances. At the eye center, therapy was prescribed because his eyes were not focusing together, and the patient had symptoms of visual snow.

Visual snow syndrome and neck instability

Depersonalization-derealization disorder

When asked, the boy described among his many symptoms a sensation that his head is not attached to his body, and he feels ungrounded. He also has headaches and neck pain. His neck pain is in his suboccipital (back of head) area, mid cervical spine, and lateral neck. Flexion and extension worsen his pain. He becomes dizzy and lightheaded when standing and in elevators.

Dissociation, Anxiety, Personality Disorders and Depression – Uncontrolled emotion in cervical spine instability patients

Comprehensive symptom complaints

Cardiac: Irregular heartbeats/palpitations. ECHO, Holter, and other test results are normal according to parents.

Eyes: He suffers from visual snow. He sees vortexes and light flashes. He has sensitivity to light. Going from light to darkness sets him off. His brain has problems adjusting to changes, which causes anxiety. He has eye pain and pressure as well.

Chronic Neck Pain – Cervical Neck Instability

Ears: He has bilateral intermittent tinnitus, non-positional. He feels pressure in his ears.
GI/Swallowing: His GI motility has slowed since the accident, and he has developed chronic constipation. Early on, he had problem swallowing food, like the muscles in his throat were not working. This has improved and is rare now.
TMJ: He has crepitus but no pain in both his TMJs.

Mental health

His brain has problems adjusting to changes and he experiences above average anxiety. He has lost desire to eat and has slept erratically for weeks. Panic attacks became frequent along with constant ruminating thoughts and racing thoughts.

He no longer finds pleasure in favorite activities. His lack of concentration and visual impairments have made going to school impossible. Parents opted to home school because he is often set off by loud noises in school. He no longer socializes and finds normal family gatherings exhausting.

The family is struggling with change as we have to cut normal activities short or he refuses to partake in them. He has started to see a therapist. A neurologist suggested anxiety meds but they did not get them. He does not have a day that he feels well rested or normal.

He has lost desire to eat and has slept erratically for weeks. Panic attacks became frequent along with constant ruminating thoughts and racing thoughts.

His lack of concentration and visual impairments have caused him to be home schooled because he is often set off by loud noises and anxious.

The family is struggling with change as we have to cut normal activities short or he refuses to partake in them. He has started to see a therapist. A neurologist suggested anxiety meds but they did not agree. He does not have a day that he feels well rested or normal.

We see many patients at our neck center diagnosed with anxiety, depression, and dissociation, often accompanied by personality disorders. While these issues can be described as psychiatric-like, in many cases, including adolescents, the problems can come from underlying cervical spine and craniocervical instability. This instability can be caused by text neck syndrome, whiplash, or other neck area injury. Dr. Hauser explains further in this video and article

Symptoms and misdiagnosis of cervical Instability in children, adolescents, and teenagers

Vagus nerve manipulation

He currently sees an occupational therapist twice a week. The therapist manipulates his spine to activate his vagus nerve. He gets symptom relief for a few hours including mood improvement, anxiety lessens and he sleeps better the night of treatment. The occupational therapist herself had a concussion and was familiar with vagus nerve problems that could stem from head/neck injuries. She has done some fairly forceful manipulations, including TMJ intra-orally. See below article for detailed discussion of vagus nerve related symptomology

Vagus nerve compression in the neck: Symptoms and treatments

Diagnosis:

In diagnostic and imaging testing, he showed:

Multi-level cervical instability and changes in cervical curve.
Diagnostic revealed bilateral internal jugular vein compression.
Increased eye pressure(s). Enlarged pupil(s). Swollen optic nerve(s).
Abnormal MCA (middle cerebral artery) velocity

I caught my kid slouching with his head down: Here’s why it matters for their cervical curve!

DMX findings: A young boy going through the flexion and extension head movements during a Digital Motion X-ray.

Digital Motion X-ray (DMX)

Showed suspected muscle guarding in the upper neck hiding instability. Muscle guarding is a protective mechanism that limits movement and lessens pain by causing an involuntary muscle contraction around an injured area.
Neuro foramina narrowing at multiple levels and gapping.
- Neuro foramina or foraminal stenosis, is the narrowing of the neural foramina, the openings in the spine where spinal nerves leave. Nerve compression from this narrowing may result in pain, tingling, weakness, or numbness. The widening or opening of the foramina is commonly referred to as “gapping” and can result in more widespread symptoms when it happens at multiple levels in the spine.
- Twisting/ doubling of George’s line with flexion and extension. A sign of cervical spinal instability caused by ligament weakness or failure.

Further description of symptoms

Anxiety, depression, cognitive and mood
- Often feels anxious with increasing severity;
- Brain fog happens regularly with severe severity;
- Obsessive thoughts happens constantly with debilitating severity
- Concentration difficulty happens often with severe severity;
- Feelings of depression/hopelessness happens occasionally with debilitating severity;
- Irritability happens often with severe severity;
- Panic attacks happens occasionally with debilitating severity;
- Admits rumination on traumatic events happens constantly with debilitating severity.

Emotional stress: Anxiety, Depression and Panic Attacks: A neurologic and psychiatric like condition caused by cervical spine instability

Eye/Vision changes
- Blurred vision happens regularly with severe severity;
- Sees flashes of light happens occasionally with severe severity;
- Eye pain/pressure happens occasionally with intense severity;
Change in senses
- Changes in taste/smell happens occasionally with severe severity;
- Temperature fluctuations happens regularly with severe severity;
Swallowing
- Choking sensation happens often with severe severity;
- Difficulty swallowing happens occasionally with debilitating severity;
- Chronic hiccups happens occasionally with intense severity;
- Early on, he had problem swallowing food, like the muscles in his throat were not working. This has improved and is rare now.
Digestion
- Digestion problems happens regularly with intense severity;
- GI motility has slowed since the accident and he has developed chronic constipation.
- Dizzy and balance issues
  - Difficulty with balance happens regularly with severe severity;
  - Dizziness happens often with severe severity;
  - Lightheadedness happens constantly with debilitating severity;
  - Vertigo happens regularly with debilitating severity;
- Ears and hearing
  - Ear fullness/pressure happens constantly with debilitating severity;
  - Hearing loss/changes happens rarely with moderate severity;
  - Ringing in ears happens occasionally with intense severity;
  - Admits sensitivity to light happens constantly with debilitating severity;
  - Sensitivity to sound
  - Tinnitus symptoms regularly with intense severity;
Hearing and sound issues: Sound sensitivity, autophony, misophonia
- Skin sensations
  - Skin feels hot/cold happens occasionally with intense severity;
  - Skin sensitivity happens rarely with moderate severity;
- Headaches
  - Headache happens often with severe severity;
  - Migraines with aura happens occasionally with severe severity;
- Cardiac
  - Heart palpitations happens constantly with debilitating severity;
  - Irregular heartbeats happens often with severe severity;
- Neck pain
  - Has neck grinding/cracking happening often with severe severity;
  - Neck pain happens often with severe severity;
  - Muscle spasm/tension happens constantly with debilitating severity;
  - Dysautonomia happens often with debilitating severity;
  - Muscle spasm/tension happens constantly with debilitating severity;
  - Postural hypotension happens constantly with debilitating severity;
  - Fatigue happens constantly with debilitating severity;
  - Insomnia happens often with debilitating severity;
  - Admits non-productive cough happens constantly with debilitating severity;
  - Admits shortness of breath happens constantly with debilitating severity;
  - Admits speech difficulty/changes happens regularly with intense severity;
  - Admits trigeminal neuralgia happens occasionally with severe severity;
  - Admits walking difficulty happens occasionally with moderate severity.

Other Diagnosis

Symptoms and misdiagnosis of cervical Instability in children, adolescents, and teenagers

Seeking treatment

We see many adolescents who have horrible neck curves. These teenagers are having all sorts of health issues. They can’t think straight, they can’t problem solve, and their personality has changed (this is a significant symptom in suspecting vagus nerve problems). They have a very dysfunctional cervical curve that is messing up the brain pressure, the fluid flow in and out of the brain, they suffer from rage, stress, and anxiety. The vagus nerve is responsible for calming someone down. If the vagus function is altered, suppressed, or compromised, the ability to control rage is greatly diminished.

The sooner cervical instability is addressed, the better the chances of preventing long-term complications. If you suspect your child may be struggling with symptoms related to cervical instability or “text neck,” contact Caring Medical today to schedule an evaluation and learn about effective treatment options.