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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
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Experience:  GP in the United States
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Hi, Im a 43yr old female with a long history of neurological

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Hi, I'm a 43yr old female with a long history of neurological issues due to a car accident.
Short history, car accident 24yrs ago, mis-diagnosed with IIH for 14yrs, correctly diagnosed in 2008 with CSF Rhinoreah due to a skull fracture in the cribriform plate. In 2009 I had a right frontal temporal craniotomy to repair the skull fracture with muscle from the facial temporal area. Surgery was a success but I've never quite been the same.
Recent issues started August 2012 when I developed Hyperacusis, found high pitch / frequency sounds like hearing aids whistling, general whistling and girls screaming really painful / uncomfortable. I've spent the last 19 months back and forth with ENT appointments but the ENT wanted me to undertake CBT. I went to see a CBT Therapist but was sent away as they deemed they could not help me as I did not have an unhealthy fear of sounds. I had an MRI and that ruled out an Acoustic Neuroma but not ETD. I'm convinced it's a physiological issue possible stemming from my surgery or even car accident.
Most recently starting Nov 2013 I've developed a range of additional symptoms some of which are quite frightening such as (1) Tremors in 2 specific finger & thumb, (2)Ocular Flutter / Short term Nystagmus, (3) Right Ear Whooshing so loud it can wake me, (4)occasional Coordination issues, trouble walking like my brain is not sending the message to my legs to walk so I walk like a robot. (5)Extreme Fatigue, sometimes I wake up totally wiped, other times after just very light tasks I’ll be so tired physically & mentally I shut down for an hour or more. (6) Migraines, these are usually triggered by loud or high frequency sounds or low weather pressure.
Other issues I’ve been dealing with for years are: Tinnitus, since the car accident, not very loud, it’s manageable. Eye lashes & Eye brows that fall out around my hormonal times so ovulation & menstruation. Irregular menstrual cycle between 39-65 days. Always cold. Constipation, sometimes it’s a bit like IBS symptoms but more often its constipation. Clicking hip / sacral joint. Crunching shoulder joint.
Recently I’ve had my hormones & thyroid checked and was told all was fine. My ENT has referred my back to Neuro for the migraines and I’m waiting on an appointment which could take a while. I’m getting increasingly concerned as in the past 6 months I appear to have more ‘bad’ days where I’m not working and just not living life like I should at my age, mentally I feel young but physically not so much. Clearly I’ve been on Google, my concerns are an Auto Immune Disorder such as Fibromyalgia however I don’t have the pain or worse MS. Any advice which way to search would be helpful.
Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Thanks for this question

I think fibromyalgia is a consideration. Also autoimmune is a valid concern. For once google did someone well!

What about post concussion syndrome?
Customer: replied 3 years ago.

Hi Dr Phil,


Thank you for replying to my questions. I've never heard of post concussion syndrome. Could someone have issues with this 24yrs after a car accident or do you feel the brain surgery is also a contributing factor? My surgeon did state that there was a section of brain that had died like due to a mix of the car accident & the fact it was poking thru the 1cm hole in the cribriform plate. At the time of the car accident I do not feel I was treated properly. How would I investigate PCS and is there any treatment?




Yes, I think this could be partially due to PCS many years later.


Also, the brain injury is probably the major cause.


Here is an article on all aspects of PCS including treatment

Customer: replied 3 years ago.

Ok, I've read most of that. TBH I'm not 100% convinced mainly as it's been 24yrs since the car accident.


I probably should have mentioned but forgot that whilst I had CSF Rhinorrhoea I suffered 4 boughts of viral meningitis.


The other reasons I'm not convinced its PCS is the fatigue is so much worse now that a few years back. For example I'm a silversmith, I run a jewellery business with my husband. We sell a particular product that is popular yet labour intensive. 3yrs ago I was running the business on my own. I made 45 of said product in 1 day, just 2 months ago I struggled to make 8, I'll go as far to say it nearly killed me to make the 8.


Secondly some of the symptoms seem to be psychological such as apathy, anxiety, depression. I don't feel any of these apply to me. After I had surgery in 2009 I realised I was going to struggle to find a job to suit my pace so I started my own business just 3 months after surgery. Now my husband works with me and we have 9 part time staff. I'm a fairly motivated and determined person, just not all the time I'd like to be because of my physical & cognitive limitations.


I think I will need to do some more research on PCS before I feel it's a line to pursue, I can't imagine this will be an easy one to get diagnosed in the UK.






Yes, Belinda you are correct.

It will be hard to diagnose but worth a look

I would try to see a rheumatologist and have a workup for autoimmune and fibromyalgia as well

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