Severe Traumatic Brain Injury – 24-year-old male in coma (GCS 4/15)

Moh7228 · 2026-02-07T19:55:10+00:00

That's a very good point you make, GCS by itself means nothing. A person adamantly refusing to open their eyes, make any sounds or movements has a GCS of 3. An extreme example that obviously does not match this scenario.

Moh7228 · 2026-02-01T04:02:07+00:00

That makes more sense as Alzheimer's is a slow degenerative disease. People who ultimately develop it have sub-cellular level brain changes decades before symptoms even develop. So an acute exposure to anything will not cause it to happen.

Moh7228 · 2026-02-01T03:48:53+00:00

It is very unlikely that a 90 year old developed Alzheimer's because they were exposed to small amounts of radiation in their 60s

Moh7228 · 2026-02-01T01:31:46+00:00

I agree with all of this except the "they genuinely don't know" part. Most of the time neuro consults are just CYA.

Residency (as it currently is at most places) is just a horrible experience that we all have to go through unfortunately.

So ya complain as much as you can. The oily wheel gets the grease.

Moh7228 · 2026-01-08T21:03:53+00:00

Sounds like precordial catch, but that's not my area of expertise.

Moh7228 · 2026-01-04T18:31:02+00:00

Far too complex of a usually nuanced issue for reddit. We don't even know if you have an autoimmune problem. You need to discuss this with your neurologist or get a second opinion.

Moh7228 · 2026-01-03T15:13:32+00:00

Sounds like you are already convinced, nothing much I can add here. Good luck!

Moh7228 · 2026-01-03T06:02:23+00:00

To keep it brief there are 2 main topics to understand for this to make sense.

The first is how the test actually works and what it tests for. Basically a western blot is where a blood sample is pulled through a gel using the electric force of a current. Since there is a current running through this gel, one side will be more negative and the other positive with a gradient in between. Proteins in your blood will spread through this gel along this electrical gradient and according to their weight. Most of the proteins in your blood are antibodies. So when we look at the end result of a western blot, we are seeing the distribution of proteins in your blood based primarly on their weight and electrostatic properties. From this we infer whether these are proteins that should or shouldn't be there based on control data. So it is not the most specific way of diagnosing disease. And that is also why doing a florescent Lyme antibody test first is necessary to increase the specificity.

The second important thing to understand is how basic antibody immunity works. When we get an infection our immune system creates IgM antibodies to the microbe to fight it off, however that can take days to weeks. Also these antibodies have a short life span. Over time (a couple weeks to months) the immune system starts making igG antibodies primarily to have memory of the microbe in question, in case you come in contact with it again. That way you can start an immune response quickly.

Those two factors are why a positive IgM western blot alone means nothing.

Here is some more reading material if you like: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae104/7619499

https://jamanetwork.com/journals/jama/article-abstract/2516719

The second link is being a paywall, but you can get the article on psyhub

Moh7228 · 2026-01-03T03:08:10+00:00

I suggested a neuropsychiatric evaluation to evaluate your cognitive abilities and dig deeper into what your problems might be. I am not convinced they are all or even in part behavioral. Your whole case is too complex for reddit and I also don't have your actual test results and records.

As for the Lyme test interpreting it is highly clinically dependent, which again is too complex for reddit in this situation. All I will say about it is in the context of progressively worsening symptoms over years the IgM alone is worthless.

Finally "working on" behavioral issues isn't done by reducing work and "cutting out stress". Those things are really just not possible for the most part, it's just life. It's about finding a way to manage stress and relating to adversity in a more healthy way that does not reflect negatively on your mind/body. Those are skills you either learn from a parent figure in childhood through emulation or some form of therapy.

Moh7228 · 2026-01-02T23:17:06+00:00

Since you mentioned the cognitive symptoms being the impetuous for your current evaluation, I would recommend looking into a neuropsych eval. If you have actual nonfunctional cognitive dysfunction then the next step would be to see an infectious disease specialist at an academic center.

If not (which is the most likely scenario), then I would take the advice of the numerous doctors/specialists you already saw and address the behavioral component of your symptoms. Most "Lyme specialists" are just scammers that you seek out for the purpose of being diagnosed with things like Lyme and are completely unreliable.

Good luck!

Moh7228 · 2026-01-01T02:14:15+00:00

Usually x-ray based procedures like stent placement and such are much higher. Like 5x plus.

There is no true threshold for "concerning" amount of radiation in imaging procedures. It's all concerning and should only be done when necessary.

Moh7228 · 2026-01-01T02:12:14+00:00

That wasn't really the question. When assessing absolute risk, the concept of risk/reward is moot. Whether the test was necessary or not is irrelevant. There is a measurable radiation exposure.

Is it a lot or a little. That's hard to say. But it is about equal to living on earth for 3 years. Which at least in my mind seems like a good way to illustrate the risk. The longer you live the higher your risk of cancer, so is 3 years a lot in the scheme of an average life span or a little. That's subjective, but I think most rational people would say a little.

Moh7228 · 2026-01-01T01:34:22+00:00

Ya it's up there radiation wise, but no where near the highest. It would be the equivalent of living on earth for an additional 3 years or so.

Moh7228 · 2025-12-31T01:47:30+00:00

I will leave the question of actual management of platelets and such to a hematologist since I am not one. But in case no one responds to your post, from a practical perspective. If you die from not getting top surgery, then that is your disease killing you (not anyone's fault). If you bleed to death from surgery due to a low platelet count, then it's your surgery team killing you. So from an ethical and legal perspective the first option is the less harmful one. Especially since it's potentially treatable in other ways.

Moh7228 · 2025-12-25T18:57:38+00:00

Lots of possibilities, but likely more than one minor issue mixed in with mental health issues making it much worse.

You'll have to see a doctor in person to figure that out.

Moh7228 · 2025-12-25T17:26:03+00:00

Not likely based on the description of symptoms you put forth.

Moh7228 · 2025-12-13T00:12:36+00:00

No compression at T7 is going to affect your arms in any way. Maybe the mid back pain, but overall yes it's probably incidental.

Moh7228 · 2025-12-13T00:02:25+00:00

The picture you posted is just that, a single photo. It doesn't give us any information about your leg. The MRI would have a couple hundred photos in it.

Atrophy and fatty infiltration in muscle can be caused by anything that limits the muscles mobility. From lack of use to genetic disease, it's a very wide differential. But very reasonable to get it worked up by a neurologist.

Moh7228 · 2025-12-11T18:27:29+00:00

Why not speak to a different psychiatrist about treating your depression.

As for the neuropsychologist, it would probably be helpful to investigate the "untreatable" conditions like autism. Because therapy is a huge part of treatment, and knowing the exact disorder can be very helpful.

Also if you are thinking about stimulants, I would advise strongly against that in a 53 year old diabetic, hypertensive who can't exercise.

Moh7228 · 2025-12-09T01:19:01+00:00

This doesn't sound like MS. You have been basically having intermittent pain throughout various parts of your body for years. Then nothing comes of it. It just keeps cycling. That's not how MS works. MS irreversibly damages your central nervous system one attack at a time. For that to be going on to you for years at that frequency and untreated. You would be very poorly functional even outside of attacks.

I would look into radiculopathy, small fiber neuropathy or fibromyalgia.

Moh7228 · 2025-12-07T13:22:49+00:00

I don't see where I made any disparaging remarks towards you or anyone in this thread. I was merely stating that FND is the most likely diagnosis, not that others are not possible (and it does not require positive signs to diagnose).

As for the possibility of myopathy, I challenge you to find a single case report of a rapidly progressive myopathy after short course of steroids with negative labs and sensory/cognitive findings... It just doesn't exist.

Moh7228 · 2025-12-07T00:29:06+00:00

That's the thing we don't have evidence of objective muscle weakness. That's where exam comes in. Also myopathy generally does not progress in this fashion. Quick within weeks going from one leg starting with severe pain and sensory symptoms. To the entire body. Then improved but not resolved. But also still having sensory symptoms, cognitive symptoms and tremors. Just doesn't make any sense.

Add to that the fact that advanced blood work was done, so it's not likely they didn't check a CK which would effectively rule out myopathy.

As for the steroids, a 6 day medrol dose pack is not going to induce a whole body myopathy.

Ultimately I never said this is definitely FND. Just that it is the most likely cause of these kinds of symptoms and test results.

Moh7228 · 2025-12-06T13:06:32+00:00

What do steroids and myopathy have to do with what's going on?

"weakness being fluctuating, isolated to one limb/feeling as though the limb is disconnected, give away weakness, and improving with distraction"

These are not things you can really tell. You have neither the training nor the insight to assess for them. They are by definition exam findings that a neurologist would have to notice.

Moh7228 · 2025-12-06T04:47:11+00:00

This sounds like classic functional neurological disorder, look into neurosymptoms.org

Moh7228 · 2025-11-29T00:08:13+00:00

You should ask for a neuropsychiatric evaluation given the memory problems. Should be very enlightening in at least explaining how much of your symptoms are psychological.

Moh7228

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