headaches

[smithc1]

I have a patient who had a 250kg beam fall on his neck. GCS normal, no loss of consciousness, although he said he couldn't hear the people around him for a while. Xrays normal, and CT scan of C6-T1 normal. Patient was in hospital for 6 days for the above tests due to bilateral p/n in arms - lasted for 5/52. Now presents with constant extreme headache posterior/temporal region and behind eyes and also recently reported that since the accident has lost his sense of smell. verbrobasilar artery tests strongly positive with rot right and extension. Headaches almost immediately relieved with unilateral GrII/III but relief short lived. Neck movements are almost normal with only s.flex and rot right at EOR reproducing S&S. Soft tissue around neck tight. Does anybody have any ideas how this gentleman can be treated with more long lasting results? or should I refer him back for further tests, but if so what?

[perfphysio]

The CT of C6-T1 seems a bit low. I would lookhigher. What level are you doing the unilateral ?PA's or are the AP's. What distribution if any was the paresthesia? How are his manual muscle tests and spinothalamic indicators e.g touch, two point discrimation etc etc. Were the cwervical xrays only front and lateral or was there an oblique one as well? and a jaw open view of C2. This sounds like a great case to discuss online. Can you try to give us more info. regards richard