Brief Answer:
What is the timing of the pedestrian accident to the symptoms above?

Detailed Answer:
Good afternoon. Thank you for your question on this network. You'll have to be more specific with the timing of the accident that you put in at the end of your other statements and when the MRI was obtained.

Very sorry to hear your daughter was the victim of a pedestrian vs. SUV accident....sounds like overall she's Ok though...but the MRI findings do not explain her symptoms. Cervical LORDOSIS doesn't really say much to me unless the report said something to the effect of "straightening of the cervical lordosis"....or "loss of cervical lordosis..." The term LORDOSIS simply means curvature of the spine. In fact, it is normal for us to have 4 LORDOSES or spinal column curves. Bottom line....that diagnosis is meaningless to the other symptoms. As far as there being "subtle brain volume loss" or mild prominence of the cerebellar folia....again, that's a lot of medical vocabulary which is of no utility to her symptoms and especially if these events were recent.

But here is what I believe at least as likely as not happened. Your daughter very well may have suffered a mild TRAUMATIC BRAIN INJURY. No matter whether she cushioned her head with her arm on impact or not....the fact is a pedestrian being struck by a 4-5 ton vehicle has little time or where-with-it-all to be thinking about "cushioning" her head with her arm...and even if she did have enough time to do all that before striking the ground....it would be the equivalent of saying that just a football player with a nice cushiony modern HELMET with plenty of padding inside was being worn when he got hit by a linebacker....we know concussions happen all the time with body and head padding and armor.....Bottomline? Your daughter's symptoms are definitely consistent with what can be seen as a sequela or consequence of a traumatic type of brain injury though it was likely mild if she was just dazed or confused a bit without being knocked out.

As far as not being able to maintain CORE TEMPERATURE....that is not diagnosable but simply checking the temperature of her hands, fingers, nose, or face, and recognizing that she feels cold. Core temperature is what is measured when a thermometer is placed in under the tongue. If you do this and consistently see BELOW NORMAL temperatures which would generally be below 36.5 deg C or 98.6 degrees F then, one could say that she had difficulty with maintaining core temperature.

Spastic Diplegia is not a term that is typically used as a diagnosis unless it is connected with a diagnosis of CEREBRAL PALSY (CP). Does your daughter suffer CP? But if she's got spastic diplegia then, I don't know why she would have shaking/jerking or the other symptoms you mentioned. It doesn't go together.

If your question was adequately responded to could you do me the favor of CLOSING THIS QUERY?

I sincerely hope your daughter can determine what exactly is the matter with her but I would definitely recommend that a brain injury examination be done on her if one was not done when the pedestrian accident occurred.

This query has utilized a total of 39 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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Brief Answer:
Thank you for your clarifications

Detailed Answer:
Now, I have a better and more organized picture of what the sequence of events are that you're asking about as well as WHAT and WHEN things happened. I also did read a colleague's opinion and would like to point out something in that answer that may be misinterpreted.

First, what and when things happened.....Your daughter was in an accident in 2012 as a pedestrian and was struck by a motor vehicle. She buffered her fall by placing her arm under or about her head before striking the ground as she was thrown from the spot of impact. She was unable to open her eyes after impact though she recalls hearing things around her. She subsequently developed balance issues and had to use a cane at work with dysequilibrium becoming worsened about 9 months post-incident. In 2013, she had a bad fall that resulted in injuries to her dominant hand which has reduced function due to that event. In 2014, dysequilibrium got worse and she was ordered a knee brace, SI belt, and back support (I'm assuming due to spontaneous loss of posture or strength to her antigravity muscles?). Cognitively speaking things have never returned to normal and in fact she is having problems with memory and other domains of cognition which have caused her to have to withdraw from school. At the time of the accident an imaging study was done in the ER (probably CT of the head) but this was unremarkable. Your daughter does not carry a diagnosis of cerebral palsy. An MRI obtained in 2015 showed a "loss of cervical lordosis" as well as "slight prominence in the cerebellar folia." A second MRI also agreed with the loss of cervical lordosis as well as mild prominence of the cerebellar folia but in addition added a "subtle loss of brain volume."

So let's take it from the TOP please.....

So, as a neurologist my evaluation of that little clinical vignette is that:

1. In my opinion, your daughter clearly and unmistakenly suffered from a mild traumatic brain injury at the time of the accident (mTBI). Cushioning her head at the time of impact was nowhere near adequate for the jolting and impacting forces her brain received inside the skull as she was struck by the vehicle and then, some seconds later struck the ground. In other words, she suffered a concussion. It is termed MILD since she did not lose consciousness or orientation for her surroundings or ability to respond appropriately to people/perform actions in response to needs for a period of time greater than 24 hrs.

2. The consequences of that injury are the marked problems she is having with balance and equilibrium as well as cognitive types of problems and issues which interfere with her ability to go to school and/or perform or maintain other jobs, duties, and responsibilities.

3. The radiological diagnoses imply the following:

a. Loss of lordosis- this is the terminology used by radiologists to describe what is clinically interpreted as neck and back muscle spasms that may cause a STRAIGHTENTING of the spinal column. As I previously mentioned we have 4 curves to the spine so the report should specify whether or not the loss of the lordotic curve is in the cervical, thoracic, lumbar, or sacral regions. In my experience loss of lordotic curves are almost entirely within the cervical spine region. This diagnosis does not have anything to do with the consequences of her TBI in terms of balance, equilibrium, or cognition.

b. Prominence of cerebellar folia- What the radiologist is saying is that in HIS/HER opinion the FOLIA of the cerebellum (anatomic folds of brain tissue) are more EASILY VISUALIZED on the scan. It is hard to know when one sees this type of picture whether there is actual pathology involved or not because there is no reference point to compare (CT scan would not be a great point of comparison since it poorly sees the cerebellum due to the limitations CT has for viewing that part of the brain). Prominence generally suggests there is an increased widening of the fissures between each folium (singular) in the cerebellum. This can happen as a result of injury such as trauma, inflammation, bleed, infarct, OR it can be a normal anatomic variant that a person has without any clinical correlation.

Since the radiologist is calling the picture a SLIGHT degree of increased visualization it is difficult to say that it is pathologically abnormal....but it could be. Had an MRI been done in 2012 at the time of the accident then, future comparisons 3 years later would've answered that question.

By the same toke, the term SUBTLE brain volume loss suggests that the cortical layers of the brain are LESS THICK or less SPACE OCCUPYING than what is expected by the reading radiologist for a 30 year old. Again, this suggests the possibility of things such as increases in fluid volumes through the ventricular system since CSF flows through and around the brain so if there is BRAIN SHRINKAGE to any extent it must be accompanied by an increase in circulating liquid volume. It would be interesting to see if the radiologist actually made any mention of the ventricles and their prominence or whether any of the ventricles (lateral, 3rd, or 4th) seemed to be slightly enlarged or otherwise showing increased capacitance to the presence of fluid.

But again, without a comparison to any study in the past this is a very soft radiographic call which could just as easily be seen by another radiologist as a normal variant.

Therefore, tieing these radiographic signs to the symptoms would be a bit challenging though tieing the symptoms and what's going on in terms of the balance, equilibrium, and loss of cognitive function are clearly linked to the brain trauma.

Now, for the clarification of what a colleague stated in another response you solicited on this question:

"Prominence in cerebellar fovia means that there is a damage to the fovia. This is a part of the brain , cerebellum in particular that is involved with balance. It maintains our balance and posture as we stand and during standing."

The first statement of PROMINENCE meaning "damage" is an overstatement of anatomic status in the brain. As I explained above, prominence does not necessarily imply DAMAGE to anything and can be a normal anatomic variant in an individual. And though it is true that the cerebellar is believed the major organ of vestibular control in the brain we also know that many cases of TBI that involve loss of balance as a consequence occur in the complete absence of visible damage to the cerebellum. Some authors believe that there are even higher levels of cortical control to the cerebellum that control the balance mechanism. But clearly balance is an issue which is front and center in many patients who suffer TBI so there is a chance that in your daughter's case the finding could be related.

I hope these clarifications give you a better picture of what the MRI's show and what they DON'T show.

If your question was adequately responded to could you do me the favor of CLOSING THIS QUERY?

In any future query if you would like to actually upload the MRI reports I would happy to read them in their entirety.

This query has utilized a total of 85 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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