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A friend said he was riding last week and hit his head hard on an oak tree branch. He went to the ER and wasn't even seen by a doctor. A PA checked him out.

Anyone know of a good neurosurgeon in the Oakland / SF / Marin area? He might want to get double checked.

Thank you,

Kevin
 

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So the likely-hood of your friend having an intracranial bleed after hitting an oak tree is pretty low. After a week without any neurological deficits it is highly highly unlikely there is anything detectable going on. I don't doubt the PA's diagnosis, (hell just because the provider was a PA doesn't mean the quality of care/management is going to be any different; there are some mighty fine PA/NPs out there) a concussion is far more likely. Concussions suck, you feel horrible for a while and it takes time to recover. If he is having some vomiting, numbness, weakness then he should of gone back to the ED sooner.

I'm of the opinion that he should wait a while to recover; when I had my concussion it took a few weeks before I felt normal, e.g no malaise, normal mentation; chances are a neurosurgeon won't touch him and he'll just be out a few hundred bucks.
 

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If it has been a week since the crash I personally wouldn't worry about it. The main thing is that he stays off the bike for a few weeks at a minimum so he does not get a second impact to his head.

A moderate concussion will usually leave the person feeling like they are not quite all the way there (blurred vision, disrupted thinking patterns, headache, more emotional, change in sleep pattern, etc). These symptoms can last a few weeks, and it is no fun. The PA in the ER most likely did the same neurological exam that a Neuro MD/DO would do, and if there were no red flags there, he is most likely fine. The only way to officially rule out brain bleeding is a CT scan, which I doubt a physician would do at this point.

That said, if one of his pupils is larger than the other, or he is vomiting, or loses consciousness at any point, go back the ER immediately.

-Ryan
 

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Agree with nayr & reno, the biggest risk for concussion is for follow on cranial bleed in the first 48 hours. If it's been a week and he's improving he's probably going to be ok. He should go back to doc if he gets ANY increasing headache or increasing symptoms. He should also rest, not ride, not drink, minimize mental exertion, & physical exertion to give the brain a break. Neurologist would get involved if symptoms persist or get worse at all.

If he does need follow on I really recommend UCSF neurology, I saw them for persistent migraine and they were very good.
 

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He should definitely stop riding until he has no more symptoms. No symptoms, none at all. No headaches, no unusual spaciness, no unusual irritability, no unusual forgetfulness, no blurred vision, nothing. It could be weeks or months, but he needs to wait.

A friend of mine waited a few months after a concussion, but he still had lingering symptoms. Stupidly, he rode again, crashed again, and had another concussion. Now he may never be able to ride again-- it may be too risky for him. Second concussions when the first one is not totally healed are dangerous.
 
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