Concussion and Multilevel Cervical and Lumbar Disc Herniations After a Motor Vehicle Collision: Interpreting Overlapping Symptoms

A man in his 30s presented 7 days after a rear-impact motor vehicle collision with headache, neck pain and low back pain, each rated 8/10 on the Numeric Pain Rating Scale, and with impaired concentration and disturbed sleep, each rated 8/10 for severity. He reported feeling dazed without loss of consciousness or a recognized period of post-traumatic amnesia and was uncertain whether his head struck the steering wheel; emergency department cervical radiographs and head computed tomography were negative. The treating clinician made a working diagnosis of concussion. Examination showed restricted cervical and lumbar range of motion and decreased sensation in the right L3 and left L4 and L5 dermatomes, with normal reflexes and strength. Magnetic resonance imaging (MRI) 34 days after the collision showed a C2–C3 disc herniation and lumbar herniations at L3–L4, L4–L5 and L5–S1. Conventional brain MRI was normal, while diffusion tensor imaging and quantitative electroencephalography (qEEG) were reported as abnormal. The patient completed an eight-week program of cervical and lumbar nonsurgical decompression and six sessions of qEEG-guided neurofeedback. At discharge, headache, concentration and sleep were rated 0/10, neck pain 1/10 and low back pain 2/10. Follow-up qEEG showed software-reported reductions in overall total deviation of 27% under eyes-open conditions and 29% under eyes-closed conditions; the clinical significance of these changes could not be independently established. The right L3 sensory deficit was anatomically compatible with a right foraminal L3–L4 herniation, whereas the left-sided deficits were less specifically explained by central herniations, and the headache and cognitive complaints could not be assigned to a single injury source. This case illustrates the risk of attributing each post-collision complaint to an imaging or electrophysiological abnormality without clinical correlation.