open access


A concussion is a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. A primary head injury can be catastrophic, but the effects of repetitive head injuries must also be considered. Second-impact syndrome (SIS), a term coined in 1984, describes the situation in which an individual sustains a second head injury before the symptoms from the first head injury have resolved. Importantly, even if the effects of the initial brain injury have already resolved (6-18 mo post injury), the effect of multiple concussions over time remains significant and can result in long-term neurologic and functional deficits. These multiple brain insults can still be termed repetitive head injury syndrome, but they do not fit the classification of SIS. True SIS would most likely have a devastating outcome. The Brain Injury Journal noted in 2015 that animal models of concussion and mild traumatic brain injury suggest that a concussion can result in anxiety and fear reactions. The pathophysiology of depression following a concussion appears to be consistent with the cortico-limbic model of depression. Additionally, some individuals may be at risk for neurobiological depression and/or anxiety following a concussion.

Case Presentation

We present a case of a 14 year old female with repetitive concussions causing anxiety and depression. It has affected her daily activity such as leaving the house. The start of a new school year was a major stressor. Other concerns included headaches, vision issues such as depth perception and skewed perception, balance and focus, memory concentration and emotional balance. The patient presented with symptoms including: poor appetite, sweat easily, bleeding/bruising easily, sudden energy drop, dizziness, poor vision, headaches, poor balance, weight loss, fatigue, cravings, change in appetite, pimples, eye strain, blurry vision, poor sleep, migraines, jaw clicks/pops, nausea, abdominal pain/cramps, neck pain, back and muscle pain, muscle weakness, shoulder pain, knee pain, anxiety, depression, bad temper, easily susceptible to stress and poor memory. The patient had seen multiple neurologists, had participated in counseling, was taking anxiety medications, undergoing physical therapy and vestibular therapy as well as neuro-ophthalmology. She was taking several pharmaceuticals including Cymbalta 30 mg; Xanax .25 mg as needed; Seroquel 25 mg and Zomeg as needed.

Upon presentation, on August 3, 2019, the patient underwent a complete health evaluation, was placed on multiple supplements and underwent cranial body work. On August 4, 2019 the patient underwent cranial body work and exercise with oxygen therapy. On August 5, 2019 the patient was evaluated using Heart Rate Variability, Brain Gauge, Clear Mind EEG brain map, and underwent exercise with oxygen therapy, a Clear Mind biofeedback session, cranial body work, and an EVOX emotional reframing session. On August 6, 2019 the patient was treated with cranial body work, a Clear Mind biofeedback session and was administered 0.2 ml exosomes from Stemell intranasally, three times and three hours apart. On August 7, 2019 the patient was administered a new Heart Rate Variability screening, a Brain Gauge screening, underwent an exercise with oxygen therapy session, a Clear Mind Biofeedback session, an EVOX emotional reframing session, cranial body work, a Clear Mind Biofeedback session and was administered 0.2 ml Exosomes, from Stemell, intranasally, two times three hours apart.

After a two day break, the patient underwent a remote EVOX emotional reframing session followed by another session on August 12, 2019. On September 13, 2019 the patient returned to the clinic and underwent a new Heart Rate Variability screening, Brain Gauge screening, a comprehensive health evaluation, a Clear Mind EEG brain Map, an EVOX emotional reframing session and Cranial body work. On September 14, 2019 the patient underwent Cranial body work. On September 17 and September 19, the patient completed treatment with remote Evox emotional reframing sessions.

Figure 1.Improvement in Brain Gauge scores pre and post treatment.

During the September 13, 2019 visit, the patient stated that the anxiety had decreased significantly, her sleep had improved, her focus was better, she was experiencing healthier emotions, less reaction to tones and for the first time, she was able to ride in the car to a movie with her friends without her mom being the one to drive. This was a first.


The results of this study suggest that exosomes, administered intranasally, played a significant role in the improvement of the patient’s anxiety and depression caused by repetitive concussions. Exosomes combined with other treatments appear to have had an impact on allowing the patient to resume normal life, leave her home, enjoy time with friends and live a healthier life. This study reaffirms the need to consider exosomes as a viable treatment option when working to recover patients who present with primary and multiple head injuries.


1. Broshek D, De Marco A, Freeman J. (2015). A review of post-concussion syndrome and psychological factors associated with concussion. Brain Injury. 29 (2).