A-02 Multifaceted Treatment of Sports Concussions and Resulting Conversion Disorder: A Case Study

Abstract

Abstract Objective This case illustrates the complexities of concussion resulting in Conversion Disorder, rarely discussed in the literature, in a 12-year-old female. Diagnosis, treatment, and recurrence of symptoms through three injuries and retirement from sports are presented. Method Initial injury, with disorientation and amnesia, occurred following three impacts during a soccer tournament. Patient was a high average student, in a divorced family, who recently lost her maternal grandfather and began middle school. Subsequent to initial injury, she reported a loss of memory for all family members, colors and numbers. Family was seen by Neurology, multi-disciplinary Concussion Clinic (CC) providers, and cranial MRI was completed. Neuropsychological testing included IQ, academics, memory, executive functions, emotional, and effort testing. Return to play occurred seven months later, although school avoidance continued through a second injury. A third injury occurred 32 months after initial injury, with additional neuropsychological testing and retirement. Interventions included alternating courses of cognitive-behavioral therapy, family interventions, headache clinic, academic modifications, psychiatry, and continuous CC follow-up. Results All imaging results were normal. Neuropsychological results were average to above average in all areas except calculation tasks and effort testing, with minimal change over time. Significant relation between emotional symptoms, social stressors, self-concept, and cognitive symptoms supported Conversion Disorder. Lack of clearance to return to play motivated initial recovery. Multiple courses of varied interventions addressed complex self-identity issues. Conclusions As research indicates, diagnosis of conversion requires medical and psychological methods. The complex components of this case highlight change resulting from a CC coordinating equally complex medical and psychological treatment.