C-24 Free Communication/Poster - Cardiovascular 1

Abstract

HISTORY: A 17-yo hs football lineman with transient headaches after collisions. Referred for a third opinion to determine clearance for participation. Reports history of 3-5 concussions. Symptoms and amount of time lost for each concussion were minimized by athlete on repeated questioning and compared to previous physician notes. During his junior season, he suffered headaches that would gradually worsen as the season and each individual game went on. Heahaches would only occur with contact and would gradually build in severity until he had to “take a play off”. He repeatedly denied any other symptoms such as difficulty concentrating, nausea, light sensitivity, etc. He denied offseason headaches unless he did maximum power lifting or participated in any minicamps. During a consultation with a neurosurgeon, the athlete denied experiencing any headaches with maximal lifting. The athlete’s father was concerned about minimization of symptoms and poor school performance. PHYSICAL EXAMINATION: BP: 120/84 Height: 6’2” Weight: 283lbs Gen: large, healthy appearing; parents present at each visit HEENT: normal Neck: full ROM; neg Spurling; non-tender Neuro: non-focal; CN II-XII grossly intact - Neurovestibular testing and balance testing normal and without symptom production - SCAT3 and BESS at baseline - Computerized NP testing: cognitive efficiency index: less than 0.2 is poor performance on speed and accuracy o 9/20/2010: 0.12 o 9/7/2011: 0.18 o 6/24/2013 - following most recent concussion: 0.20 DIFFERENTIAL DIAGNOSIS: 1. Concussion 2. Arnold Chiari Malformation 3. Migraine or tension headaches 4. Tumor 5. Vascular malformation TEST AND RESULTS: MRI Brain: 1. Ectopic cerebellar tonsils consistent with mild Chiari I malformation 2. Incidentally noted minimally prominent cistern magna Neuropsychological testing: 1. Deficits of 1.5-2.0 Standard Deviations in memory tasks and executive functioning. Effort judged to be excellent FINAL WORKING DIAGNOSIS: 1.Concussion (recurrent) with cognitive impairment 2. Arnold Chiara Malformation Type 1 TREATMENT AND OUTCOMES: 1. Restricted from participation in high school football. 2. Reassess neuropsychological testing at 6 months and 10-12 months. 3. Continue to work out in non-contact fashion and otherwise continue life and academics without restrictions.