HEAD INJURY - FOOTBALL

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480 HISTORY - A 16 year-old center, during the varsity football game, was struck in the back of the head while lying face down on the ground. He appeared to be momentarily unconscious, but is awake when the trainer evaluates him. Athlete complained of a headache the remainder of the game. He was also noted to have some post-traumatic amnesia. The parents became increasingly concerned when the athlete developed dizziness and unsteady gait. In the ER the athlete was noted to have an ataxic gait, left-sided headache and post-traumatic amnesia. The parents found the athlete to be more lethargic the next day and a half, following which examination by the neurologist was negative. Further the parents state that the athlete had sustained a mild head injury 3 days prior. The initial head injury occurred while blocking. At that time the athlete complained of headache, dizziness, and feeling“funny.” PHYSICAL EXAMINATION - Athlete appeared pleasant, cooperative and in good hygiene. Mini-Mental Status Exam was 30 out of 30. Vital signs, heart and lungs were within normal limits. Neck and back were supple, non-tender, and without deformity. Cranial nerves were intact. Negative Romberg's and heel to shin bilaterally. Gait without abnormality. Deep tendon reflexes were 2+ and equal bilaterally at the knees. 1+ and equal at the elbow and ankles. Babinski's were negative. Strength was 5 out of 5 and equal bilaterally upper and lower extremity. Muscle tone and range of motion normal through out. DIFFERENTIAL DIAGNOSIS: Recurrent Mild Brain Injury. Second Impact Syndrome. Epidural Hematoma. Subdural Hematoma. Post-concussion Syndrome. Malignant Brain Edema Syndrome. Rule out associated neck sprain. TESTS AND RESULTS: CT Scan of the Head without Contrast: No evidence of acute or old bleed. No evidence of edema. Neck X-rays: No evidence of fractures or dislocations. FINAL WORKING DIAGNOSIS: Recurrent Mild Brain Injury: Initial mild head injury followed by a moderate. MANAGEMENT: Athlete was held out of participation for 1 month. He was symptom free for at least 3 weeks. School performance returned to base line after the rest period.