Head Injury - Soccer

Abstract

HISTORY: A 20-year-old male college soccer player suffered a head injury during the second half of a varsity game. While attempting to head a ball his head forcefully collided with his opponent's head. He was brought to the sideline where he was found to have amnesia to the event and was confused. His only reported symptom was a headache. The neurologic exam was non-focal. He reported to training room for physician evaluation three days later. At that time he continued to have lack of memory of events occurring between 1 pm and 6 pm on the day of event. He otherwise was symptom free. Past medical and social histories were negative. He denied the use of medications, prescription or otherwise. PHYSICAL EXAM: Evaluation in the training room revealed a blood pressure of 146/80 and a pulse of 58. Cardiac exam showed a regular rate and rhythm. There were no murmurs. Three word recall was appropriate. He was able to recite the months of the year in reverse without hesitation. Cranial nerves 2-12 were intact. Reflexes were 2+ in the upper and lower extremities bilaterally. Strength was 5/5 in bilateral upper and lower extremities. There was a negative Romberg test. Finger to nose test as well as heel, toe and heel-to-toe walking were all appropriate. DIFFERENTIAL DIAGNOSIS: 1. Concussion 2. Idiopathic hypertension 3. Thyrotoxicosis 4. Traumatic brain injury induced hypertension 5. Autonomic dysfunction syndrome TESTS AND RESULTS: CBC: within normal limits BMP: within normal limits UA: within normal limits EKG: within normal limits ImPACT: (performed 7 days after injury) no significant difference when compared to baseline FINAL/WORKING DIAGNOSIS: Traumatic brain injury induced hypertension TREATMENT AND OUTCOMES: Athlete was symptom free by day 3 status post injury. At that point he was progressed per protocol for return to play following concussion. Review of patient's records revealed a normal blood pressure at time of pre-participation exam at the beginning of current season. Between days 3 and 10 post injury his blood pressure was monitored by the athletic trainer. Readings during that period ranged from 132-150/80-90. During training room evaluation at day 10 further testing was performed. From that point forward his blood pressure remained less than 140/90 and he was allowed to continue to compete. He continues to be closely monitored.