Recurrent Concusions - Football

Abstract

HISTROTY: A 19-year-old male collegiate quarterback with a history of two previous mild concussions during his high school career presented for evaluation of two recent concussions. The first concussion occurred at football practice, when he was struck in the head by a football thrown from 30 yards away. He sustained a loss of consciousness (LOC<30 sec) and a headache prompting a visit to the emergency room. CT scan of the head was unremarkable and his symptoms resolved over the next twenty-four hours. He progressed his activities and returned to competition one week later. The second concussion occurred at that game when he sustained trauma to his head. There was no LOC, but he noted decreased concentration and dizziness causing him to be pulled from the game. PHYSICAL EXAMINATION: -He was alert and oriented to person, place and time. Head and neck examination reveals no evidence of trauma and no tenderness to palpation. Pupils were normal and equally reactive to light and accommodation. Cranial nerves II-XII were intact. He had normal range of motion of the cervical spine and upper extremities. He had normal strength, sensation and reflexes of the upper and lower extremities. Romberg testing was normal. Immediate memory and 5 minute recall was normal. Performance of finger-nose-finger and heel-shin-heel was normal. He was able to perform serial 7's, repeat up to 7 digits forward and backwards. He was able to perform push-ups and sprints without any symptoms. DIFFERENTIAL DIAGNOSIS: Recurrent mild traumatic brain injury Focal brain injury Congenital brain vascular malformation Brain tumor TESTS AND RESULTS: - MRI of Head/Neck: Grade 1 Arnold Chiari malformation with the cerebellar tonsils 9mm below the foramen magnum -Neuropsychologic testing: Normal, though lower performance with higher level executive function (no baseline) FINAL/WORKING DIAGNOSIS: Recurrent mild concussions Grade I Arnold-Chiari malformation TREATMENT AND OUTCOMES: No participation in practice or game for 4 weeks Consultation with multiple physicians regarding return to play: consensus that no to minimal increased risk for sports participation Counseling of athlete, parents, coaching staff and medical team Functional progress of exercise activity to sports specific Return to play at 4 weeks without any recurrent concussions