Author: Christine Harris-Spinks, MD, MPH
Co Author #1: Sourav Poddar, MD
Co Author #2: Stephanie Chu, DO
Editor: Diana Heiman, MD
19 y.o. F collegiate volleyball player with a hx of 2 prior concussions was struck under chin by a volleyball on a rebound from a spike. She was not expecting the impact.
She complains of headache, neck pain, nausea, dizziness and emotional lability. She was diagnosed with a concussion by the ATC, held from play, and placed on cognitive and physical rest. Initially she reported 8/22 concussion symptoms with a total symptom score of 20/132. Four days later, the patient had improvement in symptom scores and return to baseline on Standardized Assessment of Concussion (SAC). Additional neuropsychological testing demonstrated return to baseline parameters. However, as she had tried to return to class and cognitive/visual effort, she reported blurry/double vision and trouble focusing on objects in left lateral visual field.
Physical examination (4 days after impact):
Neck exam was within normal limits without any tenderness to palpation. Modified BESS test found 0 errors on double-leg stance, 1 error on single-leg stance, and 1 error on tandem stance. Her upper limb coordination exam was 1/1. Delayed recall 4/5 (at baseline). IMPACT Test returned to baseline. Eye examination: 20/20 vision in each eye on eye chart. Convergence: reports double vision when object is 10cm from nasal bridge. Vertical gaze: intact superior and inferior gaze with both eyes. Lateral gaze: she was able to gaze fully to the right with both eyes. The right eye was able to achieve full gaze to the left. However, in the left eye there was a 6mm lag in terminal lateral gaze Case Photo #1. On visual field testing, she had reduced ability to see items in left peripheral visual field compared to the right.
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