Atypical Post-concussion Symptoms In A Young Adult Female Soccer Player - Page #4

Working Diagnosis:
Anosmia secondary to Traumatic Brain Injury
Vasovagal episode with Syncope

Patient was hospitalized for 24 hours during initial workup in which she was observed for further development of neurological symptoms. She was then discharged with planned follow up which included mandatory rest from contact activities as well as follow up with her PMD, Neurology and ENT. Her Team Doctor, Athletic Trainer and Head Coach were all aware of the hospital course and discharge plan.

Concussion rapidly recovered per return to play protocol; however, patient still had persistent Anosmia. Patient was seen by both Neurology and ENT as outpatient 4-6 weeks after initial injury - they recommend no contact for 6 months from injury. Patient to have no contact for 6 months from date of injury and will miss the entire soccer season. Frequent return visits scheduled for continued evaluation and treatment in Sports Clinic during this time. Patient referred for mental health counseling and will work with Athletic Trainers on non-contact training activities to maintain stamina and fitness level.

Author's Comments:
Teaching Points
1) Head Trauma / Post Traumatic Injuries are believed to be the most common cause of anosmia accounting for 19% of anosmia cases.
2) There are two main categories of olfactory dysfunction - disorders of conduction and sensorineural injuries.
3) There is limited literature in return to play guidelines - consensus was 6 months.
4) 15-39% of anosmia patients will over time regain there sense of smell.

Editor's Comments:
Interesting but rare presentation of a common injury

Bromley, Steven. Smell and Taste Disorders: A Primary Care Approach. Am Fam Physician. 2000 Jan 15;61(2):427-436.

1) Doty, Richard: Handbook of Olfaction and Gustation. New York, Marcel Dekker, Inc. 2003, pp 461-473.
2) Doty R, Anupam M. Olfaction and its alteration by nasal obstruction, rhinitis, and rhinosinusitis. Laryngoscope 2001, 111:409-423

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