Author: Matthew Silvis, MD
Co Author #1: Michael Plakke, BS
Editor: Kathryn Ackerman, MD, MPH
A 19 year old female suffered a closed head injury while playing collegiate soccer after being struck in the temple with a ball. After a brief loss of consciousness, she experienced headache, nausea, and vomiting. She was brought to the emergency department and an initial head CT was normal. She was held in the hospital overnight for observation. The next morning she was discharged with a diagnosis of posttraumatic headache with vestibulopathy.
At a follow-up with her family physician several days later, she complained of continued nausea and vomiting, blurred vision, photophobia, vertigo, tremulousness, and insomnia. Atypical post-concussion symptoms developed over the next several months. These included right-sided foot drop and intermittent ataxia. Proper imaging was ordered and neurology was consulted.
On initial physical exam, her vital signs showed no abnormalities. There were no cranial nerve deficits, negative Lhermitte's sign, and normal motor strength and reflexes. Positive findings included decreased sensation to pinprick in her left hand, a positive Romberg sign, and a gait abnormality characterized by the right-sided foot drop.
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