Atypical Post-concussion Symptoms In A Young Adult Female Soccer Player - Page #3

Lab Studies:
No abnormalities

Other Studies:
One week post-concussion sagittal FLAIR image with fat saturation Case Photo #1 demonstrating multiple tiny hyperintensities in the periventricular and subcoritcal white matter bilaterally.

Six month follow-up sagittal FLAIR image Case Photo #2 demonstrating stable multiple T2 hyperintense lesions.

Eighteen month follow-up coronal T1-weighted MRI post-contrast Case Photo #3 demonstrating stable white matter lesions.

Sports Medicine (one week after injury): "Many of her symptoms appear classic for a concussion, although her gait instability and MRI findings are certainly concerning."

Neurology (two weeks after injury): "At the present time, the neurologic exam is within normal limits [...] The MRI study shows several white matter abnormalities which are nonspecific. I would not strongly consider them to suiggest multiple sclerosis [...] it is possible [the lesions] are related to previous head injuries."

Sports Medicine (18 weeks after injury): "I do not feel that she should progress with her activities."

Sports Medicine (6 months after injury): "I continue to be concerned about the findings on the MRI [...] I do feel that Neurology should reevaluate."

Neurology (10 months after injury): A second opinion was sought by the patient and her family. After careful review of the patient's history and lingering neurological symptoms in correlation with white matter lesions on MRI, the patient was given a formal diagnosis of multiple sclerosis and treatment was discussed.

Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.

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