Bad Luck From A Puck. - Page #1
 

Author: Lauren Greene, MD
Co Author #1: Sadiq Haque
Senior Editor: Joseph Chorley, MD
Editor: Yaowen Hu, MD, MBA

Patient Presentation:
35 year-old previously healthy male was seen during an NHL hockey game after receiving a puck to the mastoid process of the left ear.

History:
35 year-old previously healthy male was seen during an NHL hockey game after receiving a puck to the mastoid process of the left ear. He immediately removed himself from the game after the injury. He complained of immediate pain over the mastoid with moderate soft tissue swelling and bruising. He also complained of dizziness, tinnitus, headache and nausea. In addition, he denied visual changes, hearing loss, vomiting, numbness, tingling, and speech dysfunction. He has a history of two previous concussions over his lifetime, with the most recent being in 2017 (more than 2 years ago) where he subsequently missed 1 game.

Physical Exam:
General AOx4, baseline behavior and gait
HEENT 3-4 cm tender, erythematous lesion with ecchymosis on the left mastoid process. No crepitus, TM intact, no hemotympanum or clear drainage within ear or nose.
Rinne AC>BC
Weber Midline
CN II through XII intact, facial nerve intact
Smooth pursuit normal, no nystagmus or sx
Vertical/Horizontal saccade normal
Near point convergence normal, 6cm
Accomodation no symptoms
Vestibular ocular reflex no symptoms

Modified BESS testing:
Romberg 0 errors/20 seconds
Balance
3 errors single leg / 20 seconds
3 errors Tandem gait /20 seconds
Finger to nose 5 repetitions in 4 seconds

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

© The American Medical Society for Sports Medicine
4000 W. 114th Street, Suite 100
Leawood, KS 66211
Phone: 913.327.1415


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