Complex Concussion - Page #1

Author: Ifran Asif, MD

Patient Presentation:
Senior college free safety suffered a head injury while making a tackle. On the field, he was found unconscious and was noted to have shallow respirations and a heart rate in the 120's. He regained consciousness after approximately 4 minutes and was combative and agitated. He was placed on a spine board and was transported. Sedation and intubation were later required.

The athlete had a history of nausea, vomiting, fatigue and difficulty concentrating for 4 weeks after a prolonged episode of binge drinking February 2005. Head CT scan at that time was negative. In August 2005 the athlete suffered a concussion and was held out of contact for 1 week. Symptoms cleared completely. In June 2006 the athlete was diagnosed with hypertension in the 122-160/88-96 range. Medication was prescribed, but the patient did not continue to take them. In October, 2007 the athlete suffered the current concussion.

Physical Exam:
On presentation to the emergency department, the vital signs were: Temperature 36.9, heart rate 110 and blood pressure 140/70. The patient was intubated, but arousable. Pupils were 4mm and reactive. Deep tendon reflexes and Babinski's test were normal. Cardiac, lung and abdominal exams were normal. Neurological exam 12 hours post injury showed a PERRLA, EOMI, negative Romberg test, inaccurate finger-to-nose test, difficulty with 3 word recall at 5 minutes, normal ability to count by 3. He could repeat 4 digit sequencing forward and backwards. Previously he could do this with 5 digits.

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