Disequilibrium In An Amateur Mixed Martial Artist - Page #1

Author: Christopher Johnson, MD
Co Author #1: Christopher Johnson, MD
Co Author #2: Mark Lavallee, MD

Patient Presentation:
A 33 year old martial artist presents to the ED with headache, neck pain, nausea and disequilibrium for 24 hours.

The patient reports that his symptoms started immediately after receiving a guillotine choke hold. He reports diffuse headache with right-sided neck pain. He also reports nausea and vomiting. The patient did not continue practice and went home to rest. However, his pain persisted despite ibuprofen and ice. His feeling of disequilibrium also increased, which prohibited him from walking. However, he did not seek medical care, instead choosing to rest. The next day, his symptoms improved overall. He did not have any further episodes of vomiting. He still felt unsteady, but was able to ambulate. However, his headache and neck pain persisted, which prompted a trip to the ED at his wife's urging.

Physical Exam:
Afebrile, normal vital signs. Orthostatics normal. Tenderness over upper right trapezius, otherwise head and neck were unremarkable / atraumatic. Cardiovascular exam unremarkable. CN II-XII intact. Gross motor, sensory intact. Normal reflexes and coordination. Rhomberg negative. Mild difficulty with tandem gait, with deviation to the right.

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