Author: Edward Cho, MD
Co Author #1: Edward K. Cho, MD
Co Author #2: Mikhail S. Carlow, MBBS
Co Author #3: Dean W. Padavan, MD
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Caleb Kiesow, MD

Patient Presentation:
Healthy 21 year old female with medical history including combined oral contraceptive use and anxiety controlled on Zoloft 50 mg daily presented to our office for evaluation of possible concussion after striking the back of her head while dancing 10 days prior.

History:
A 21-year-old female with medical history including anxiety presented to our office for concussion evaluation after hitting the back of her head during dance 10 days prior. She initially had headache and dizziness that resolved within 24 hours, and denied loss of consciousness, visual changes, or amnesia. She remained asymptomatic until Day 5 when her left-sided headache returned with increased severity, now constant and radiating from the left temple and skull base to the eye and neck, with dizziness, nausea, photophobia, and tinnitus. She went to the emergency department on Day 9, where CT head without contrast was negative and symptoms improved briefly with IV fluids and pain medication. Her symptoms returned later that same evening, prompting her to schedule an appointment with our office. At our initial evaluation, she reported left temporal headache radiating to the left face and neck that worsened with bright lights and positional changes of her head. Her headache woke her up at night and was affecting her school performance due to fatigue and difficulty concentrating. Ibuprofen and Tylenol were ineffective. She denied constitutional symptoms.

Physical Exam:
Vitals: BP 106/72, HR 78, SpO2 99% on room air. Constitutional: Appeared mildly uncomfortable at rest; skin flushed. Eyes: Pupils round, equal, and reactive to light bilaterally; fundoscopic exam normal. HENT: No abnormalities noted. Cardiopulmonary: Normal rate, regular rhythm; normal heart and lung sounds. Musculoskeletal: Full neck range of motion; taut left trapezius; left cervical paraspinal tenderness. Neurologic: No focal cranial nerve deficits; sensation, coordination, strength, and reflexes intact. Special tests: Negative Kernig and Brudzinski. Concussion testing: VOMS negative; SAC 28/30; PCSS 42; patient feels 50% her normal self.

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