Author: Hazim Rishmawi, MD
Co Author #1: Wade Rankin, DO
Editor: Brian Vernau, MD
Concussion from the sideline to the emergency department
Our patient is 12 year old male football player who had an MCL sprain and recently returned to practice reported to the Emergency Department after a collision during practice. He was hit by two tacklers while catching the football. History was difficult to obtain from the patient
as he was very confused at the time of interview. Collateral information was obtained from the coaches and players present. The players denied any helmet to helmet contact. The coach said they were only practicing at about 50% because they had a game the following day. No
one else saw the contact. There was no loss of consciousness at the time of the contact. After about five minutes, the boys noticed him acting “funny.” He was confused, couldn’t remember their names, where he was or what he was doing. He also complained of a headache, difficulty hearing, and trouble with balance. He denied fever, chills, sweats, vision changes, loss of bowel or bladder control, tongue biting, cough, neck pain, shortness of air, easy bruising, easy bleeding, or bleeding gums.
Temperature 98.4, respiratory rate 18, pulse rate 80, blood pressure 114/74.
54 inches tall, weighs 152 pounds.
GENERAL: healthy-appearing, mildly distressed, obese.
HEENT: PERRL. EOMI. Sclerae anicteric. Pharynx clear. Diminished hearing on the left.
NECK: Supple. No lymphadenopathy present.
CHEST: Clear to auscultation bilaterally.
HEART: Regular rate and rhythm.
ABDOMEN: Soft, nontender.
EXTREMITIES: No clubbing, cyanosis or edema.
MSK: Full passive ROM all extremities. Difficulty following directions.
NEUROLOGIC: Awake, alert, and oriented to name only. He couldn’t remember his birthday, the year, where he was or his relatives. Confused speech, difficulty answering direct questions and following commands. CN normal other than inability to follow commands for shoulder shrug. Loss of sensation to pain and light touch bilateral lower extremities, 2/5 strength of bilateral lower extremities with inability to stand while upper extremities remained 5/5. Decorticate convulsive movements of the bilateral upper extremities. Rhomberg was grossly positive with eyes open. Unable to test coordination. Reflexes 2+ bilateral knee, ankle and triceps.
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