Nausea Is A Pain In The Neck - Page #1

Author: Tyler Adamson, DO
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Stephanie Aldret, DO

Patient Presentation:
A 22-year-old female presented for concussion evaluation.

A 22-year-old female rugby player presented for concussion evaluation after sustaining a blow to the temple region while tackling during a scrimmage. She was able to finish the scrimmage without symptoms but reported onset of headache, nausea, vomiting, eye pressure, blurry vision, and photophobia an hour after finishing. After the initial exam, she was sent to the Emergency Department (ED) for further evaluation of persistent vomiting. Her symptoms resolved shortly after receiving Computerized Tomography (CT) of the head in the ED which led to her being discharged home. A follow-up visit for return to play revealed four prior concussions that occurred after blows to the neck or low occipital region. Symptom profiles were similar in onset, nature, and resolution with additional symptoms consisting of dizziness and neck pain. Her last concussion was 3 months prior. All concussions occurred while playing collegiate rugby. Recovery has been 3-4 weeks with no further workup for each previous concussion. No past medical or surgical history of note.

Physical Exam:
General: Appears acutely distressed; lying in fetal position on exam table; vomits once during encounter
Cervical Spine: Full range of motion, non-tender to palpation, negative Spurling’s test
Neurologic: Alert and oriented x 3, cranial nerves intact without focal deficiency, cerebellar testing intact, vestibulo-ocular motor testing normal but does provoke headache, single and double leg stances without error, tandem stance with 5 errors noted. Sensation and muscle strength are intact and equal.
MSK, Cardiac, Pulmonary, Abdominal: Unremarkable

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