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The Collision That Sparked A Mystery - Page #1
 

Author: Hassan Cheaito, DO
Co Author #1: Johnathan Stoddard, MD
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Emily Miller, MD

Patient Presentation:
A previously healthy 17 year old male high school football and lacrosse player presented to clinic in the fall for evaluation of upper and lower extremity shaking episodes.

History:
He noted his first episode in the spring prior to presentation. During a lacrosse game he was hit in the back of the head. Subsequently both his upper and lower extremities started shaking and he was unable to control the movements. This lasted for a few minutes and then resolved spontaneously. He had no other symptoms at the time of the initial event. He did well until he presented in the fall after a second episode which occurred after he took a hit while playing football. This time however his symptoms only involved the right arm and leg, with no symptoms noted on the left. Symptoms were similar in that he had shaking that he was not able to control, which resolved spontaneously. At the time of evaluation he was asymptomatic. He otherwise felt well without any additional symptoms. He denied loss of consciousness with either episode and had full memory of both events.

Physical Exam:
Vitals: Temp 97 F, BP 132/78, HR 55, Ht 184.2 cm, BMI 23.01
General: No acute distress. He was not ill-appearing, toxic-appearing or diaphoretic.
Skin: No rashes or lesions.
Abdominal: Abdomen was flat, non-tender, non-distended.
MSK: No obvious deformities.
Neurological: No focal deficit present.
- Mental Status: At baseline. Alert and oriented to person, place, and time.
- Cranial Nerves: No cranial nerve deficit.
- Sensory: No sensory deficit.
- Motor: No weakness.
- Cerebellar: Coordination & balance normal.
- Gait: Normal.
- Deep Tendon Reflexes: Normal.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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