Transient Lower Extremity Paralysis In The Collegiate Baseball Athlete - Page #1

Author: Brett Bentley, Student
Co Author #1: Jocelyn Gravlee, MD; John Barrett, LAT ATC

Patient Presentation:
An 18 year old college baseball player presents with right lower extremity paralysis after diving head first into the outfield wall.

An 18 year old freshman collegiate baseball player dove head first into the outfield wall pursuing a long fly ball during a game. He struggled to his feet and awkwardly hopped toward the ball, noticeably favoring his right leg. He grabbed the baseball and threw it back toward the infield before dropping to the outfield grass.

The team's certified athletic trainer (ATC) initially examined the athlete on the field and the player complained that he could not feel his right leg from the knee distally. A nearby teammate relayed to the ATC that the athlete had hit the wall hard with his head. There had been no loss of consciousness. He denied neck or back pain, headache, visual changes, dizziness, confusion or amnesia. He did, however, complain of nausea.

Physical Exam:
GENERAL: Cooperative with exam, able to respond to questions appropriately
HEENT: left occipital tenderness, EOMI, PERLLA bilaterally
RESPIRATORY: respiration unlabored, no difficulty breathing
NEURO: A&O x3. No tenderness of the cervical spinous processes and no palpable deformities. CN II - XII grossly intact. Normal mini-mental status exam. Muscle strength 0/5 with right knee flexion and extension, ankle dorsiflexion, plantarflexion, eversion and inversion. No sensation with light touch of the entire right lower extremity. Reflexes absent in the right patella and achilles. No Babinski present.
KNEE EXAM: full passive ROM and no ligamentous laxity

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