Post-Concussive Disorder complicated by B12 deficiency
The patient was treated with Escitalopram, Mirtazepine, Vitamin B12 supplement and Fish Oil. The patient was also instructed to increase dietary B12 intake.
The athlete had a significant improvement in her mood after 3 days of B12 supplementation. She improved both socially and academically. She is doing well and is back competing on the rifle squad. She continues to be asymptomatic.
This case is a good example of how co-morbid conditions can prolong the recovery from a concussion. It is a good idea to look for additional factors effecting recovery from concussion when the course is prolonged more than the typical 7-14 (or at the outset 30) days. A history of depression, anxiety or migraines have been associated with prolonged recovery from concussion. In this case vitamin B12 deficiency may have been a contributing factor to the delay.
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