Uncommon Course Of A Common Injury - Page #1

Author: Benjamin Petty, MD
Co Author #1: Benjamin Petty, MD
Co Author #2: John Hyden, MD
Co Author #3: Nahum Beard, MD

Patient Presentation:
A 21 year old female rifle athlete suffered a concussive event on 10/26/2013 after falling and hitting her head in her dorm room. She did not have loss of consciousness, but had headache, nausea, irritability, and dizziness. She had a complicated and long recovery, and complained of various somatic and affective (anxiety) symptoms. She was also seen by a Neuropsychologist in February 2014 and was started on Escitalopram to treat her associated symptoms. She presented to the athletic training room on 3/20/2014 with an exacerbation of her post concussive syndrome after hitting her head on a car door. She was seen in the Emergency Department that day with symptoms of dizziness, headache, nausea, vomiting, anxiety, irritability, and fatigue. She was given pain medication, phenergan, and anti-inflamatory medication. The athlete was instructed not to travel and to avoid training activities. She also reports that she is trying to lose weight and is a on a modified vegan diet.

PMHx: Migraines, Anxiety
PSHx: wisdom teeth extraction 2011
Meds: Ocella, Escitalopram
Fam Hx: noncontributory

Physical Exam:
Physical Exam: 5'4" 155 lbs BP 129/71 Pulse 64
General: NAD; HEENT: normocephalic atraumatic, PERRLA, EOMI, no septal deviation, no neck pain Musculoskeletal/Neuro: Cranial Nerves 2-12 are intact, full AROM, strength 5/5 in both upper and lower extremities, no focal neurologic deficits, no tremor, smooth pursuit testing and saccades testing reproduced headache and dizziness without significant nausea.

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