Author: Carl Rasmussen, MD
Co Author #1: Sean Robinson, MD, CAQSM
Editor: Tricia Beatty-Webner, DO
JC is an unvaccinated 15 year-old with a learning disability, but otherwise healthy, who presented to clinic for worsening nausea after head trauma.
Approximately 6 weeks prior, a vehicle struck JC while cycling. He hit his head, and his abdomen struck the handlebars. He was wearing a helmet. There was no reported loss of consciousness. He did not seek immediate medical evaluation. JC returned to his regular routine of school and recreational exercise. However, he had ongoing headache and neck pain, as well as fatigue, difficulty concentrating, and mild nausea. He began doing poorly in school. About 1 month after the accident, he developed blurry vision and faintness while at school. He was taken to a local ER; the work-up, including a head CT, was normal. He was diagnosed with a concussion; outpatient follow-up was recommended. JC first presented to sports medicine clinic 1 week later. He complained of ongoing symptoms above, worsened with activity. He vaguely commented on feeling ill and reported family members having “the flu.” His SCAT symptom severity score was 75. Physical exam was unremarkable. He was diagnosed with post-concussion syndrome and routine management recommendations were made.
JC was seen in clinic 6 days later for significantly worsening nausea. He also complained of dull epigastric pain and thought his eyes looked yellow. He again reported ill contacts with “the flu” at home, but could not provide further details. He denied recent travel. JC had been taking acetaminophen as needed for headache but denied other medications. He also endorsed poor appetite, weight loss, and dark urine.
Normal vitals. HEENT with faint scleral icterus. Abdomen with mild tenderness to palpation in epigastrium and right upper quadrant. The rest of the exam was unremarkable.
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