He Didn't See It Coming: An Unusual Concussion Complication

Home
About Us
- - About Us
  - About AMSSM
  - FAMSSM Designation
  - Awards
  - Founders
  - Past Presidents
  - Board of Directors
  - Committees
  - Contact Us
  - Bylaws/Policy & Committee Handbooks
- - FAMSSM Applications
  - Application submission is now closed for the 2025 Class of AMSSM Fellows. New Fellows will be announced to the AMSSM membership after the first of the year and honored at the 2025 Annual Meeting.
    
    Applications for the FAMSSM Designation will be available on an annual basis. Please contact Ellen Glasgow with any questions regarding the FAMSSM application.
- - We Understand You

Communications
- - Online AMSSM Community for Members
  - AMSSM Collaborate online community provides a forum for year-long connection, giving members the chance to have conversations, share resources and make connections with your peers.
- - AMSSM Informational Brochures
  - Find informational brochures about sports medicine physicians geared toward coaches, parents and other healthcare professionals.
Education
- - AMSSM Sports Medcasts
  - Find all current and past AMSSM Sports Medcast episodes in one convenient location.
- - AMSSM Fellow Online Lecture Series
  - The AMSSM National Fellow Online Lecture Series features talks from national experts on fundamental sports medicine topics pertinent to fellowship training and sports medicine board certification. Go to the collaborate.amssm.org site and view the available lectures in the Upcoming Events area.
Research
Advocacy
- - Legislative and Policy Issues
  - AMSSM is the go-to organization for legislative and policy issues related to sports medicine and athlete health and safety.
- - Legislation by State
  - AMSSM offers a variety of advocacy resources, including a map that tracks legislation important to sports medicine physicians.
Sports US
- - Sports Ultrasound Online Didactics
  - These 35 educational modules cover all of the didactic instructional session topics recommended for sports medicine fellows by the AMSSM.
- - Sports Ultrasound Committee
  - Find all the resources, materials and guidelines from the AMSSM Sports Ultrasound Committee
Patients
- - Need a Sports Medicine Physician?
  - FindADoc
- - SportsMedToday.com
  - Your comprehensive sports medicine resource for athletes, coaches and parents.
Additional Information
- - Additional Information
  - Sports Med Today
  - Journals
  - Weekly Digests
  - Store
  - Careers
  - Industry
Foundation

He Didn't See It Coming: An Unusual Concussion Complication - Page #4

Working Diagnosis: He was treated for a concussion with cranial nerve IV (trochlear) palsy and left homonymous hemianopia due to an occipital lobe injury. Case Photo #3 Case Photo #4 Treatment: He was advised to rest from all physical and cognitive activity, including school. He was advised to wear an eye patch. He underwent visual training with occupational therapy and his headaches were treated with pain medication. Outcome: His visual field deficits and trochlear nerve palsy spontaneously resolved two months following his injury. He continues to have post-concussive symptoms eight months later including cognitive dysfunction with difficulty forming short term memories. He suffers from anxiety and depression, mild headaches and fatigue. He has been able to return to school. Author's Comments: The trochlear nerve is susceptible to injury due to its location. It is the only cranial nerve to exit the brain stem dorsally and it has the longest intracranial length as it courses around the brainstem to enter the cavernous sinus and orbit where it innervates the superior oblique muscle. It is injured most commonly due to head trauma or infarct. The contrecoup forces of head trauma compress it against the rigid tentorium. It is usually associated with a loss of consciousness although not in this particular case. The visual disturbances are due to superior oblique muscle paralysis. Nearly all cases resolve within weeks up to six months. If they do not resolve, there is a surgery than can be performed to resect the inferior oblique muscle to realign the eyes. References: Stiller-Ostrowski, JL. Fourth cranial nerve palsy in a collegiate lacrosse player: a case report. Journal of Athletic Training 2010;45(4):407-10 Brazis, PW. Isolated palsies of cranial nerves III, IV, and VI. Seminars in Neurology 2009;29(1):14-28 Enzenauer, RW, Hoehn, ME, and Del Monte, MA. Strabismus. Rudolph's Pediatrics, Chapter 586. McGraw-Hill Publishing; 2009. Return To The Case Studies List.		Back
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

Back	Top

UPCOMING EVENTS

FIND A SPORTS DOC