Saved By The Bell Being Rung

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Saved By The Bell Being Rung - Page #1

Author: Tyson Sessions, DO Senior Editor: Justin Mark Young, MD Editor: James Robinson, MD Patient Presentation: 15 year old male wrestler presented to the concussion clinic for initial evaluation of concussion that occurred one week prior. History: Patient was taken down in the match and fell backward striking the posterior aspect of his head on the mat. Patient reports that he had an immediate onset of headache and dizziness. He reports that with initial impact he had difficulty moving both his arms and legs for approximately five seconds. Patient saw his primary care provider the day after the injury. He reports he had c-spine x-rays that he was told were normal. The images were not available for review. Since the injury, the patient reports some intermittent headaches and dizziness. He denies any continued weakness, numbness, or tingling in his extremities. After more persistent questioning, the patient reveals that several years earlier he had a similar experience where he fell on a trampoline and felt like he could not move his extremities for about five seconds. Physical Exam: Neurologic Exam: Cranial nerves II through XII intact. Normal strength and sensation in bilateral upper and lower extremities. Smooth pursuits are normal without diplopia. Near point convergence is normal. Normal horizontal and vertical saccadic eye movements without symptoms. Normal horizontal and vertical VOR without symptoms. Romberg is negative. Vestibular Ocular Reflex cancellation test was without dizziness or postural sway. Eyes-closed head shake on firm surface was without dizziness or postural sway. There was no bilateral occipital nerve tenderness. Reflexes in bilateral upper and lower extremities were 2+ and symmetric. Cervical Spine Exam: There was full pain free ROM of cervical spine. There was bilateral cervical paraspinal muscle tenderness, but no spinous process tenderness. Spurling's test was negative. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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