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Spontaneous Onset Of Unilateral Headache While Playing Soccer - Page #1
 

Author: Crystal Graff, MD
Co Author #1: Christian Nicolosi
Co Author #2: Ben Ingraham
Senior Editor: Kristine Karlson, MD, FAMSSM
Editor: Shane Hudnall, MD, FAMSSM

Patient Presentation:
A 17-year-old male Division 1 college soccer recruit was playing in a high school soccer game when he developed acute onset right facial and temporal pain.

History:
He thought the pain was due to a direct blow to the head but there was no witnessed head contact from onlookers. About 20 seconds later, the athlete spontaneously collapsed to the ground. He was seen attempting to stand but collapsed again. When the athletic trainer met the athlete on the field, he was conscious and speaking but with a notable left facial droop, left-sided weakness and sensory deficits. The athlete's cervical spine was stabilized, and he was transported by ambulance to the emergency department. En route the patient had two short episodes of loss of consciousness with immediate return to full alertness.

Physical Exam:
At the emergency department, he had a Glasgow Coma Scale (GCS) score of 15. The patient was noted to be alert and oriented and in no acute distress. His speech was intact without dysarthria. A cranial nerve exam was notable for left lower facial paralysis. The patient had 5/5 strength in the right upper and lower extremities but no spontaneous movement of the left upper and lower extremities. He had complete loss of sensation of the left side of his body while the right side remained intact. He additionally displayed left-sided neglect. His coordination was intact with finger-to-nose testing on the right side. There were no abnormal involuntary movements. His muscle tone was normal. His left patellar reflex was 3+ and there were 3 beats of clonus in the left ankle.

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