Working Diagnosis:
Post-Concussive Disorder complicated by B12 deficiency
Treatment:
The patient was treated with Escitalopram, Mirtazepine, Vitamin B12 supplement and Fish Oil. The patient was also instructed to increase dietary B12 intake.
Outcome:
The athlete had a significant improvement in her mood after 3 days of B12 supplementation. She improved both socially and academically. She is doing well and is back competing on the rifle squad. She continues to be asymptomatic.
Editor's Comments:
This case is a good example of how co-morbid conditions can prolong the recovery from a concussion. It is a good idea to look for additional factors effecting recovery from concussion when the course is prolonged more than the typical 7-14 (or at the outset 30) days. A history of depression, anxiety or migraines have been associated with prolonged recovery from concussion. In this case vitamin B12 deficiency may have been a contributing factor to the delay.
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