How a Seemingly Minimal Physical Exam Finding Unveiled a More Serious Condition: A Case Report

Abstract

Cerebral contusion following a concussion is a severely debilitating and possibly life-threatening condition that is not readily uncovered in American football players. We describe the case of a 16-year-old high school male who presented to a university-based concussion clinic 5 days post helmet-to-helmet collision with symptoms of nighttime headaches, dizziness, and difficulties with concentration and word finding. Neurocognitive evaluation demonstrated decreased visual and verbal memory, along with a very high concussion symptom score on the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Physical examination findings revealed lower extremity hyperreflexia with pathologic spread to bilateral knees and Achilles tendons. These focal neurologic signs prompted obtention of brain and cervical spine imaging, which demonstrated a right temporal lobe contusion and multiple cervical disc herniations. This case emphasizes the importance of a thorough neurologic examination. Failure to recognize these critical signs could have resulted in premature or unsafe return to play, ultimately exposing the athlete to the risk of additional trauma. Concussion is primarily diagnosed clinically and therefore imaging is not routinely obtained. Thus, fastidious upper motor neuron testing should be a fundamental component of the standard neurologic examination when evaluating players suspected of having a concussion.




J Med Cases. 2015;6(6):240-242
doi: https://doi.org/10.14740/jmc2047w