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

Joshua Rothenberg, Kimberly Ross, Alexander Harrington, Alberto Panero

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

Keywords


Concussion; Contusion; Neurologic; Exam; Symptoms; Headaches; Memory; Hyperreflexia; Imaging; Neuron

Full Text: HTML PDF
 

Browse  Journals  

 

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

 

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

 

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

 

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

 

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 
       
 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org    elmer.editorial@hotmail.com
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.


Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.