Injury incidence and injury patterns in professional football - the ...
HEAD INJURY with Delayed Presentation in Football
description
Transcript of HEAD INJURY with Delayed Presentation in Football
![Page 1: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/1.jpg)
HEAD INJURY with Delayed Presentation in
Football
Wes Bailey, MDMoses Cone Sports Medicine Fellow
SEACSM Annual MeetingFebruary 5, 2011
![Page 2: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/2.jpg)
Case ID/CC
17 year-old male Varsity cornerback c/o left-side headache (HA).
HPI HA began during a football game 5 days
prior to presentation. HA started after he suddenly arose from the
ground following a play. The player did not recall the details of the play. Player eventually pulled from the game when
he could not remember a play call.
![Page 3: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/3.jpg)
Case Ensuing 4 Days - Not evaluated by trainer or
MD. Worsening headache severity. Day # 4 (AM) - One episode of vomiting along with
generalized fatigue. Day # 4 (PM) - Head strike after return to practice.
Blurred vision for ~5 minutes. Feet felt “asleep” for ~10 minutes.
Went to bed early 2/2 headache.
Day # 5 Brought by mother to SM office. Decreased HA severity. No mood lability or impaired concentration.
![Page 4: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/4.jpg)
Physical Examination Entire PE including neurological exam WNL. Standard Assessment of Concussion (SAC)
Score: 24/30. Deficits:
Orientation – Date (1 point) Immediate memory (2 points). Delayed recall (1 point). Recitation of the months of the year backwards
(1 point). Recitation of a six-number string in reverse
order (1 point).
![Page 5: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/5.jpg)
Panel/Audience Questions
![Page 6: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/6.jpg)
Differential Diagnoses Concussion. Second Impact Syndrome. Intracranial Bleed. Post-Concussive Syndrome.
![Page 7: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/7.jpg)
Panel/Audience Questions
![Page 8: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/8.jpg)
Image Findings Cervical Spine X-Rays
Normal.
Head CT Thin extra-axial fluid
collection on the left cerebral hemisphere without mass effect, midline shift, or hydrocephalus.
![Page 9: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/9.jpg)
Final Working Diagnosis Subdural Hematoma. Concussion.
![Page 10: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/10.jpg)
Treatment & Outcome Referred to a local neurosurgeon on the
day of presentation. Managed non-operatively given stable
medical condition and lack of mass effect, midline shift, or hydrocephalus.
Held from practice and physical education activities.
Instructed to f/u with the neurosurgeon for interim re-assessment and repeat head CT(s).
![Page 11: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/11.jpg)
Treatment & Outcome Instructed to avoid non-steroidal anti-
inflammatory drugs. Mother received emergency precautions
and instructed to limited the player’s physical activities at home.
![Page 12: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/12.jpg)
Treatment & Outcome
Slightly decreased size of the fluid collection.
Head CT - 2 Days Later
![Page 13: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/13.jpg)
Treatment & Outcome
Cleared subdural hematoma.
Final Head CT - 3 Weeks Later
![Page 14: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/14.jpg)
Treatment & Outcome Headache resolved. Resumed full-time academic activities w/o
difficulty. Returned to baseline without
mood/behavior changes.
![Page 15: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/15.jpg)
Treatment & Outcome Held from sports and physical education
activities for the remainder of the 2010 football season; for a period longer than 1 month.
Gradually resumed non-contact physical education activities at school.
Restricted from wrestling this season. Cleared for unrestricted sports participation
beginning in the summer of 2011 as long as he remains symptom-free.
![Page 16: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/16.jpg)
Key Points Head injury is the leading cause of death
in football, and in sports in general1. Early communication is key. Athletes with intracranial bleeding can
have normal physical findings. History is essential. Individualized neurosurgical management
with serial imaging.
1. Gerberich S et al. Concussion incidences and severity in secondary school varsity football players. Am J Pub Health. 1983; 73:1370-1375.
![Page 17: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/17.jpg)
Key Points No official guidelines wrt NSAID use. No official guidelines wrt activity restrictions.
No physical activity for at least 1 month. Professional hockey player s/p craniotomy for
parenchymal hemorrhage.
Soccer & ice hockey players s/p sx for ant/post wall fractures of the frontal sinus.
16 y.o. female soccer player s/p drainage of large chronic SDH which communicated with an arachnoid cyst and caused a mass effect. RTP 1 year later. No interim incidents.
![Page 18: HEAD INJURY with Delayed Presentation in Football](https://reader036.fdocuments.net/reader036/viewer/2022062323/568167f2550346895ddd661f/html5/thumbnails/18.jpg)
Panel/Audience Questions