A 20-year-old college student comes to the office for evaluation of a recent head injury. Two weeks ago, he sustained a blow to the head with loss of consciousness while playing football. He had headache, mild confusion, and dizziness for several days after the injury, but these symptoms have since resolved. The patient has resumed his schoolwork in the past week and is performing at his prior academic level. Comprehensive neurological examination and computerized cognitive testing are unremarkable.
Which of the following is the most appropriate recommendation regarding this patient's return to play?

Question

A 20-year-old college student comes to the office for evaluation of a recent head injury.  Two weeks ago, he sustained a blow to the head with loss of consciousness while playing football.  He had headache, mild confusion, and dizziness for several days after the injury, but these symptoms have since resolved.  The patient has resumed his schoolwork in the past week and is performing at his prior academic level.  Comprehensive neurological examination and computerized cognitive testing are unremarkable.
Which of the following is the most appropriate recommendation regarding this patient's return to play?

Quizplus · Accepted Answer

This patient's presentation is consistent with sports-related concussion. Most sports-related concussions do not involve a loss of consciousness and may consequently be underrecognized. Symptoms of confusion and amnesia are highly characteristic and can be accompanied by headache, dizziness, and nausea/vomiting immediately following the injury. Within hours to days, patients may also develop changes in mood and cognition. Seizure typically occurs with severe or complicated (eg, intracranial hemorrhage) concussions. Athletes with concussion who return to play while symptomatic have a higher risk of recurrent concussion and cumulative brain injury. As such, these individuals should be removed from play until symptom resolution. Athletes may subsequently benefit from a 6-day graduated return to play protocol in which they are evaluated for recurrence of symptoms while performing stepwise increases in physical activity. Those who remain asymptomatic throughout the protocol may ultimately return to play. (Choice A) Athletes with recurrent concussion and persistent neurobehavioral abnormalities should consider retiring from contact sports. (Choices C and E) There is no set time frame that determines when it is appropriate for an athlete to return to play after a concussion. Although this patient's symptoms have resolved, immediate return to play is not appropriate as he should initially participate in a graduated return to play protocol. (Choice D) Brain MRI can be considered in patients with concussion who have persistent mental status or neurologic abnormalities, but it would be of limited utility in this patient. Educational objective: Athletes with concussion should be removed from play until their symptoms have resolved, and they can subsequently benefit from a graduated return to play protocol. __________ References: Treatment of head injuries. (http://www.ncbi.nlm.nih.gov/pubmed/23668643)

A 20-Year-Old College Student Comes to the Office for Evaluation