A 20-year-old woman comes to the office for follow-up of a head injury. She plays soccer for her college, and yesterday she was treated in the emergency department after a brief episode of loss of consciousness while using her head to redirect the soccer ball. In the emergency department, the patient was unable to remember details of the game, but her neurologic examination was otherwise normal. A noncontrast CT scan of the head was also normal. Today, she reports some pain associated with a bump on the top of her head, but otherwise feels well. The patient has had no dizziness, nausea, or vomiting. Neurologic examination is normal. She would like to know if she can play in a soccer tournament in 2 days. Which of the following is the most appropriate recommendation?

Question

A 20-year-old woman comes to the office for follow-up of a head injury.  She plays soccer for her college, and yesterday she was treated in the emergency department after a brief episode of loss of consciousness while using her head to redirect the soccer ball.  In the emergency department, the patient was unable to remember details of the game, but her neurologic examination was otherwise normal.  A noncontrast CT scan of the head was also normal.  Today, she reports some pain associated with a bump on the top of her head, but otherwise feels well.  The patient has had no dizziness, nausea, or vomiting.  Neurologic examination is normal.  She would like to know if she can play in a soccer tournament in 2 days.  Which of the following is the most appropriate recommendation?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c189_8b93_8f63_fd88117bbb24_MD0005_00 This young woman with a loss of consciousness and amnesia after head trauma has a concussion, characterized by a transient neurologic disturbance (eg, disorientation, amnesia) that results from mild traumatic brain injury. Other common signs and symptoms include headache, dizziness, slurred or delayed speech, and incoordination; nausea/vomiting and brief loss of consciousness may also occur. Initial management includes removal from sports play and a thorough neurologic examination; a CT scan of the head is often performed to rule out other etiologies or complications (eg, skull fracture). Patients should be monitored closely for 24 hours (usually as an outpatient), but in the absence of risk factors (eg, anticoagulation, neurologic deterioration), further imaging is usually not required (Choice C). Premature return to sports play increases the risk of both recurrent concussion and long-term sequelae (eg, chronic traumatic encephalopathy, second impact syndrome); therefore, a graduated return to play protocol has been recommended to reduce this risk. Average-risk adults should rest for ≥24 hours before gradually increasing activity level each 24-hour period they remain asymptomatic, potentially returning to full contact activities no sooner than in 1 week (Choice E). Initial activity should begin with light aerobic exercise, transition to noncontact sports (eg, running), and progress to contact sports (eg, lacrosse); those who develop symptoms should return to the activity level at which they were last asymptomatic for 24 hours prior to activity progression. (Choices A and B) In the absence of recurrent symptoms, patients on a graduated return to play protocol can typically advance through progressively more strenuous activity and return to contact sports in 1 week. Although patients with significant sequelae (eg, posttraumatic epilepsy) should generally avoid all contact sports, this patient with a single, uncomplicated concussion does not require extended activity restriction. Educational objective: Concussion is characterized by a transient neurologic disturbance (eg, disorientation, amnesia) that results from mild traumatic brain injury; headaches, dizziness, slurred or delayed speech, and incoordination are also common. After a concussion, average-risk adults should rest for ≥24 hours before gradually increasing activity level each 24-hour period they remain asymptomatic, potentially returning to full contact sports in 1 week.

A 20-Year-Old Woman Comes to the Office for Follow-Up of a Head