High School

A 16-year-old boy sustained a head injury during wrestling practice. During a practice match, the boy's head struck the concrete floor and then received a secondary blow to the head by a nearby wrestler. He briefly lost consciousness and then was dazed, confused, and slow to respond to questions for a few minutes. His vision became briefly blurry and double. His balance was initially unstable but improved with time; however, he developed lethargy and a headache. He did not have any nausea or vomiting. His mother was instructed to have him checked for a head injury.

On examination about an hour later, he appears tired but is alert and oriented, and able to recount the events leading to his injury, though he is somewhat unsure about what happened right after. His vitals are stable, and visual acuity is 20/40 in both eyes; head and neurologic exam are normal, including equal and reactive pupils and cranial nerves. His very anxious mother says he suffered a concussion 2 seasons ago while playing football and had to sit out practice for 2 weeks.

What management options would be best for this patient?

1. Observation only
2. Cranial CT scan
3. MRI
4. Skull radiographs
5. Ultrasonography

Answer :

Final answer:

For a 16-year-old boy with suspected concussion and a previous history of concussion, close observation and rest constitute the primary management. Further imaging like a CT scan or MRI might be considered if his condition worsens or doesn't improve but is usually not necessary with a normal neurological exam.

Explanation:

The management of a concussion, also known as a mild traumatic brain injury, typically includes observation, rest, and possibly further imaging if symptoms worsen or don't improve. Given the 16-year-old wrestler's history of a prior concussion and the symptoms described, close observation and rest are warranted. If red-flag symptoms such as worsening headache, repeated vomiting, changes in behavior, seizures, or any new neurological deficits emerge, a cranial CT scan might be considered. However, as CT & MRI scans are often ineffective in detecting concussions and since the boy's current neurological examination is normal, advanced imaging like a CT scan or MRI might not be immediately necessary unless his condition changes. His visual acuity of 20/40 is slightly reduced, and this should be monitored too as it can be a sign of other injuries or the concussion's impact. It is important for the patient to be educated on concussion symptoms and to ensure a follow-up is in place. The decision about imaging would ideally be made by a healthcare provider based on the patient's ongoing symptoms and clinical course.

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