Presented at the 2013 AAPM Annual Meeting « Back

Misdiagnosis of Post-Concussion Syndrome: A Case Report

Robert Kent, DO MHA, rkent@health.usf.edu¹, (1) University of South Florida, Tampa, Florida

The patient was a 14-year-old female who suffered a concussion after hitting the top of her head on the concrete base of a pool with resulting axial load. She did not suffer any loss of consciousness but did note dizziness and headache immediately. That evening she began feeling extreme nausea with emesis, balance and vertigo issues, light and sound sensitivity, and confusion and presented to ER with negative workup. One week following the incidence her headache became worse and she began having multiple bouts of emesis again. She was taken back to the ER and admitted into a local pediatric hospital. She was discharged after one week with the diagnosis of post concussive syndrome as diagnosis of exclusion after all findings negative. The patient reported to our sports medicine clinic one week after discharge, four weeks after initial trauma, for continued management of post concussive syndrome. Patient was noted to have poor balance, increase in headache and nausea with rapid rotational movements, and decreased cervical range of motion. On examination of her cervical spine, she was noted to have cervical paraspinal hypertonicity and decreased cervical lordotic curvature. She was treated with manual manipulation of her cervical spine with significant correction. She stated her headache decreased after the treatment and the next day her headache had improved by 75 percent. After a second manipulation one week later her symptoms resolved within one week and she was able to discontinue all medications and remains headache and symptom free. This case demonstrates a patient suffering from cervical dysfunction that was misdiagnosed as lasting sequelae of a head injury which most likely was cervical injury from the beginning. Concussions are a complex process and without proper assessment, there is a high likelihood of misdiagnosis.

Funding: None