Persistent

A 15-year-old girl presents two days after sustaining a head to head collision with another player, while competing in a soccer match.

At that time, she had an initial loss of consciousness for about two minutes and was transported to the emergency department in a C-collar, where a CT of the head and neck was found to be normal. Her GCS has continuously remained at 15/15, from the time of recovery of consciousness.

She now complains of a mild to moderately severe, pounding headache which is worse in bright light and relieved by lying in a darkened room. She also reports intermittent light-headedness, blurred vision, nausea and emotional lability.

There is no history of vomiting, vision loss, numbness or tingling in her extremities. She has no significant medical history, and denies consuming alcohol or using recreational drugs.

Select Relevant Investigations
Non-contrast CT head and neck

Performed

The repeat CT scan appears completely normal.
MRI head and neck

Performed

The MRI appears completely normal.
Computer-based neurocognitive assessment

Performed

The patient is unable to complete the assessment due to an exacerbation of her symptoms
Flexion and extension C-spine radiographs

Performed

There is 2mm of subluxation on the flexion view, which is not evident on extension

Select Relevant Management
Temporary restriction of activity
Acetaminophen
C-spine bracing
Vision therapy