In the final minute of the high school state championship match, with the score

Question

In the final minute of the high school state championship match, with the score tied 1 to 1, the corner kick sailed toward the far post. Lunging for a header and the win, the 17-year-old midfielder was kicked solidly in the right side of her head by a defender. She crumpled to the ground and lay motionless. The team physician rushed onto the field, where the midfielder lay on her back with her eyes closed. She was breathing normally but failed to respond to the sound of her name or a touch on her arm. An ambulance was immediately summoned. After a few moments, her eyes fluttered open, and she looked up at the doctor and her teammates with a confused expression on her face. Asked how she was feeling, she said “fine” and attempted to sit up but winced in pain and put her hand to her head as the physician told her to remain lying down. It was an encouraging sign that all four limbs and her trunk muscles had moved normally in her attempt to sit up, suggesting she did not have a serious injury to her spinal cord.

The physician then asked her a series of questions. Did she remember how she had been injured? She responded with a blank look and a small shake of her head. Did she know what day this was and where she was? After a long paused and a look at her surroundings, she replied that it was Saturday and this was the championship soccer match. How much time was left in the game, and what was the score? Another long pause, and then, “It’s almost halftime, and it’s zero to zero.” Before he could ask the next questions, her eyes rolled back in their sockets and her body stiffened for several seconds, after which she once again looked around with a confused expression.

These signs suggested that she had suffered an injury to her brain and should undergo a thorough neurological exam. The ambulance arrived, she was placed on a rigid backboard with her head supported and restrained, and she was transported to the hospital for further assessment and observation.

By the time she reached the ER, she was less disoriented and had no nausea but still complained that her head hurt. Her pulse rate and blood pressure were normal. A series of neurological tests was then performed. When a light was shone in either eye, both pupils constricted equally. She was also able to smoothly track a moving object with her eyes. Her sense of balance was good, and she was able to feel a vibrating tuning fork, light pinpricks, and warm and cold objects on the skin of all of her extremities. Muscle tone, strength, and reflexes were also normal. Asked again about the collision, she still was unsure what had happened. However, suddenly straightening in her chair, she said, “Wait – the game was almost over and we were tied one to one…Did we win?”

1. What happened to this player?

2. What is the mechanism and what part of the brain is involved?

3. What is the recommended treatment for this condition?

4. What is the consequence of repeated injuries of this type?

Explanation / Answer

1. The patient suffered from temporary confusion after being hit with an incoming kick. This can be described as a case of mild concussion that is generally observed in the case of falls, some accidents is sports etc. As observed, the patient was not able to respond to the sound of her name and later replied with delayed and confused answers.

2. This concussion occurs as a result of mild hit on the brain. This is because the brain gets an impact and a result of which is a back and forth movement of the brain inside the skull, that is a major cause of the confusion. The patient loses consciousness and appears to be confused long with dizziness. The type of concussions suffered by the patient is grade II concussions in which the patient suffers unconsciousness along with amnesia for approximately 30minutes to 24 hours.

3. For treatment - the return to sports or any other vigorous activity is proscribed for time being. The treatment includes treatment for mild brain injury and some good amount for rest with mild to heavy medication. Ample amount of sleep is recommended and physical exertion is supposed to be avoided. Acetaminophen may be given for head aches.

4. Consequences of repeated concussions may lead to severe bleeding and bruising. This may give rise to symptoms that may be similar to dementia and this dementia may be prevalent some years after injury. It may also affect some brain functions and executive functions.

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