New Case for Winter
2010
Return to Play -
Case of the Month
Nathan, age 14 -
Ice Hockey
Introduction - Body check with no loss of
consciousness
Nathan sustained a body check at the
center of the ice. He
sustained an immediate headache
following the check but did not loose
consciousness. He is an elite
ice hockey player on a traveling team.
Nathan was hit on a Saturday with an
open ice collision with another
player as both were going for the puck. The collision was
"a good hit" according to his coach.
Nathan is a tall and well build
defenseman. He weighs 170 pounds.
He was not knocked unconscious and
returned to play after a few minutes.
After the game he developed a dull
headache. On Sunday morning he
felt significantly better and largely
without symptoms. Neither parent
observed the injury. Nate expected
he would play in the Sunday tournament
game and said nothing about the injury
to his parents.
Unfortunately, Nathan was hit again quite hard early in his
next game. He had a significant reaction including severe
head pain, fogginess, and confusion. Again he did not
loose consciousness. He immediately told his coach and was
removed from competition. This is an example of second
impact syndrome. These
symptoms lasted for 5-7 days and
required a formal consultation with his school to provide
academic accommodations. Nate had undergone no preseason
testing so there was no baseline
neuropsychological data to compare with.
Academic history
Nathan was a solid B student who
planned on playing junior ice hockey
like his father. Neuropsychological testing revealed a
moderate elevation in his symptom score
including difficulty sleeping, recurring
headaches, fatigue, irritability,
feeling more emotional than usual and
mild change in concentration.
His testing revealed deficits in reaction time, scanning and
visual motor speed. He was
prescribed a course of rest to allow his
brain to return to its estimated
baseline functioning. He slept for
most of 3 days after the second injury. Given this
was his second concussion extra care
was taken to assure Nathan did not
return to play before he was ready.
Continued
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