case

1. CONCUSSION CASE
MULTI DISCIPLINARY EXPERT PANEL

2. Case
● 13 year old healthy boy with elbow to head in PE
basketball
● No LOC, some HA and dizziness
● Assessed and had no “red flags”
● Continues with regular school activities
● Complains of ongoing worsening headache and new
migraines

3. Case (4 weeks)
● See neurologist and starts on Topamax
● Normal MRI brain
● Symptoms continue to progress
● No longer tolerating sports or even exercise
● Struggling with academics and grades (was 4.0 student)
● Feeling depressed and hopeless
NO Academic Accommodations

4. Case (3 months)
● Seen in our clinic 3 months later
● Ongoing severe:
● Cognitive deficits
● Vestibulocular deficits
● Exercise intolerance
● Cervical dysfunction and migraines
Now What?

5. Case: Cognitive test

6. Case: Vision testing
● KD scores: 25, 31, differed
● NPC: 17cm Accommodation: R: 18cm L:12cm

7. Case: Vestibular testing
● BESS Testing: 1: macro sway, 2: >5 errors, 3: differed
● Force Plate: Severe deficits with post/left midline shift
● Laser Sway: 8 deviations

8. Oculomotor Tracking

11. Evoked Potentials (P300)