Head Injury in High School Football Player

HISTORY: 17-year-old junior football running back presents to training room with complaints of left retro-orbital pressure without vision changes. PHYSICAL EXAMINATION: Examination revealed normal vital signs (BP 130/65, pulse 73). Cervical neck exam was normal. He had a GCS of 15, his cranial nerves and cerebellum were intact. DIFFERENTIAL DIAGNOSIS: Concussion Subdural hematoma Cluster headache Migraine headache Acute sinusitis TEST AND RESULTS: Head CT w/o contrast -findings consistent with an acute subdural hematoma overlying the left frontal lobe with some mass effect and effacement of the underlying sulci. Additional hemorrhage was identified layering along the falx. No midline shift. FINAL WORKING DIAGNOSIS: Acute subdural hematoma TREATMENT AND OUTCOMES: Admitted Cincinnati Children's Hospital for observation Neurosurgery consultation: no surgical intervention was required NO contact sports, climbing, or wheeled activities until cleared by Neurosurgery Cognitive rest with modified school schedule 1 month repeat head CT and subsequent follow up with Neurosurgery Discussion of return to sports, including contact and non-contact