Repetitive Head Injury Syndrome Clinical Presentation

Updated: Feb 08, 2017
  • Author: David Xavier Cifu, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

History

The history is a key element in evaluating an athlete with a suspected head injury. However, the athlete may not be able to provide a good history because of slowed mentation or confusion. In such cases, obtain the history from a teammate, coach, or observer. Symptoms of a head injury may include the following:

  • Memory impairment
  • Confusion
  • Diplopia
  • Fatigue
  • Photophobia, phonophobia, or both
  • Blurred vision
  • Dizziness
  • Hemiplegia
  • Nausea
  • Sensory loss
  • Impairment of hand-eye coordination
  • Irritability
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Physical

The goals of the physical evaluation are to (1) recognize that a head injury may have occurred, (2) determine which athletes require immediate transport to a medical facility, and (3) decide when the athlete can return to competition. Emergency management includes the ABCs of first aid. That is, assess and manage the individual's airway, breathing, and circulation. Signs of head injury include the following:

  • Altered levels of consciousness
  • Posttraumatic or retrograde amnesia
  • Gait abnormalities
  • Weakness
  • Visual abnormalities
  • Sensory loss
  • Pupillary concordance and/or accommodation
  • Poor concentration
  • Apprehension
  • Increased symptoms with exertion
  • Focal symptoms – Facial or extremity twitching, smelling of atypical odors, tasting of atypical tastes
  • Generalized symptoms – Tonic-clonic movements of body, incontinence, altered level of arousal

The brief neurologic examination should be performed without moving the athlete until the patient's ABCs and spine are deemed stable. The following are assessed:

  • Verbal quality and appropriateness
  • Memory (eg, to event), orientation (eg, to date), cognitive (eg, ability to perform the serial 7 s test)
  • Visual findings – Pupillary size and reaction, tracking, nystagmus, gross visual fields, diplopia
  • Motor findings – Coordination (finger to nose), strength (focal findings), balance (eg, single-leg stance, heel to toe)
  • Romberg test results
  • Tone
  • Reflexes
  • Sensory abnormalities – Touch, pinch, and pain
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Causes

Factors that may increase the risk of a poor outcome with a repetitive head injury include the following:

  • Previous head injury
  • Persistence of symptoms from a previous head injury
    • Headache
    • Labyrinthine dysfunction (balance disorder)
    • Visual, motor, or sensory changes
    • Mental difficulties that affect thought and memory processes
  • Alcohol or illicit drug use
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