Medicine & Science in Sports & Exercise:
May 2003 - Volume 35 - Issue 5 - p S362
H-13G Clinical Case Slide Presentation Football
HISTORY
A 17-year-old senior high school football special teams player reported a head injury while attempting to tackle. The injury may have occurred during the second quarter of a game, when he experienced a helmet to helmet collision during a kick-off. There was no loss of consciousness, and he did not immediately experience symptoms. During half time, however, he reported a headache to the coaches, and at that time the team physicians were notified. Over the next 30 minutes, he experienced increasing anxiety, agitation, and feelings of unreality. Further questioning revealed he took two Yellowjacket capsules (an herbal supplement containing ephedra and caffeine) before the game. He denied other substance abuse. His parents were contacted, and he was transported to the emergency department for further evaluation.
PHYSICAL EXAMINATION
Locker room examination revealed an anxious player, but oriented to person, place, time, and situation. There was no anterograde or retrograde amnesia, but concentration was poor. He could not perform serial 7's, although he claimed, I'm bad at math. Strength, sensation, and coordination were all normal. He continued to complain of a global headache, without vision changes. Subsequent serial neurological examinations remained normal, and mental status normalized over the next 60 minutes.
DIFFERENTIAL DIAGNOSIS
1. Concussion
2. Evolving cerebral hematoma or mass lesion
3. Herbal stimulant toxicity
4. Atypical anxiety reaction or brief psychosis
TESTS AND RESULTS
1. Emergency Department evaluation revealed hypertension (149/70) and tachycardia (pulse 108)
2. Cervical spine radiographs: - normal Noncontrast head CT: - normal
FINAL/WORKING DIAGNOSIS
Possible concussion complicated by possible herbal stimulant toxicity
TREATMENT AND OUTCOMES
1. No football for one week. May return if asymptomatic.
2. Discontinue taking herbal stimulants (Yellowjackets).
3. Returned to play in following game.
4. Four week follow-up on sidelines - no residual symptoms, no longer taking herbal stimulants.