Is it really the result of a concussion? Lessons from a case study

Abstract

Background: Within the last two decades, attitudes have shifted from considering sports-related concussion as an insignificant minor injury with no long-term repercussions to a potentially serious brain injury garnering attention from media, clinicians, researchers, and the general public. Objectives: To conduct a case study to determine the underlying cause of persistent issues suspected to be associated with a history of sports-related concussion. Protocol: Participant A underwent neurophysiological testing following the Neary protocol (assessment of cerebrovascular and cardiovascular variables), comprehensive concussion assessment at a dedicated sports concussion clinic (history, neurological assessment, cervical spine screening, vestibulo-ocular screening, SCAT-5, and exercise testing), referral to a neurologist, structural MRI scan, and referral for specialised assessment at a dedicated dizziness and balance centre. Results: Despite a history of multiple sports-related concussions, Participant A’s persistent symptom reports were associated with peripheral vestibular dysfunction and otolithic dysfunction seemingly unrelated to his concussion history. Discussion: Lessons from Participant A’s case study showed that on-going symptoms that patients may associate with the effects of concussions may instead be due to unrelated causes that share similar symptomology. Conclusion: This research exemplifies the importance of a multi-disciplinary assessment using a repeated testing protocol.