Subdural Hematoma In A High School Football Player

Author: Bill Moreau, DC, DACBSP, CSCS Moreau Chiropractic Clinic, Estherville, Iowa Category: Head, neck and spine

HISTORY: During a high school football game an 18-Year old high school player developed symptoms of decreased sensation and muscle weakness of the right leg. This was discovered during a time out. He was removed from play for sideline evaluation. Upon initial presentation he was alert with no other complaints. The athlete identified no significant impacts. During the initial workup the athlete complained of immediate intense right temporal headache. Within 1-2 minutes new symptoms of nausea, vomiting, convulsions and a rapid loss of consciousness were demonstrated.

PHYSICAL EXAMINATION: Testing was restricted to orthopedic and neurological testing that could be performed on a sideline. No nuchal rigidity, no increased pain with cervical spine movements, or cervical spine compression. Progressive loss of consciousness promptly followed by seizures, anisocoria and decerebrate posturing was noted. An absence of response to verbal or pain stimulus, and fixed pupillary reflexes were also detected.

DIFFERENTIAL DIAGNOSIS: included Acute Subdural Hematoma (ASDH), Acute Epidural Hematoma, and intracranial aneurysm.

TEST AND RESULTS: head CT revealed ASDH.

FINAL/WORKING DIAGNOSIS: ASDH.

TREATMENT: Initial emergency management by sideline personnel included the activation of EMS, immediate application of supplementary oxygen and spinal stabilization. The athlete was transported via ambulance to a local hospital and air flighted to a level one trauma center. CT imaging demonstrated a large rightsided subdural hematoma. The hematoma mass was surgically excised revealing two different aged hematogenous components. The neurosurgeon identified this as evidence of a two intracranial bleeds, one a few days old and the acute hematoma. A post surgical interview of the athlete’s parents revealed that three days prior to this event after a football practice the athlete had complaints of headache, extreme fatigue, and listlessness. This case study emphasizes the 1 importance of sideline staff being prepared to manage traumatic brain injury and having the correct equipment nearby for rapid accessibility. The importance of educating the parents and the public in regards to the identification of traumatic brain injury is also brought to light.