On a minor concussion

27yo male presents 5days post-fall with occipital contact on semi-padded surface and no loss of consciousness.

Waking up on Saturday, I felt a little groggy. Not sure if it was the ice cream binge of black cherry talenti, or the late night of studying combined with a low pressure system rolling through the morning, or the mild brain trauma of Monday finally showing itself.

During the fundamentals class earlier in the week, we practiced takedowns from standing. A single-leg shoot, very common in wrestling. The drills went well, until the instructor came over to refine my partner’s technique by using me to demonstrate.

When falling to the mat, there are certain practices that lessen the risk of injury, such as slapping the ground with the palms and tucking the chin to prevent the head from contacting the mat. During the demonstration, my training partner stood closer than I had anticipated and the instructor threw me causing the back of my head to strike the top of my partner’s foot.

Definitely felt my brain rattle around a bit. No loss of consciousness, which is a great sign. Finished the rest of the class without a problem, grappling from the standing position nice and easy without any further brain complaints. That night, I decided to rest and relax rather than grind for the exam in a week.

History of Present Illness: Patient notes no symptoms immediately after fall and completely asymptomatic with no change in activity level until 4days post-fall, when patient inverted for repeated headstands. Immediately following inversion, patient noted feeling ‘off’. The following morning, patient reports mild headache relieved by breathing exercises, some difficulty concentrating, and transient photosensitivity to bright lights.

The following days, I pretty much forgot about the bop on the back of the head. Woke up the next morning without any concussion symptoms and decided to carry on as I normally would. A couple workouts that week, including another sparring session at BJJ, and no problems.

On Friday, I woke up a bit sore and ready to grind. C7T2 on Monday, the last meaty exam of second year before we begin to transition over to Step Prep. Spent most of the day in the apartment, reviewing lectures and flashcards. In the evening, after a delicious float and some food in my belly, I got a bit anxious and decided to complete some gymnastics training.

Workout went well, felt good even. Completed a few rounds of headstands for 24sec, a progression to develop a freestanding-handstand. These felt good, too. Once completed, I noticed a bit of head-wooziness. A bit off. Perhaps the inversion and subsequent rush of blood to the head aggravated an already bothered brain.

Studied a bit for the rest of the night. Woke up the next morning with a headache. Not a great sign, tells me that I jumped back in a bit too fast.

Past Medical History: Significant for one undiagnosed concussive episode four years prior, following an amateur mixed-martial arts fight with repeated strikes to the head. Patient reports that current symptoms are similar, but significantly milder.

Physical: Patient is A&Ox3. Neurologic exam reveals no focal or gross deficits in cognition, sensation, or motor reflexes. Pupils are equal, round, reactive to light and accommodation. Cranial nerves II-XII are grossly intact.

Having received a moderate concussion after an MMA fight a few years back I can confidently say that these symptoms are similar, but way less intense. After the fight, I didn’t get it checked out by a healthcare professional because I was pretty dumb and figured I’ll be fine. I was fine, but in retrospect that was quite arrogant. Now, at least, I can perform a physical on myself with the help of my partner and evaluate my risk for serious injury or secondary harm.

Assessment: 27yo male presents 5days post-fall with occipital contact and no LOC.

On the differential is minor concussion (most consistent with mechanism of injury and history, inversion as aggravating factor), subdural hematoma (consistent with mechanism of injury, less likely as no loss of consciousness and no neurologic deficits or changes), and headache disorder (trauma-induced, less likely because of singular episode).

Plan: Monitor symptoms and hydrate consistently. Avoid strenuous physical activity and possible additional head trauma.

Woke up today, Sunday, feeling pretty good. Went to bed early last night and that seemed to do the trick. No headache. Ready to publish this post, grind the day away, and crush the exam tomorrow. I probably won’t go to BJJ afterwards, as is my Monday/exam day ritual. Maybe I will, against the informed advice of myself.

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