Scenario
In the case study provided, the patient, a 12-year-old, presents at the clinic after having hit her head while playing soccer. The mother denies any instance of loss of consciousness, but notes that the child seems “loopy” and cannot recollect what happened immediately after the fall. She collided and fell on her back on the ground. The patient denies vomiting or diplopia but admits a significant headache since then. Neurologic examination and physical examination are all normal and negative respectively. There are three possible diagnoses for this patient;
Differential diagnosis
Concussion: In the event of a fall or a collision that impacts significantly on the head or the neck region, a patient may experience a concussion. The unique symptoms associated with a concussion include a headache which can also be reported as a feeling of pressure in the head, confusion, reported as “loopy” by the patient’s mother, temporary unconscious state as characterized by the inability of the patient to recall what happened immediately after the collision (Karlin, 2011). The patient could also indicate signs of dizziness and some form of ringing in the internal ears section. Depending on severity of the concussion, the patient may also present with nausea and vomiting (Karlin, 2011).
Intracranial lesions: This is normally the development of an abnormal tissue in the brain or on the brain and it manifestation could be triggered by a knock or fall on the head. It is characterized mainly by constant headaches, mood swings, nausea and vomiting, low or poor concentration, vision problems, personality changes and balance problems (Meehan, Taylor & Proctor, 2011). The patient does not however experience temporary episodes of loss of consciousness especial in the early stages.
Migraine headaches: These are pulsating headaches that normally present from one side of the head. At times when intense they can be felt as emanating from both sides of the head. The patient experiences elevated sensitivity to light, smell, sound and touch, there could occur vomiting and nausea, blurred vision and lightheadedness which sometimes could escalate to a point of fainting if severe. It could be triggered by a knock or a fall especially on the head (Karlin, 2011).
Primary diagnosis: Concussion
The patient experiences all the major symptoms associated with a concussion including the temporal consciousness loss and the loopy feeling which can be translate as dizziness. Due to the short period between the collision and the arrivals at the clinic or the mild severity of the impact of the collision, the patient may not have developed other associated symptoms such as nausea and vomiting (Karlin, 2011).
Treatment and Management
Considering that the condition is mild, the use of pain relievers such as ibuprofen can go a long way in easing the pain (Sharp, Fleminger& Powell, 2016). Additionally, as a non-pharmacological measure, the patient requires enough rest and relaxation so as to foster the clearing of the symptoms. There is an underscoring for closely monitoring the patient purposely to observe progress and identify cognitive alterations that may occur or any other sign of exacerbation (Jarvis, 2015). Patient education is equally significant in order to promote self-efficacy and holistic healing for the 12-year-old. Believably, resting for some time means that the patient may have to avoid playing at school or at home and this is something that may interferes with the girl’s psychosocial aspects of life. As such, patient education would mainly focus on equipping the parent with skills on how to go about offering emotional and social support to the 12-year-old (Jarvis, 2015).
Among the strategies to use in educating this patient and the family, would include engaging the two in an open and democratic conversation whereby each member contributes to the teaching exercise. This will enhance trustworthy, openness and commitment to the post-discharge advice. On the other hand, it is important to suggest various credible pediatric health websites for the parent to visit and gain a better understanding of promoting the patient’s quality of life and health (Jarvis, 2015).
References
Sharp, D. J., Fleminger, S., & Powell, J. (2016). Traumatic brain injury.Oxford Textbook of Cognitive Neurology and Dementia, 435.
Jarvis, C. (2015). Physical examination & health assessment (6th ed.). St. Louis, MO: Saunders Elsevier.
Karlin, A. M. (2011). Concussion in the pediatric and adolescent population:“different population, different concerns”. PM&R, 3(10), S369-S379.
Meehan, W. P., Taylor, A. M., & Proctor, M. (2011). The pediatric athlete: younger athletes with sport-related concussion. Clinics in sports medicine,30(1), 133-144.
