BACKGROUND: A concussion is classified as a type of traumatic brain injury, or TBI, that is caused by a blow or jolt to the head or body that causes the brain to rapidly move back and forth. Concussions are common in contact sports, however between 2014-2019, women’s volleyball had an incidence rate of 4.93 per 10,000 athlete exposures with 6.05 occurring in competition and 4.43 during practices. Symptoms related to concussion typically involve somatic, cognitive, behavioral and/or sleep disturbances, however seizures are uncommon. The risk of developing a seizure disorder following a traumatic brain injury, or concussion, depends on the severity, site, and previous history of a traumatic brain injury (Anwer, 2021). METHODS: 21-year-old African American female, recreational volleyball player fell and hit the back of her head during a recreational volleyball practice. Initially after the incident, the patient was verbal and complained of pain between C2-C4 spinous processes and presented with constricted pupils. Within minutes the patient became nonverbal and was instructed to respond to questions by blinking her eyes once for yes and twice for no. Heart rate was shallow at 68-72 bpm and O2 levels were 98%. Dermatomes, Myotomes, and Strength were reported as normal. She was transported to the Emergency Room. Differential diagnoses included: epidural hematoma, brain lesion, aneurysm, concussion, and epilepsy. RESULTS: Initial assessment of the athlete was an epidural hematoma with a possible cervical fracture. Further evaluation and imaging revealed a concussion with seizures secondary to brain injury. The athlete was put on Levetiracetam, a seizure medication, for one week following the injury. The medication was discontinued and no subsequent seizures occurred. Within 5 months, many concussion symptoms disappeared, but she still reported occasional post-concussion migraines, nausea, and light sensitivity. The patient was prescribed medication for migraines and cleared to return to sport. Currently, she has chosen not to return to activity. CONCLUSIONS: In this case, nonverbal responses and constricted pupils indicated a more severe injury. The resultant post-concussive seizures and migraines affected the athlete’s ability to perform activities of daily living and ability to return to sport. Clinicians should be cautious underestimating the potential for serious complications following concussion.

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