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20 year-old young man with knocked unconscious
A 20 year-old young man is brought to the ED by paramedics after being knocked unconscious during a
football game about 40 minutes ago. He plays quarterback for the local college and he was tackled from
behind by an opposing player. He was driven to the turf and his head struck the ground sharply. He was
unresponsive for roughly 30 seconds, and upon awakening he knew where he was and remembered
being hit from behind but said he felt dizzy and groggy and was slow to answer questions. The on-site
medical personnel transported him directly to the ED. He is otherwise healthy with normal birth and
development and no history of medical problems or prior surgeries. On examination, he is awake and
alert, lying comfortably but nervously on a gurney with his neck immobilized in a hard cervical collar. He
is oriented to place and date, follows three-step commands briskly, has fluent speech, and has full power
in all extremities.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why those are
less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses for
one medication you might prescribe, along with an estimate of the cost per month of your proposed
therapy. How would you counsel the patient about her condition and about any proposed therapy?
A 20 year-old young man is brought to the ED by paramedics after being knocked unconscious during a
football game about 40 minutes ago. He plays quarterback for the local college and he was tackled from
behind by an opposing player. He was driven to the turf and his head struck the ground sharply. He was
unresponsive for roughly 30 seconds, and upon awakening he knew where he was and remembered
being hit from behind but said he felt dizzy and groggy and was slow to answer questions. The on-site
medical personnel transported him directly to the ED. He is otherwise healthy with normal birth and
development and no history of medical problems or prior surgeries. On examination, he is awake and
alert, lying comfortably but nervously on a gurney with his neck immobilized in a hard cervical collar. He
is oriented to place and date, follows three-step commands briskly, has fluent speech, and has full power
in all extremities.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why those are
less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? Include doses for
one medication you might prescribe, along with an estimate of the cost per month of your proposed
therapy. How would you counsel the patient about her condition and about any proposed therapy?\
20 year-old young man with knocked unconscious