Level 1: Headache – Contrasting Case #2: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 15 year-old male who presents to the emergency department with a 12-hour history of headache. He is accompanied by his father. The onset of the headache came after sustaining a blow to the head from a collision during football practice. He was sent home after the episode and told to “take it easy.” Since then, the headache has remained of 5/10 severity and is described as a dull ache that is diffuse/poorly localized. He reports blurry vision initially that has since resolved. He reports continued experience of dizziness. The patient’s father reports that he has been acting “a little off,” and seems slower than normal. The patient has never experienced a similar episode before. He reports no other symptoms.

PE: The patient is alert and oriented, but appears confused and shows delayed response to simple questioning. There are no gross deformities of the skull or facial structures. There are no gross neurological deficits on exam. MMSE shows deficits of attention and concentration (serial 7’s and spelling “WORLD” backwards).