STEP 2: Concussion Live Course - November 5-6, 2024, in San Diego, CA-Case Discussion: Risk Factors of Special Populations (Aging Brain)

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A 67-year-old physically active woman experienced a concussion after a fall while walking her dog. She briefly lost consciousness and received treatment for a scalp laceration at the emergency department, where a CT scan showed no bleeding. Despite this, she developed symptoms such as headaches, mild nausea, and a foggy feeling, which persisted, prompting a referral to a primary care physician by November 2024.<br /><br />Her symptoms, as measured by the Post-Concussion Symptom Scale (PCSS), included headache, balance problems, dizziness, fatigue, difficulty sleeping, and sensitivity to light and noise, among others, with a total score of 38. Cognitive testing using the Montreal Cognitive Assessment (MOCA) resulted in a score of 17, suggesting borderline moderate cognitive impairment. The physical examination showed a normal eye exam, inability to perform a single-leg stance, and normal strength without muscle atrophy, though she appeared fatigued and slightly teary.<br /><br />Risk factors for her condition included coexisting cerebrovascular diseases such as hypertension and diabetes mellitus, potential drug interactions with antiplatelet and anticoagulant medications, increased dural adherence and volume loss with age, and an undiagnosed mild cognitive impairment. <br /><br />During the immediate in-office assessment, the Dix-Hallpike maneuver was considered for further diagnostic testing. It was advised that if she experienced worsening symptoms or new neurological signs, an immediate CT scan would be necessary.<br /><br />Overall, the case highlights complexities in managing concussion in older adults, especially with underlying health issues and the potential effects of aging on brain structures and cognitive functions.

Asset Subtitle

Kathleen R. Bell, MD

Keywords

concussion

older adults

cognitive impairment

headache

Dix-Hallpike maneuver

hypertension

diabetes mellitus

Post-Concussion Symptom Scale

Montreal Cognitive Assessment

cerebrovascular diseases