STEP 2: Concussion Live Course - October 21-22, 2025, in Salt Lake City, UT-Case Discussion: Risk Factors of Special Populations (Aging Brain)

Pdf Summary

This case involves a 67-year-old physically active woman who sustained a concussion after falling while walking her dog, resulting in a brief loss of consciousness and a scalp laceration treated in the emergency department. A CT scan showed no intracranial bleeding. Immediately post-injury, she experienced headache, mild nausea, and a foggy feeling. Despite initial care, symptoms persisted, prompting referral to a concussion clinic.<br /><br />At the clinic, her reported symptoms included headache, balance issues, dizziness, fatigue, sleep difficulty, light and noise sensitivity, and cognitive slowing, with a Post-Concussion Symptom Scale (PCSS) total score of 38. Cognitive screening via the Montreal Cognitive Assessment (MOCA) scored 17, indicating borderline moderate cognitive impairment. Physical examination revealed normal eye function, inability to perform single leg stance, normal strength without atrophy, signs of fatigue, and slight tearing, with no skull, cervical spine, or temporalis muscle pain noted.<br /><br />Risk factors complicating her concussion recovery include co-morbid cerebrovascular conditions—hypertension and diabetes—that increase dural adherence to the skull and vascular tension, escalating injury risk. She is on antiplatelet or anticoagulant therapy, which may impact bleeding risk and recovery. Undiagnosed mild cognitive impairment and potentially poor physical conditioning also contribute. This reflects concerns for an aging population increasingly engaging in recreational activities.<br /><br />Immediate in-office assessments included the Dix-Hallpike maneuver for dizziness evaluation, with plans for further diagnostic testing due to early presentation. Instructions emphasized urgent CT scanning if symptoms worsened or new neurological signs developed. The case highlights challenges in concussion management in older adults with co-morbidities, underscoring the need for careful monitoring and multidisciplinary follow-up.

Asset Subtitle

Kathleen R. Bell, MD

Keywords

concussion

older adult

head injury

cognitive impairment

post-concussion symptoms

dizziness evaluation

co-morbidities

hypertension

diabetes

anticoagulant therapy