Disclosures: Mark E. Sederberg, DO: No financial relationships or conflicts of interest

Case Description: There was no loss of consciousness, and he played the remainder of the game. He felt normal that evening. Over the coming weeks, he noticed progressive worsening of tiredness and difficulty concentrating. One week prior to presentation he noted mid-line lower lip numbness, teeth pain while chewing, hearing his pulse in his left ear, and poor sleep due to sweatiness. He missed the last three days of school due to lethargy and difficulty concentrating. His medical history was significant for a recently diagnosed inguinal hernia. Physical exam showed mild deficits in attention and memory, impaired balance, but normal motor strength. Cranial nerve exam demonstrated ptosis of the left eye, mild left facial nerve palsy, decreased hearing in the left ear, and altered sensation to light touch over the left lower lip.

Setting: Sports Medicine Clinic

Patient: 16 year old male with one month after a head-to-head collision during soccer with concern for concussion. Assessment/

Results: MRI Brain with and without contrast showed enhancement of the left V, VII, and VIII cranial nerves, and diffuse bilateral pachymeningeal enhancement. Bloodwork revealed WBC 19k, platelets 80. CT Abdomen, Pelvis showed a large abdominal soft-tissue mass herniating through the inguinal canal, most consistent with a lymphoma. CSF Cytology then showed Enlarged B-cells consistent with Burkitt lymphoma. Patient was admitted, and chemotherapy was started promptly. He is currently in remission.

Discussion: Concussions can present with many symptoms, none of which are specific. It is important to perform a thorough history and examination with each patient to avoid missing other diagnoses.

Conclusion: This is a rare case in which the patient’s symptoms of lymphoma were attributed to a head trauma that roughly coincided with pronouncement of symptoms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/when-a-concussion-isnt-a-concussion-a-case-report/