The Clinical Coach: Vasovagal syncope, Occipital Neuralgia & Concussion Walk Into Your Clinic

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Here’s a case I am currently managing.

Keep in mind it’s only been 13 days since the initial incident.

If you have any input, feel free to reply.

Background:

For the sake of anonymity we’ll call her Felicity.

Felicity is a 14 y/o f whom 10 days ago had an episode of syncope after landing a tumbling pass. The witnessed told mom the following:

Day 1: “Felicity landed her back tuck, began walking off the mat when her eyes rolled over and she collapsed on the mat.”

She was unconscious for a few minutes. Regained her consciousness and walked off the mat. This would’ve been around 7:30pm.

Over the next couple of days, she began presenting with light sensitivity, neck pain (pin point to the sub/occipital region on the R side), dizziness, and an excruciating headache spanning from the back of her head to the R eye.

Information that wouldn’t be shared with me until 10 days later.

Day 3 She came into the office last Tuesday with some mild neck pain. They described the incident and mentioned Felicity had had issues with light sensitivity and headaches growing up. They didn’t think much about it.

Immediately I thought, concussion.

I began testing memory, movement, balance, blood pressure, ocular movements, cervical ROM, orthos, and palpation.

Keep in mind Felicity has never had a baseline concussion screen. (SCAT)

• Memory was not great

• Balance was not great, but mom said it was “normal”

• Blood pressure read 110/50

• Ocular movements did not result in any symptoms

• Cervical ROM was painful in a-flexion and p-flexion

• Jacksons, C/S compression, Distraction negative

• Palpation of the R suboccipitals, splenius capitus, and semispinalis capitis tender to palpation and reproduces a mild headache.

Treatment involved of pin & stretch, joint mobilization and cervical exercises emphasizing the posterior cervical musculature.

Felicity felt good at the end of the treatment, and was recommended not to jump, land or tumble, but could go through the routines with her team.

She participated in a team practice and fainted again. This time there was no tumbling, but she did some mild jumping.

Day 4: I ordered a c/spine x-ray, resulting in an unremarkable image. Mom took her to her PCP for a neurologist consult.

Day 9: Mom decided to consult with a neurologist, whom diagnosed her with vasovagal syncope and migraines. Provided her with a list of supplements and scheduled a follow up appointment in 3 months.

Felicity’s headaches began to worsen over the next couple of days. Mostly towards the afternoon.

Day 12: Her current symptoms as of our last visit this week are as follow:

• Reading leads to headaches.

• Standing and sitting up leads to dizziness.

• Light sensitivity

• Occipital neuralgia headaches

If you are familiar with symptoms of concussion, you are seeing the pattern.

Felicity is currently dealing with concussion symptoms, occipital neuralgia and episodes of vasovagal syncope.

I am starting her on a rehab program that is taylored to improve her concussion symptoms, and she is going to be DN for occipital neuralgia headaches.

The main questions that we still have to answer… why did she faint 13 days ago?

What do you think?

In health and strength,

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