Four months of concussion — the woman who cannot work
| Patient | 42F, chronic phase |
|---|---|
| Injurypersisting post-concussion symptoms; imaging unremarkable | |
| Severity | Worst GCS 15 |
| Days since injury | 120 |
| Before the injuryIndependent. Report designer — full-time screen work. | |
| Also on the chartNeck stiffness since the fall; New-onset anxiety | |
| PrecautionsExercise below the measured symptom threshold; Screen exposure paced and scheduled, not avoided | |
Test yourself
What is the treatment shape now?
The teaching
Four months of rest produced the patient sitting in front of you, and the consensus answer is multidomain treatment: graded aerobic exercise below the measured threshold, cervical and vestibular rehabilitation for the findings that are actually there, oculomotor referral for the reading complaint, and psychology for the anxiety — in parallel. What you do with it: measure the threshold, dose under it, log the response, and treat the drivers you can examine rather than the label you cannot.
- Headache character changing — thunderclap, positional, or with neurological signs
- Anxiety sliding toward hopelessness — screen and act, do not just refer onward
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Leddy JJ et al. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010. Patricios JS et al. Consensus statement on concussion in sport: the 6th international conference, Amsterdam 2022. Br J Sports Med. 2023 · Ciuffreda KJ et al. Occurrence of oculomotor dysfunctions in acquired brain injury: a retrospective analysis. Optometry. 2007. Patricios JS et al. Consensus statement on concussion in sport: the 6th international conference, Amsterdam 2022. Br J Sports Med. 2023 · Leddy JJ et al. A preliminary study of subsymptom threshold exercise training for refractory post-concussion syndrome. Clin J Sport Med. 2010. Leddy JJ et al. Early subthreshold aerobic exercise for sport-related concussion: a randomized clinical trial. JAMA Pediatr. 2019