2024-04-172024-04-172024-03-21https://hdl.handle.net/20.500.12503/32720Research Appreciation Day Award Winner - Texas College of Osteopathic Medicine, 2024 Medical Student Government Association Best in Fourth Year ClassCase History: Patient was a 16-year-old male with a history of depression taking Prozac and ADHD taking Adderall. No previous history of psychosis. Patient presented in February 2023 for evaluation after an episode of LOC following a blow to lateral eye while wrestling. Patient regained consciousness after a few seconds, but reported difficulty with speech, gait, and inability to remember the incident in detail. Patient was taken to the emergency department and CT scan was negative for acute abnormalities. Patient presented 7-days post-incident with dizziness, light sensitivity, and cognitive slowing. At patient visit 1-month post-incident he reported resolution of dizziness and light sensitivity, but persistence of cognitive slowing. Between 1-month and 2-month post incident visits patient experienced episode of psychosis resulting in self-harm. Patient had no recollection of episode. Physical Examination: In office patient was well appearing with no sign of distress. Neck was nontender and supple with full ROM and no bony tenderness. Negative spurling test. No increased work of breathing. Heart sounds normal. No bruits present on auscultation of neck. Alert and oriented with normal mentation and speech. No motor or sensory deficits present. Negative dysmetria, dysdiadochokinesia, pronator drift, Romberg. No evidence of bruising or bony abnormalities to either orbit. Pupils were PERRLA with EOMI. Vertical and horizontal saccades present bilaterally with provocation of symptoms. Normal mood and affect with clear and logical thought processes. Differential Diagnosis #1: Concussion Differential Diagnosis #2: Orthostatic syncope Differential Diagnosis #3: Post traumatic migraine Differential Diagnosis #4: Subdural hematoma Differential Diagnosis: Chronic fatigue syndrome Tests & Results: Testing performed 7-day post-incident; VOMS: saccades horizontal 9 and vertical 9. C3 Logic Data: symptoms severity 15of 27, SAC 20, BESS abnormal with 44 errors, trails A 78.3, trails B 93.3. Testing performed 28-day post-incident; VOMS: saccades horizontal 12 and vertical 11. C3 Logic Data: symptoms severity 17of 27, SAC 26, BESS abnormal with 11 errors, trails A 18.1, trails B 41.6. Final/Working Diagnosis: Psychotic episode with self-harm secondary to concussion. Discussion: Literature suggest mild traumatic brain injuries can trigger initial psychotic episodes in adolescents and adults. This case demonstrates a possible psychotic episode triggered by a TBI due to a concussion. In addition, the risk of trigger may be greater in adolescents with a pre-existing psychiatric diagnosis. Further analysis and research are necessary to evaluate a possible connection between the frequency of psychiatric symptoms following a concussion in adolescents with and without prior psychiatric diagnosis. This information may help identify at risk individuals and help guide prophylactic treatment to prevent psychiatric symptoms from occurring in the post-concussive period. Outcome: Following the psychotic episode patient saw a psychiatrist and medication for MDD was changed from Prozac to Abilify. The patient was stable on this medication regimen at his 2-month follow up visit. At this time patient report 98% improvement from original symptoms and had returned to physical activity and full days at school. He was cleared for full-activity and advised to follow up as needed.enposter