Abulia in a Concussed Athlete (IN5-1.010)

OBJECTIVE: This is an atypical presentation of a sports related concussion in a 14-year-old athlete with post-concussive abulia. BACKGROUND: While the majority of sports-related concussions present as headache, nausea, dizziness, confusion, and unsteadiness, there are other less common presenting symptoms such as mood disorders and irritability. Abuila is a disorder of diminished motivation with a reduction of spontaneous thought content and initiative. DESIGN/METHODS: In the case report we present a 14-year-old male who sustained a sports related concussion after falling during a high school basketball game. He injured the front of his head and initially complained of headache, nausea, and dizziness, which later progressed to symptoms of abulia. On neurologic examination he answered mental status questions appropriately but with a lack of emotion. The remainder of his neurologic exam was unremarkable. RESULTS: Our patient underwent a head CT scan that was unremarkable. All of his symptoms improved over the next three days with the exception of his abulia. This persisted for a total of ten days and then he spontaneously remitted back to his baseline and was able to begin the return to play protocol. CONCLUSIONS: While abulia is not a common symptom of sports related concussion, this case illustrates an interesting presentation of frontal lobe injury resulting in lack of emotion, apathy, and decreased motivation. It is important to recognize that in addition to the classic symptoms of sports concussions, less common symptoms exist such as impulsivity, depression, insomnia, and in this case, abulia. Disclosure: Dr. Madey has nothing to disclose. Dr. Williams has nothing to disclose. Dr. Bodle has nothing to disclose. Dr. Williams has nothing to disclose. Dr. Lehman has nothing to disclose.