Designated Institutional Officer Burke Rehabilitation Hospital White Plains, New York, United States
Case Diagnosis: We reviewed two cases in athletes who had brain injury. Both of whom had unknown underlying cardiac conditions that caused brain injury post exercise. Cardio exercises are recommended to patients in order to maintain robust cardiac function. However, we evaluate the need for more comprehensive medical clearance before participating in sports.
Case Description: Case 1. 58 year-old male with no past medical history presents with anoxic brain injury post cardiac arrest after jogging at a track when he suddenly collapsed to the ground. Patient received CPR, 3 shocks, and was given 3 doses of epinephrine. ROSC was achieved in field. CT brain showed no acute findings. Echocardiogram revealed aortic stenosis. He had a full physical exam and lab work 3 weeks prior with no abnormal findings. Case 2. 63 year-old male with no past medical history presents to ED after being found on bathroom floor with right sided weakness. CT head revealed left MCA stroke; tPA was administered. Echocardiogram revealed PFO. Patient reported cycling 3-4 times per week for 1-2 hours in the evening, and 4 hours per day during the weekends. Patient had been healthy and up to date with his PCP prior to the event.
Discussions: Is history and physical exam enough before clearing patients for strenuous exercises? Both patients had recently have been medically cleared. Despite passing routine health workup, cardiac conditions went undetected leading to brain injury post exercise in both cases.
Conclusions: The need for more comprehensive evaluation besides routine history and physical may be helpful in identifying potential candidates at risk for brain injury associated with participating in strenuous physical activity. Echocardiogram which traditionally is indicated for evaluating suspected or known cardiac diseases may also need to be used for medical clearance in athletes.