Assistant professor orthopedics and sports medicine Augusta University Medical Center Augusta, Georgia, United States
Case Diagnosis: Epidural Hematoma
Case Description: We herein report a case of a 16-year-old male baseball player with an epidural hematoma and subsequent craniotomy and his successful return-to-play. The patient was struck in the right side of his head by a "stray ball" thrown by a teammate. After an initial asymptomatic interval, he began experiencing a headache, nausea, and phono/photophobia at which time was taken to the emergency department where a head CT revealed an epidural hematoma. Neurosurgery performed craniotomy and evacuation. He remained stable and was discharged home two days later with instructions on returning to daily activities as tolerated and to abstain from heavy physical activity at that time. At follow up, his activity level was slowly increased as tolerated beginning with cardio and hitting soft pitch and eventual clearance for high intensity activities at 3 months post injury.
Discussions: Concussion knowledge and return-to-play progression has evolved over the last decade, but guidelines are sparse on other traumatic brain injuries such as epidural or subdural hematomas. Blood pressure increases with increasing activity levels which is concerning for risk of re-bleeding. There is also the possibility that the total body bracing involved in hitting a baseball as well as throwing in itself may increase the pressure within the vasculature to a clinically significant level. Expert opinion may be more resolute regarding collision sports, but there is less confidence in recommendations for non-collision sports.
Conclusions: This case illustrated the particular difficulties in determining the timing of initiating activities and progression to full return to play in intracranial hemorrhages. Sports-related structural brain injuries are few and no published cases related to baseball could be found. Because of their rarity and associated risk, an effort should be made to report these cases commenting on mechanism and outcomes.