Heads up! Comprehensive concussion care is now available.

Heads up! Comprehensive concussion care is now available.

Concussions have become recognized as a significant injury with potential longlasting morbidity in children. However, the medical community has few resources to address the lingering symptoms following a concussion.

Upstate update Even though the Upstate has a large number of certified athletic trainers embedded in schools and other facilities, many club, county and church sporting leagues do not have such personnel – plus, concussions are not limited to athletic endeavors. In fact, many concussions are the result of trauma and motor vehicle collisions. That’s one of the reasons why Blake Windsor, MD, with Prisma Health Pediatric Pain Medicine, developed a multidisciplinary

concussion team with expertise in sports medicine, pain and headache medicine, and pediatric neuropsychology, along with a concussion-related partnership with ATI Physical Therapy.

The team carefully evaluates children who have symptoms persisting for at least seven days after the injury and then implements therapies to address the symptoms. These experts establish an educational accommodation plan and any other specialized testing or care needed to support the child to recovery.

To refer a patient, call Pediatric Pain Medicine at 864-522-4888 or make an Epic referral. The office is located at 1350 Cleveland St., Greenville.

Making headway in the Midlands In the Midlands, Jeff Holloway, MD, a sports medicine specialist, offers a similar Prisma Health program. Its format combines the expertise of a pediatric sports medicine physician, USC Concussion and Health

Dr. Windsor follows up with a patient at his Greenville office.

Research suggests that 50% of teens with a concussion can continue to have symptoms for at least one month.

Neuroscience Laboratory, and Prisma Health Physical Therapy Specialists.

The evaluation process is especially key with remote concussions where signs can be subtle. Dr. Holloway explained, “A football player may have been injured several weeks ago, but he and his parents may not relate current symptoms to that injury. My role is to tease out those signs and help with a treatment plan that offers the best way to help a child get back to school and activities. It’s so important to follow the right protocols.” The doctor added, “Patients also benefit from working with our research team.”

He sees patients for initial evaluation and acute injuries Mondays and Wednesdays, 1–5 p.m., at Prisma Health Pediatric Rehabilitation Medicine. The address is 9 Richland Medical Park Dr., Ste. 410, Columbia. To refer a patient, call 803-434-2221 or fax 803-434-7983.

Cat scratch disease presenting with neuro-retinitis Optic disc edema with a macular star pattern is indicative of several disorders, though this finding might be idiopathic in nature. Diagnoses to be considered include Lyme disease, toxoplasmosis, syphilis and cat scratch disease. Nematode infections, especially Toxocariasis, should also be considered.

In this patient, Bartonella hensalae IgG antibody titer was 1:256, leading to the diagnosis of cat scratch disease. Following diagnosis, the patient was treated with doxycycline, rifampin and a short course of oral steroids. The patient is improving and continues to be followed by the Ophthalmology unit.

Ten percent of healthy controls exhibit Bartonella hensalae IgG titers of 1:64-1:128, but none show titers of 1:256 or greater. Thus, in the appropriate clinical scenario, this titer is diagnostic of cat scratch disease.

Clinical manifestations of cat scratch disease in an immunocompetent individual are variable. Although most patients are afebrile, constitutional symptoms such as malaise, anorexia and fatigue are common, as is headache. Localized lymphadenopathy lasting several weeks is a traditional presentation of this disease. Less common manifestations of Bartonella hensalae infection include endocarditis, encephalopathy, osteolytic lesions, granulomas of liver and spleen, glomerulonephritis, and pneumonia.

Up to 10% of patients have ocular disease, which includes painless vision impairment, optic disc swelling and macular edema with lipid exudates (macular star). Rare manifestations of ocular cat scratch disease such as Parinaud’s syndrome have been reported.

Several treatment options are available for cat scratch disease, including azithromycin, ciprofloxin and trimethoprim-sulfamethoxazole. When neuro-retinitis is present, however, doxycycline, rifampin and steroids are medications of choice.

References Red Book 2018-2021, American Academy of Pediatrics, ed. David Kimberlin MD:244-47. M. Tariq Bhatti, MD; Reem Asif, MD; Lubna B Bhatti, MBBS; “Macular star in neuroretinitis,” Arch Neurol 2001; 58(6):1008-09. Z. Habot-Wilner, et al., “Cat scratch disease: ocular manifestations and treatment outcomes,” Acta Ophthalmol 2018;96(4):e524. Epub 2018 March 5.