This case describes an 18-year-old English male professional soccer goalkeeper who sustained a significant head injury during training with transient loss of consciousness and seizure-like posturing exhibited on the field of play. Initial CT imaging in the emergency department demonstrated a focal intracranial haemorrhage within the septum pellucidum. Subsequent MRI identified multiple microhaemorrhages, predominantly within the right centrum semiovale, consistent with traumatic microhaemorrhages and possible underlying axonal injury. The player was admitted for hospital observation for four days. On discharge, he underwent an initial management period of prolonged rest for six weeks. A structured graduated return to sport programme was completed, incorporating serial neurocognitive assessment and repeat neuroimaging to guide progression. In the absence of definitive return to play guidance for structural brain injury, a conservative, clinically reasoned, specialist multidisciplinary team approach was adopted. The athlete returned to pre-injury competition level six months after injury without recurrence of symptoms. This case exemplifies the importance of distinguishing concussion from structural traumatic brain injury (TBI) and highlights considerations for safe return-to-play decision-making in the absence of evidence-based guidelines.
Drummond et al. (Mon,) studied this question.