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Abstract

Background: Women’s soccer leads the National Collegiate Athletic Association for having the highest number of concussions in female sports. Common symptoms of concussion can include light headedness, headaches, and dizziness, but these symptoms are not exclusive to concussions. Female athletes may experience nutritional deficits that can lead to a wide range of symptoms mimicking those commonly experienced with a concussion such as headaches, dizziness, and fatigue. The patient in this case is a 21- year-old female soccer athlete who presented with sensitivity to light, light headedness, nausea, and fatigue after experiencing repeated ‘headers’ as well as a collision during a match. Upon evaluation, she reported a long-standing history of hyperhidrosis, eating disorders, and migraines. The athletic trainer evaluated the patient for a concussion, but all results were within normal limits. As a precaution, the patient was removed from play and any further activity pending evaluation from the team physician. Two days later, the patient was seen by the team physician who also ruled out a concussion and was cleared to return to play. Nine days after the initial injury, the patient collided with an opponent while participating in a match. During halftime the patient complained of feeling ‘off’ but assumed it was due to dehydration. The athletic trainer treated the patient with water, a salt tablet, and electrolytes which relieved symptoms prior to the start of the second half of the competition. Two minutes into the second half of the match the patient was removed from play due to dizziness, lightheadedness, headache, and nausea. The team physician referred the patient to the team’s concussion specialist. Differential Diagnosis: Initial suspicions were centered around a concussion due to the collision sustained nine days prior. Treatment: After examination, the concussion specialist ordered bloodwork. The blood panel revealed a low ferritin count, a protein responsible for iron storage. Based on her blood panel, it was determined the low ferritin count secondary to hyperhidrosis was contributing to headaches, nausea, lightheadedness, and dizziness. The physician prescribed ferrous sulfate tablets to treat low levels of iron. The physician also recommended meetings with both the athletic trainer and registered dietitian for neck strengthening and meal planning. The registered dietician provided several food adjustments to incorporate higher levels of iron into the diet such as adding more leafy greens, proteins, and potatoes. She also advised the patient to keep a daily food and symptom log. The athlete was allowed to fully participate but was instructed to check in with the athletic trainer before and after any physical activity. After following the recommendations, the patient noted an immediate decrease in the severity and frequency of symptoms. She completed the season without any further incidents. Uniqueness: Nutritional deficits in female athletes are often missed due to high hormone intricacy and the lack of research on women. In this case symptoms caused by a low ferritin count mimicked those of a concussion. Conclusion: The patient presented with a mechanism and symptoms that align with a concussion diagnosis. After ruling out a concussion, bloodwork confirmed a nutritional deficit which commonly presents with symptoms similar to a concussion. After changing her diet, the patient was able to resolve her symptoms. By collaborating with experts such as registered dieticians, athletic trainers can further their knowledge in the unique components of food and how important of a role it plays.

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