A 19.5 year old, otherwise healthy soccer player came to our clinic with a major complaint of repeated occipital headaches and blurred vision, during late phases of the game, for about a year. He was advised to rest between training sessions, and continued to train and play as usual. As his symptomatology became more frequent and disturbing, his coach brought him to our clinic for a sports medicine consultation. The coach also raised the question whether this player could safely return to his training and game schedule. Upon arrival, his personal and family medical history revealed only lower back pain and a very mild respiratory allergy to dust that required no medications. A general physical examination, pulmonary function tests, a basic neurological examination, and basic examinations of the eyes, sinuses and ears were all within normal limits. Resting heart rate was 76 beats per minute and blood pressure was 115/70 mmHg. A resting electrocardiogram (ECG) revealed a normal sinus rhythm, with an incomplete right bundle branch block and an inverted T-wave in leads II, III, AVF, V1-V4, that resemble a juvenile pattern, but without any significant signs of left ventricular hypertrophy or cardiomyopathy. In order to examine his cardiovascular responses and symptoms during exercise, he performed a maximal stress test on a treadmill up to 12 km/h and 12% inclination, with a total testing time of about 10 minutes, reaching a maximal heart rate of 195 beats per minutes and maximal blood pressure of 160/50 mmHg. His stress ECG revealed non-specific changes characterized by pseudo-normalization of the T-wave, and a good recovery of his heart rate and blood pressure responses. During this run, he developed his typical occipital headaches with blurred vision at maximal effort. Repeated high jumps from squat position revealed the same symptomatology. An examining physiotherapist suspected a biomechanical problem in his neck and/or occipital areas, with or without vascular involvement of the major blood vessels to the involved areas. His temporary medical diagnosis was effort-induced headaches and blurred vision, with suspected vascular and/or mechanical disturbance that emerged during high intensity exercise. Upon his release, our recommendations were as follows: 1. Temporary avoidance of any moderate to severe physical activities or training 2. Advanced work-up consultations and examinations: X-rays/CT/MRI of the head and neck, with neurological consultation Examinations and consultations by an optometrist and an ophthalmologist Echocardiogram, 24 hours Holter-ECG, and cardiologic consultation Results of this work-up and the final diagnoses will be presented in the case report.
© Copyright 2014 The 3rd Wingate Congress of Exercise and Sport Sciences. Published by The Wingate Institute for Physical Education and Sport. All rights reserved.