Concussion and mild traumatic brain injury — structured clinical encounter

An eleven-year-old girl is referred to your general paediatric clinic with a daily headache, fatigue, poor concentration, and sensitivity to noise that have persisted for six weeks since she fell off her scooter and hit the back of her head. She felt dazed and nauseated for two days afterwards, and her mother insisted she rest at home for a full week before returning to school. Since returning she has missed many school days because the noise and the lights in the classroom worsen her headache, she cannot concentrate on her work, and she is falling behind. She has withdrawn from her netball team and no longer sees her friends. Her mother reports she is tearful and withdrawn and no longer her usual self. She has a history of migraine and anxiety, and her father recalls she had a minor concussion two years ago that resolved in ten days. Her neurological examination, including fundoscopy, balance, and a cognitive screen, is normal.