Introduction:

The genetics of concussion remain poorly understood. Nonetheless, it is safe to assume genes play a critical role in clinical natural history. Without specific genetic determinants, clinicians must look to family history for useful information on clinically relevant inheritable traits. Identical twins offer a unique opportunity to bring these issues to light.

Case Presentation:

Identical twin 14-year-old boys playing tackle football for the same high school team in the same position (linebacker) presented to a sports neurology clinic for evaluation on day 2 of symptom onset. Both describe sustaining multiple hits during the game against bigger opponents without one specific standout impact. By the end of the game, they both developed headaches with light and sound sensitivity, nausea and feeling off balance. Both felt their headaches worsened with an increase in intracranial pressure (i.e. coughing, bending over or yelling). Thorough neurologic family history revealed an older brother with two prior concussions without prolonged recovery. Both neurologic examinations were completely normal other than symptom production with vestibular ocular motor testing.

The twins’ clinical management included taking non-steroidal anti-inflammatory medication starting on day 2 and beginning light activity on day 3. Both were asymptomatic after day 4 and were re-evaluated in clinic on day 6 with completely normal neurological examinations. The stepwise return-to-play process was completed with their school athletic trainer. They were cleared to participate in sports without restrictions on day 7.

Discussion:

This case study highlights the importance of understanding the genetics of the concussed brain as a determinant of the injury’s clinical presentation. A thorough neurologic history including family history--particularly in the pediatric population-- is paramount and should not be overlooked as it can elucidate genetic predispositions for developing patterns of neurologic presentations or for prolonged neurologic recovery from biomechanical forces.