Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

01 PERSISTENT POST-CONCUSSIVE SYMPTOMS IN A TEEN MOUNTAIN BIKER: UNMASKING KLIPPEL-FEIL SYNDROME AND CHRONIC NEUROIMAGING FINDINGS

Paul Varghese, MD; Tyler Shick, MD; Justin Weppner, DO; William Ide, MD Corresponding author: jlweppner@carilonclinic.org

VCOM-Virginia, Blacksburg, Virginia Virginia Tech-Carilion School of Medicine, Roanoke, Virginia Carilion Clinic Brain Injury Center, Roanoke, Virginia University of Virginia, Charlottesville, Virginia Case Diagnosis: Persistent post-concussive symptoms in an adolescent with previously unrecognized Klippel-Feil syndrome (KFS) and chronic cerebral volume loss. Case Description: 17-year-old male presented with ongoing lightheadedness and vestibular symptoms one month following a helmeted mountain bike crash resulting in mild traumatic brain injury with neuroimaging evidence of structural intracranial injury. Initial symptoms included dizziness, confusion, photophobia, and difficulty focusing, with persistent motion-induced lightheadedness. Neurologic examination revealed impaired balance and postural stability without focal deficits. Due to persistent symptoms, further evaluation was pursued. Brain MRI demonstrated chronic left frontoparietal focal cerebral volume loss, likely related to a history of meningitis in infancy, as well as a right frontal microbleed presumed to be trauma-related. Cervical spine radiographs showed congenital fusion of C4-5 and abnormal vertebral morphology, consistent with KFS.

Discussion: Persistent post-concussive symptoms (PPCS) in adolescents are often multifactorial, with underlying, previously unrecognized conditions sometimes contributing to prolonged recovery. In adolescents, persisting symptoms after concussion commonly reflect multiple converging “symptom generators” (e.g., cervical, vestibulo-ocular, mood/ sleep), rather than a single ongoing brain injury. Current consensus guidelines emphasize that persistent symptoms are frequently driven by pre-existing, coexisting, and resulting biopsychosocial factors, warranting thorough evaluation for other etiologies that can mimic concussion symptoms. We present the case of a 17-year-old male with PPCS following a mountain biking accident, whose evaluation revealed previously undiagnosed KFS. KFS, a congenital cervical fusion disorder, can predispose to cervicogenic headache, neck pain, and neurologic vulnerability after minor trauma, complicating symptom attribution and management.

Conclusion: This case illustrates how PPCS in adolescents can reveal underlying conditions such as KFS. Consensus guidelines emphasize the importance of thorough evaluation—including assessment for cervical, vestibular, and psychosocial factors—to identify and address coexisting etiologies. Comprehensive workup, including neuroimaging when indicated, is essential for optimal management, targeted rehabilitation, and safe return to activity. The authors received institutional approval, patient, and parent consent to use their data for this report.

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132 Edward Via College of Osteopathic Medicine (VCOM)