Chapter 4 Flashcards
When did concussion begin to be tied to physiologic changes in the brain?
1839
athletes at greatest risk for second impact syndrome
under the age of 24 who are returned to play while still neurologically at risk
what symptom may be indicative of a more significant injury process immediately following a head injury?
rapid progressive headache
Two important guidelines to follow after mTBI
- persons with mTBI who have headaches, dizziness, or sleep disturbance after injury should seek immediate help to decrease the liklihood of subsequent injuries and pain syndromes
- if other symptoms have not resolved within the first 2-4 weeks after injury, it is strongly recommended that care be sought by clinicians who are appropriately trained and have clinical skills to manage the underlying causes of persistent symptoms
Important neuropsych things to evaluate after mTBI
- screen for anxiety, depression, and PTSD
- obtain full psych history
- obtain comprehensive hx of psychological responses to past injuries
- compare recovery to natural history expectations
- Administer neuropsych evaluations PRN
- evaluate history of substance abuse
- assess functional progress and behavior in therapy or other tx modalities
- determine presence of potential secondary gains
mTBI represents what percentage of all TBIs that occur in the US annually
75%
True incidence is likely higher due to many people not seeking medical attention
Mild TBI criteria
- normal structural imaging
- LOC 0-30 min
- alteration of consciousness from one moment up to 24 hours
- post traumatic amnesia 0-1 day
- GCS 13-15
metabolic alterations
adverse chemical changes in brain as a result of transfer of kinetic energy to the soft tissue of the brain
most common form of damage to brain structure
diffuse axonal injury
axonal shearing
process of axons being twisted and disconnected
does diffuse axonal injury show up on imaging?
not readily
glutamate
- toxic to the brain in high levels
- affects balance of sodium and potassium
- involved in excitatory processes as neurotransmitter
Percentage of people who experience persistent problems after 2-4 weeks after mTBI
10-15%
Physical/somatic mTBI symptoms
headache fatigue seizure nausea numbness poor sleep light sensitivity noise sensitivity impaired hearing blurred vision dizziness/LOB neurologic abnormalities
cognitive symptoms of mTBI
inattentiveness diminished concentration poor memory impaired judgment slowed processing speed executive dysfunction
behavioral/emotional symptoms of mTBI
depression anxiety agitation irritability aggression impulsivity
frontal release
syndrome from damage to frontal areas of brain that results in disinhibition and abnormal behaviors
occipital neuralgia
most typical extra cranial trigger for migraine-like headaches
- casued by direct trauma or secondary sensitization from recurring central headaches
- associated with pain in the back of the head that worsens as the day progresses
- worsened by stress and tightening of the neck muscles
trigeminal nucleus
connection from upper spinal cord to this nucleus causes pain from occipital neuralgia to radiate to the forehead or behind the eyes
common forms of sleep disturbance following mTBI
sleep apnea
insomnia
Addressing fatigue post-mTBI
ensure restful sleep
gradual return to ADLs/IADLs
Sensory systems most prone to hypersensitivity following mTBI
hearing
vision
*important to rule out optic or auditory nerve damage
What 3 mTBI symptoms are most important to address in order to avoid subsequent injuries and pain syndromes
headaches
dizziness
sleep disturbance
post-concussion syndrome/persistent post-concussive symptoms (PCS/PPCS)
persistence of mTBI symptoms weeks to months after mTBI
-PPCS is preferred term to describe this
Predictive risk factors for PPCS
- pending litigation
- over 40
- hx of substance misuse
- low SES
- traumatic injury
- female
- previous psych history
Post-injury factors that increase risk of PPCS
headache dizziness nausea post-traumatic amnesia lasting greater than 1 hour GCS score of 13 or 14
consensus about cumulative effects of concussions
cumulative effect exists, it is important to obtain a thorough history of previous BI’s, including stroke and anoxia
Chronic Traumatic Encephalopathy (CTE)
rare, progressive, degenerative condition of the CNS, typically seen after repetitive brain trauma
cascade of events leading to CTE
- diffuse axonal injury causes release of Tau proteins
- Tau proteins create a state of chronic inflammation in brain
- Affects neighboring neurons, which spreads continuously throughout a person’s life
- may begin in childhood with contact sports
focal seizures most common in what part of brain?
temporal lobe
