Chronic traumatic encephalopathy Flashcards
In literature; concussion = ___
sports
In literature; mTBI (mild traumatic brain injury) = ___
other causes
What is used to classify TBI?
Glasgow Coma scale; tells you about patients awareness
What is there a push for?
To classify concussion different from TBI based on bleeding/contusion
Define concussion
Acute neurophysiological event related to blunt impact applied to the head, body, neck, such as accelerations, declarations and rotational forces. Can be sustained from car crashed, sports, falls, etc
Which force is more likely to cause concussion? Direct or rotatory?
Rotatory
Direct vs rotatory force
Direct = one plane; rotatory = multiple planes
What are some long-term injuries with concussion?
Micro, axonal injuries, ex. shearing of white matter; oxidative stress; can affect deeper structures like brainstem, reticular activating sys.
Where is deformation maximized in the brain?
At depth of sulci and around blood vessels (areas of engineering weakness)(also areas of prototypical tau deposition)
What are some clinical features of acute concussion?
- Amnesia (retre/antro) > loss of consciousness
- May feel normal initially, symptoms develop later
* Headache is most common symptom - Dizziness, nausea, irrtiliability, sensivitiy to light
Early concussions will have ____
symptoms at rest; over time symptoms only when exerting
Most people recover ____
quickly (days-weeks)
Roughly __ have prolonged recovery (beyond 3 months)
15%
What is clinical course dependent on ?
Thresholds, which are subjective. ex. lifestyle, personal activity etc; if you are a non-runner you obv wouldn’t be able to complete a 10k as well unlike a runner
What are the 5 classical domains of symptoms?
Headache, mental health (irritability, anxiety, ptsd), sleep, cognition, vestibular
What are risks that prolong recovery?
- multiple concussions (esp. if they are closer together)
* Concussion without full recovery –> biggest risk - Migraine history, psychiatric illness
- Litigation, blame –> psychological trauma of blaming someone = increased symptoms
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Do severity of injury, loss of consciousness etc have a correlation to prolonged recovery?
NO
What is prolonged recovery?
Beyond 3 months
Should be slow improvment/plateuing, however worsening is a red flag!
Cognitive patterns w/ prolonged recovery?
- Poor attention/concentrations
- Easily lose focus
- Short-term mem. loss, but respond to cues
- Word-finding difficulty
What are some issues patients encounter?
- Lack of wareness in public, no empathy
- Unsure of the science
- Inabiity to gradually return to work
- Screen sensitivity, headaches, balance can be barriers
- Cognitive exertion, slower, easily irritable/anxious
Who called CTE “punch drunk syndrome”
Martland 1928
What did corsellis coin in 1973?
dementia pugilistica
Who termed it CTE officially?
Omalu 2005 ; progressive neurodgeen disorder thought to arise from repeated concussive head injury; pathologic diagnosis
Describe the axonal injury that occurs with repetitive trauma?
- Mechanical deformation
- Alters ion fluxes
- Commonly seen in WM tracts (CC, internal capsule, brainstem, cerebellum)
- Areas cololaclize with APP
How is neurodegen. caused by neurovascular dysfunction during repetitive trauma?
Inflammation and impairment of perivasuclat glymphatic sys, specifically Aqp4 (aquaporin helps lymp sys clear abnormal proteins, thus leading to accumulation)
Where is tau localized in CTE?
Around small vessels (perivascular regions) in an irregular pattern at the depths of cortical sulci
Are CTE NFTs distinguishable from NFT in AD?
no
What are the clinical features in order of frequency?
- Memory impariment
- Executive dysfunction
- Attention/conc.
- Depression
- Explositivity
- Languae
- Visuospatial
- Violent/suicidal
- Parkinson
i dont think u have to memorize this, just know parkinson less frequnet
Can you diagnose CTE on living person?
nO
What is traumatic encephalopathy sysndrome used for?
Identifying potetial CTE cases
Could concussions bring out other NDDs?
Yes, could unmask other neurodegernative disorders (CTE plus pathologies)
What was the flaw in the CNN article that found “99% of NFL players”
only studied players suspected of CTE
Biomarkers of CTE:
- Caved in septum pellucidum\
- CSF –> normal amyloid beta, elevated p-tau/total tau
*PET Imaging –> negative amyloid/positive tau - Cortical t hinning.atrophy
- APOE4
