CNS injury III

Question 1

Define concussion or mild traumatic brain injury

Answer 1

concussion = transient impaired neural function, altered consciousness, distrubed equilibrium due to mech forces (LOC NOT required!!!!)

Question 2

hallmarks of concussion

Answer 2

confusion

amnesia

Question 3

Define mild TBI in terms of GCS

symptoms of mild TBI

Answer 3

GCS = 13-15

posttraumatic amnesia for less than 24 hrs, LOC less than 20 min, alter mental status with injury

Question 4

common late symptoms of concussion

Answer 4

1) persistent HA
2) lightheaded
3) decr attention/concentration
4) decr memory
5) easy fatigue, irritable, anxiety
6) decr mood
7) sleep disturbances

Question 5

signs of concussion

Answer 5

1) vacant stare
2) slurr speech
3) incoordination, inappropr emotions, disorientation
4) LOC
5) memory prob
6) delayed response, disoriented

Question 6

colorado concussion grading scale

grade 1

Answer 6

confusion w/o amnesia or LOC

Question 7

colorado concussion grading scale

grade 2

Answer 7

confusion + amnesia (PTA or RGA)

Question 8

colorado concussion grading scale

grade 3

Answer 8

LOC

Question 9

which lobes most affected in concussion

which is better scan, MRI or CT for diagnose

which forces are more damaging, rotational vs. translational

Answer 9

frontal and temporal regardless of any force direction

MRI

rotational forces

Question 10

what does gradient echo MRI measure

Answer 10

detects hemosiderin at gray/white matter junctions left behind by trauma

implies widespread axonal injury certain

Question 11

if hemorrhage detected on imaging, then ___ is certain

Answer 11

axonal damage is certain

Question 12

standard assessment of concussion

Answer 12

1) standardized mental status exam weighted for trauma (measures neurocog fxn by orientation, concentration, immediate/delayed memory)
2) neuro screen
3) neurocognitive (orientation, memory)
4) exertion/provocoative maneurvers

Question 13

treatment for concussion

Answer 13

1) rest under observation for 24 hrs by provider/responsible adult
2) CT scans with grade 3 concussions for bleeds
3) meds for sleep and acetaminophen for HA

Question 14

define second impact syndrome

Answer 14

1) catastrophic brain swelling after 2 concussions in a row
2) hydrocephalus and hemorrhage due to autonomic dysregul of intracranial vessels
3) congestion and high ICP –> fatal

Question 15

procedure for dxx concussion

Answer 15

1) 24 hr monitor
2) CT scan for intracranial bleed if LOC observed
3) careful neuro exam
4) mental status exam

Question 16

common early symptoms of concussion

Answer 16

1) HA
2) dizziness, lightheaded
3) lack awareness of surroundings
4) n/v/muddled thicking

Question 17

how do linear forces cause injury

Answer 17

skull fractures

contrecoup contusions = vapor develops from vacuum effect as skull stops and brain keeps moving

Question 18

pathophys of biomech forces

Answer 18

1) tissue deform, shearing, fluid propagation
2) rapid, chaotic electrical depol across cortex
3) XS glutamate –> excitotoxic –> incr hyperglycolysis and lactic acid
4) Na/K pump fail and axonal injury –> Ca influx –> axon swell
5) diffuse shearing of vessels and diffuse axonal injury

Question 19

Different time courses of concussion

Answer 19

1) short period of retrogade amnesia (no LOC)

2) confusion OR posttraumatic amnesia OR LOC then consciousness