CNS Injury III

Question 1

What is the number 1 cause of traumatic brain injury?

Answer 1

Falls (in toddler and elderly mostly)

Question 2

What is a concussion?

Answer 2

Clinical syndrome with immediate and transient impairment of neural function, such as alteration of consciousness, disturbance of equilibrium, etc., due to mechanical forces

Question 3

How do you measure a concussion?

Answer 3

Glasgow coma scale

Question 4

How do you quantify the severity of concussion?

Answer 4

Glasgow coma scale
Mild = GCS 15-13
Moderate = 12-9
Severe = 8-3

Question 5

What are the common early symptoms of concussion?

Answer 5

Headache
Dizziness, lightheadedness or vertigo
Lack of awareness of surroundings
Muddled thinking
Nausea and vomiting

Question 6

What are the common late symptoms of concussion?

Answer 6

Persistent headache
Lightheadedness
Decreased attention and concentration
Poor memory
Easy fatigability
Irritability
Anxiety or depressed mood
Sleep disturbance

Question 7

What are the signs of concussion?

Answer 7

Vacant stare
Delayed responses
Inattention
Disorientation
Slurred speech
Incoordination
Inappropriate emotionality
Memory problems
Loss of consciousness

Question 8

At what point does an athlete rendered unconscious become a neurosurgical emergency?

Answer 8

after 5 minutes

Question 9

Which lobes are most affected by concussion?

Answer 9

Frontal and temporal

Question 10

What is a contrecoup contusion?

Answer 10

negative pressure in the part of the skull that is not impacted leads to vaporization of brain matter in that area.

Question 11

What is the pathophysiology of concussion?

Answer 11

Biomechanical forces cause tissue deformation, shearing and fluid wave propagation through the hemisphere
Irritation leads to rapid, chaotic electrical depolarization across the cortex- mostly releasing glutamate.
Excitotoxic change drives up metalbolism (hyperglycolysis) and and lactic acid levels. Na – K pump failure and axonal stretch injury lead to Calcium influx and axonal swelling or disintegration. Rotational injuries lead to diffuse shearing of small vessels.
Diffuse axonal injury is underlying lesion.- this takes time after the injury.

Question 12

What does a hemorrhagic lesion mean for prognosis?

Answer 12

If blood vessels break, we can say for sure that there will be axonal damage, because axons are more fragile than blood vessels.

Question 13

How do you know there is axonal injury on an MRI?

Answer 13

If there is any evidence of blood (iron) on the MRI

Question 14

What is the concussion grading scale?

Answer 14

Grade 1: Transient confusion, no LOC, abnormalities resolve in less than 15 minutes
Grade 2: Transient confusion, no LOC, abnormalities last greater than 15 minutes
Grade 3: Loss of consciousness is (a) Brief [seconds] or (b) Prolonged [minutes]

Question 15

How long does it take for young healthy people to resolve concussion symptoms from a single sports-related event?

Answer 15

~7-10 days, but those with more severe injuries take longer to resolve.

Question 16

What is second impact syndrome?

Answer 16

Catastrophic brain swelling occurring if concussions happen near each other in time.
Intracranial vasodilation and cerebrovascular congestion – vascular autoregulation dysfunction