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Neuro 2 > Concussion > Flashcards

Concussion Flashcards

1
Q

what level of TBI would a concussion be classified as?

A

mild TBI

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2
Q

explain the pathophysiology of a concussion

A

this is a metabolic brain injury

↑ ENERGY DEMAND + ↓ BLOOD SUPPLY → METABOLIC CRISIS

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3
Q

list the clinical subtypes of concussion

A
  1. Cognitive/Fatigue
  2. Ocular
  3. Vestibular
  4. Anxiety/Mood
  5. Cervical
  6. Post Traumatic Migraine
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4
Q

describe the symptoms of the Cognitive/Fatigue Subtype

A

most often seen EARLY ON followinc concussion

  1. Fatigue
  2. HA with cognitive and physical activity
  3. “end of day” symptoms
  4. often see sleep distrubances
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5
Q

exam findings for Cognitive/Fatigue subtype

A
  1. Vestibular/Ocular screening
    • normal
  2. Neurocognitive Test Results
    • mild, but global/widespread, deficits across all composites
    • deficits with retrieval, encoding intact
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6
Q

treatment for the cognitive/fatigue subtype

A
  1. incorporate physical/cognitive breaks throughout the day
    • NO NAPS
  2. pharmacological options available if persistent
    • neurostimulants
    • sleep aide
  3. Cog therapy → if symptoms linger more than a few months
  4. Monitored, structured exercise progression
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7
Q

risk factors for the Ocular/Visual Subtypes

A

personal/family history of ocular dysfunction

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8
Q

symptoms for the Ocular/Visual Subtypes

A
  1. Frontal HA driven by visual work
  2. Difficulties w/visually-based classes, assignments, or activities
  3. Pressure behind eyes
  4. Visual “focus” issues
  5. Blurry vision
  6. Double vision
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9
Q

exam findings for the Ocular/Visual Subtypes

A
  1. Vision/Oculomotor Exam
    • +Smooth Pursuit, Saccades
    • Convergence difficulties
      • insufficiency
      • spasms/excess
    • Accommodative insufficiency
    • Binocular visual deficits
    • Strabismus
      • Tropias
      • Phorias
  2. Neurocognitive Test Results
    • deficits in reaction time
    • deficits w/visual memory (encoding rather than retrieval)
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10
Q

what is a strabismus?

A

a misalignment of the eyes or dysconjugate gaze at rest

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11
Q

what is a topia?

A

overt deviation of the eye

tend to be present at all time

  • exo → outward (laterally)
  • eso → inward (medially)
  • hyper → upward
  • hypo → downward
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12
Q

what is phoria?

A

ocular deviation occurs when dissociation occurs

tend to show up as the eyes get tired

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13
Q

describe what occurs if strabismus is severe or subtle

A
  1. Severe
    • diplopia
    • head tilt (vertical misalignment)
    • noticeable eye turn
  2. Subtle
    • difficulty maintaining focus
    • cosmetically normal
    • ocular soreness
    • HA
    • mental dullness
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14
Q

what is the difference between convergence and divergence?

A
  1. convergence → ability of eyes to turn inward to focus on a near target
  2. divergence → ability of eyes to move outwards to focus on a further target
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15
Q

what are the general symptoms of vergence dysfunction?

A
  1. Asthenopia when reading
  2. Frontal HA
  3. Intermittent/Constant double vision
  4. Squints/closes one eye
  5. Letters appear to float/move on the page
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16
Q

list some common vergence problems

A
  1. Convergence insufficiency
  2. Convergence excess
  3. Convergence spasm
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17
Q

describe accommodative dysfunction

A

reduction in ability to focus at near, may prematurely need reading glasses or bifocals

accommodative spasm (over focusing at near)

this is a struggle to coordinate accommodation and vergence, leading to difficulty in spatial awareness

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18
Q

accommodative dysfuction will cause trouble with ________

A

spatial awareness

computers/phones/near work

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19
Q

treatment of Ocular/Visual Subtype

A
  1. Ocular Motor Training
  2. Physical Exertion → generally well tolerated
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20
Q

risk factors for vestibular subtype

A

PMHx of car sickness/motion sensitivity, migraine, anxiety

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21
Q

symptoms for Vestibular Subtype

A
  1. Vertigo
  2. Dizziness
  3. Nausea
  4. Overwhelmed in visually-stimulating environments
  5. Balance impairments
22
Q

S/S of Vestibular Dysfunction

A
  1. Dizziness
  2. Blurry Vision
  3. Nystagmus
  4. Tinnitus
  5. Vertigo
  6. Hearing Loss
  7. Loss of balance and possible falls
  8. Broad-based stance (to accommodate for imbalance)
  9. Sweating, nausea, and vomiting (due to ANS involvement)
23
Q

list causes of Vestibular Dysfunction in TBI

A
  1. Labyrinthine Concussion
  2. Skull fracture
  3. Hemorrhage into Labyrinth
  4. Hemorrhage into brainstem
  5. Incrased ICP
24
Q

possible manifestation of Labyrinthine Concussion

A

ataxia, imbalance, BPPV may be present

most common vestibular injury due to TBI

25
Q

possible manifestations of skull fracture TBI

A
  1. UVL or BVL (partial or complete)
  2. conductive hearing loss
  3. may have mixed peripheral and central lesions

these are common w/blows to the occiput, temporal or parietal regions

26
Q

possible manifestations of hemorraghes into labyrinth TBI

A
  1. May create post traumatic hydrops (Meniere’s type syndrome)
  2. Damage to labyrinth, may create acute vertigo and unilteral hearing loss
  3. labyrinthine damage may present with S/S similar to acute peripheral vestibular damage
27
Q

possible manifestations of hemorrage into brainstem TBI

A
  1. Oculomotor signs
  2. poor smooth pursuit
  3. vertigo
  4. perception of tilt

this results in damage to vestibular and oculomotor nuclei

28
Q

possible manifestations of increased ICP TBI

A
  1. fluctuating hearing loss
  2. ataxia
  3. imbalance
  4. may cause perilymph fistual
29
Q

exam findings for vestibular subtype

A
  1. Vestibular/Ocular Screen
    • VOR dysfunction (vertical and/or horizontal)
    • VOR suppression
    • Can see +smooth pursuit, saccades
    • **not sig enough to see +skew
  2. Neurocognitive Test results
    • difficulty w/visual motor speed, reaction time
30
Q

the vestibular subtype frequently coexisits with ____________

A

Migraine and/or Anxiety Subtype

31
Q

Treatment for vestibular subtypes

A
  1. Vestibular Rehab Therapy (VRT)
  2. Pharmacological (as needed)
    • Meclizine
    • Tricyclic antidepressants
    • Melatonin
    • SSRIs
32
Q

risk factors for anxiety/mood subtype

A

personal/family hx of anxiety, migraine, vestibular disorders

33
Q

symptoms for anxiety/mood subtype

A
  1. ruminative thoughts
  2. hyper-vigilant
  3. fastidious
  4. easily overwhelmed
  5. difficulties initiating/maintaining sleep
34
Q

exam findings for anxiety/mood subtype

A
  1. Vestibular/Ocular Screen
    • normal
  2. Neurocognitive Test Results
    • normal
35
Q

anxiety/mood subtype treatment

A
  1. treat vestibular and/or migraine subtype, if present
  2. supervised exertion therapy
  3. cognitive behavior training
  4. regulated schedule
    • sleep, exercise, diet, hydration, etc
  5. Psychotherapy
  6. Pharmacology
    • antidepressants
    • benzos
36
Q

risk factors for post-traumatic migraine subtype

A

personal or family hx of migraine, ice-cream HA, motion sensitivity, vestibular disorder, anxiety

37
Q

symptoms for post-traumatic migraine subtype

A
  1. variable HA
    • often wakes with HA
  2. nausea, photo and/or phonophobia
  3. stress, anxiety, lack of exercises
  4. sleep dysregulation
38
Q

what is a migraine?

A

a neurovascular event that is a failure of central modulation of trigeminovascular system

  • 1/3 of pts will experience preceding aura
    • visual, sensory, language, motor
  • high genetic predisposition
39
Q

exam findings for post-traumatic migraine subtype

A
  1. vestibular/ocular screen
    • normal
  2. neurocognitive test results
    • verbal and visual memory deficits
40
Q

treatment for post-traumatic migraine subtype

A
  1. medications
    • pain, sleep regulation
  2. diet
  3. stress management
  4. avoid migraine “triggers”
    • alcohol, caffeine, poor sleep
  5. NO PT
41
Q

risk factors for cervical subtype

A
  1. prior c-spine injury
  2. high-velocity injury
  3. strong rotational component to injury
42
Q

symptoms for cervical subtype

A
  1. neck pain, stiffness, soreness
  2. HA radiating forward from upper C/S
    • precipitated/aggravated by specific neck movements or sustained postures
43
Q

exam findings for cervical subtypes

A
  1. vestibular/ocular screen
    • normal
  2. Neurocognitive test results
    • normal
    • cervical screen
44
Q

treatment for cervical subtype

A
  1. obtain imaging
  2. cervical stabilization exercises
  3. medication
    • muscle relaxants, analgesics
  4. injection/nerve block
  5. massage, acupuncture
45
Q

most commonly reported symptoms in post-concussive athletes

A
  1. HA
  2. feeling slowed down
  3. difficulty concentrating
  4. dizziness
  5. fogginess
  6. fatigue
  7. visual blurring/double vision
  8. light sensitivity
  9. memory dysfunction
  10. balance problems
46
Q

sideline concussion assessments

A
  1. SCAT5
  2. Sideline Impact Test
  3. NFL Sideline Tool
  4. Standarized Assessment of Concussion (SAC)
  5. King-Devick Test
47
Q

what is the purpose of the Buffalo Concussion Treadmill Test

A
  1. to investigate exercise tolerance in pts w/post-concussive symptoms >3 weeks
  2. to help establish appropriate levels of exercise to aid in return to play/activity
  3. to aid in differentiating between possible diagnoses for concussive symptoms
  4. to ID physiological variables associated with exacerbation of symptoms and pt’s level of recovery
48
Q

stopping criteria for the Buffalo Concussion Treadmill Test

A
  1. symptom exacerbation
    • an increase of 3 or more pts on the VAS scale from resting VAS score
  2. voluntary exhaustion
    • an RPE >17 w/o sig symptom exacerbation
  3. pt demo’s rapid progression of complaints, pt appears faint, has stopped communicating, or continuing the test constitutes a sig health risk for the pt
  4. pt reaches 90% or more of age-predicted HRmax
    • with or w/o any increase in symptoms and still reporting low RPE
49
Q

BCTT Exercise prescription

A
  1. 80% of the max HR reached w/o symptom exacerbation
  2. 20 min daily w/o exceeding the time or HR constraints
  3. swimming, walking or stationary cycling → do not attempt resistance training
50
Q

describe typical recovery for concussion

A
  1. 85-90% concussions show signs of recovery in first 10-14 days
    • may be more like 21-28 days for full biophysiological process
  2. Recovery from sports-related concussion in children is ~4 weeks
  3. early ID of impairments aids in return to activity/sport w/o prolonged sequelae
51
Q

predictors of prolonged recovery for concussion

A
  1. Initial symptoms
  2. sex
  3. age
  4. loss of consciousness
  5. amnesia
  6. premorbid comorbidities
    • pysch dx, migraines, vestibular dysfunction

Neuro 2 (29 decks)

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