Concussion Flashcards

1
Q

Define concussion

A
  • mild traumatic brain injury
  • complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces
  • leads to complex cascade of ionic, metabolic, and physiologic events that may affect cerebral function for several days to weeks
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2
Q

What are some neurometabolic changes that occur with concussions

A
  • decreased blood flow
  • increase in glucose metabolism, followed by hypometabolism
  • increase in extraneuronal potassium
  • increase in intraneuronal calcium
  • increase in glutamate (excitoxicity)
  • decrease in GABA
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3
Q

Incidence of concussions in miltary and sports

A
  • military: about 12% report symptoms consisted with blast reatled mTBI
  • sports: between 1.6 and 3.8 million sports related mTBIs occur annually in the US
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4
Q

What is required for a diagnosis of concussions

A
  • does NOT need to include loss of consciousness (most do not)
  • post traumatic amnesia
  • altered mental status
  • may occur several hours after concussion
  • glasgow coma scale 13-15 < 13 = need imaging for bleed

not all needed

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5
Q

Most common signs of a concussion

A
  • cognitive and or mood changes
  • disorientation
  • blank or vacant look
  • postural control and balance impairemnts

based on symptoms

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5
Q

what are some postural control or balance impairments with concussion

A
  • lying motionless
  • slow to get up
  • balance dysfunction
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6
Q

Most common reported symptoms of concussion

A
  • headache or migraine
  • dizziness
  • nausea
  • fatigue
  • sleep distrubance
  • blurred vision
  • light sensitivity
  • tinnitus
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7
Q

imaging for concussion

A
  • usually not necessary
  • indicated if recovery is slower than expected, decline in function or other injuries expected
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8
Q

CT vs MRI

A

CT is often used acutely (quicker)
MRI is better at detecting axonal damage/small microhemorrhages

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8
Q

What are some signs that imaging may be necessary

A
  • deteriorating level of consciousness
  • repeated vomiting
  • diplopia
  • agitation
  • seizures
  • severe or worsening headache
  • glasgow coma scale < 13
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9
Q

What are some other images for. concussion

A
  • brain scope
  • EEG
  • magnetoencephalography (MEG)
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10
Q

PT concussion screening role

A
  • must screen for presence or absence of symptoms, impairments and activity limitations
  • must screen patients for signs of medical emergency or severe pathology
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11
Q

PT history and intake for concussion

A
  • PMH
  • review of mental health history
  • injury-related mechanism
  • injury-related symptoms
  • early management strategies
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12
Q

differential diagnosis: what type of information can aide with dx

A
  • must evaluate for potential signs and symptoms of an undiagnosed concussion
  • triangulation of information from patient/family/witness reports
  • patient’s PMH
  • physical observation/exam
  • use of an age-appropriate symptom scale/checklist
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13
Q

what are some concussion assessments/outcome measures

A
  • self-report: graded symptom checklist
  • objective: performance-based: BESS, SCAT-5
  • computerized neuropsycholgical assessment

BESS: balance error scoring system; SCAT-5 sports concussion assessment tool

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14
Q

assessment for concussion in military

A
  • military acute concussion evaluation - 2
  • neurobehavioral symptoms inventory
15
Q

Additional screens for PTs

A
  • mental health
  • congitive impairment
  • other potential coinciding diagnosis
  • refer for additional evaluation and services as indicated
16
Q

Types of concussion

A
  • cognitive/fatigue
  • vestibular
  • ocular
  • post-traumatic migraine
  • cervical
  • anxiety/mood
17
Q

PT examination considerations with concussion

A
  • C/S and T/S
  • dix-hallpike
  • autonomic dysfunction: orthostatic hypotension, graded exercise test
  • vestibular and oculomotor function
  • balance, including dual task performance
  • headahces, fatigue, dizziness, vertigo
  • self-efficacy/self management