Concussion

Question 1

Why does the definition of a concussion use the term “impulse” instead of “impact”?

Answer 1

Because you don’t need to hit your head to have a consussion - acceleration/deceleration injuries can cause them as well

Question 2

What are the common symptoms you’ll see in concussion?

Answer 2

headache, nausea, vertigo, fogginess, difficulty reading, difficulty concentrating, mood issues, withdrawn

symptoms worse with activity and stimulation - light sound and motion

Question 3

WHat are sort of three reasons why a concussion patient can develop a depression

Answer 3

1. it can be a chemical response to the trauma
2. it can be a social reactive response to the fact that they’ve had to stop activity
3. chronic pain from headaches can also lead to a depression

Question 4

DUring what time frame after a concussion do you become more prone to a 2nd concussion> Why?

Answer 4

for the following 10 days

this is because the 1st concussion likely slowed reaction time, altered spatial awareness, and impaired concentration - these all make you more prone to a second injury

Question 5

How long does the average concussion last?

Answer 5

7-10 days

Question 6

What is the emergent condition that can occur after a concussion

Answer 6

more specifically after the SECOND concussion in a short period of time - second impact syndrome, where the injured brain swells dramatically - this is malignant intracranial hypertension

Question 7

According to MN Law, what is a coach’s responsibility in concussion?

Answer 7

Groups that have sports for which people have to pay a fee to play must require their coaches to take an online training on concussion every 3 years

plus, if the player signs a consent form to play, there must be information on concussion risk and the rules for when they get a concussion

Question 8

You are supposed to remove a player from play with both a SUSPECTED and confirmed concussion. When can they return to play?

Answer 8

It varies…

return to play after no symptoms, clearance by a healthcare provider - clearance in writing!

Question 9

What are the goals in standardized testing for concussion?

Answer 9

1. to get a baseline function
2. to objectify a deficit in concussion
3. to gauge improvement after concussion

Question 10

What are two options for side line testing of concussions?

Answer 10

the SCAT 2 is long and hard to administer

the King-Devick involves a test of visual tracking with voluntary and involuntary pathways from frontal, parietal, occipital, limbic and brainstem structures

Question 11

Why do you frequently see “improvement” post concussionon ImPACT testing?

Answer 11

people sandbag the baseline test

Question 12

The average high school football player receives ___ 20 g hits per season.

Answer 12

900

Question 13

A study showing steady memory decline in hockey players over the course of the season without frank diagnosis of concussion brought about what controverial idea?

Answer 13

that there may be such a thing as a “silent concussion”

Question 14

It takes __x as long to recover from a 2nd concussion than it did form the 1st.

Answer 14

2x -found by spect MRI

Question 15

Who seems to get concussions worse, girls or boys?

Answer 15

girls - may be that the girls are just more honest, or it may be that they have more ligament laxity causing grater force to the brain durin injury

Question 16

Brain atrophy will start in boxers after how man fights? In what are of the brain first?

Answer 16

after only 15 fights - in the thalamus first

Question 17

What are the 4 sort of physiological reactions to concussion?

Answer 17

1. you have increased energy demand and increased glucos utilization in the injured area = perfusion mismatch
2. disruption of ion channel function
3. calcium influx
4. dynamic fluid changes in the white matter
5. changes in the network connectivity

Question 18

CTE exhibits tauopathy. Where does tau usually live?

Answer 18

it’s usually in the microtubules of axons. when the axons are injured, it can leak out and trigger the brain to lay down amyloid and start an immune response

Question 19

Where does tau protein deposition usually occur in the brain from CTE?

Answer 19

perivascular, in the amygdala, thalamus and sulcal depths

different from AD because that’s usually closer to the cortex surface

Question 20

What happens to the BBB in concussion?

Answer 20

it seems to get disrupted somehow - an antibody that blocks the inflammatory changes decreases TBI symptoms

Question 21

When do you typically give someone the diagnosis of a post concussive syndrome?

Answer 21

when the patient has persistent symptoms beyond 1 month

Question 22

what might the symptoms of post concussive syndrome actually be?

Answer 22

it could just be a chronic headache disorder that was triggered by the initial concussion

Question 23

What are Dr. Kanoff’s two basic criteria for advising retirement from sport?

Answer 23

• 4 concussion in 4 years with each lasting 7 days

- 3 or more concussive events with progressive increasing deficits by both duration and severity