Concussion Flashcards
Concussion
-graded I-III
Brain Injury Continuum
- concussion
- mild brain injury
- moderate brain injury
- severe brain injury
Grade I
- conscious but confused
- <15 min
Grade II
- Conscious but has amnesia
- >15 min
Grade III
-unconscious seconds or minutes
What happens in concussion
- coup-contrecoup
- contusions
- axonal shearing/diffuse axonal injury
Response to concussion
- microglia eat away dead tissue
- inflammation
S/Sx
- headache
- dizziness
- NV
- loss of consciousness
- difficulty concentrating
- memory loss
- change in appetite
- difficulty sleeping
- irritability
- sadness
1/3 concussions from:
-sports
other=MVA, falls
Cause of concussion in age 1-2 years
-child abuse
adolescent concussion causes (age 15-24)
realted to risk-taking behaviors (biking, sports etc)
Elderly concussion cause
-falls
Challenges with Elderly
- age-related issues
- variable baseline cognition and memory
- comorbidities
- medication (intrathecal bleeding)
Diagnosis of Concussion
- SCAT 3 (20 min)
- Maddock’s Question (8 questions)
- SAC (6 min)
- BESS (5 min, balance)
- Canadian CT Head Rule
- Sports Palm Card
- Acute Concussion Evaluation Form(ACE)
NFL Sideline Concussion Assessment Tool
- includes baseline test during pre-season
- given again at time of injury
-based on SCAT-2
Acute Concussion Evaluation
- CDC recommended form for diagnosing concussions
- emergency & physician version
Biochemical Markers of Concussion
- circulating proteasome activity in children with mild head injury
- significant increase after injury
Complications
- 2x higher risk of epilepsy w/n first 5 years
- cumulative concussions: progressive impairments
- post concussion syndrome
- Second impact syndrome
- comvulsive motor phenomenon
- chronic traumatic encephalopathy
- Chronic Traumatic Encephalomyopathy
Postconcussion Syndrome
- dizziness
- headaches
- thinking difficulties
-last up to several months
Second Impact Syndrome
- getting a 2nd concussion before 1st has reslolved
- cause rapid and fatal cerebral edema
Convulsive Motor Phenomena
-benign tonic posturing and/or convulsions immediately after concussion that resolve quickly
Chronic Traumatic Encephalopathy
- progressive neurodegenerative disease caused by total brain trauma
- diagnosed only after death with Tau protein)
Chronic Traumatic Encephalomyopathy
-motor neuron disease similar to ALS
Brain chemistry changes my not resolve for:
at least 30 days
Second Impact Syndrome can lead to:
-massive increase in intracranial pressure and brain herniation–>death
Acute Concussion Management
- emergency management
- clear with onsite HCP
- clear CS injury
- SCAT or other assessment sideline
- assess cognition, CN integrity, balance
- monitor next few hours/days
if it lasts more than 10 days
it may indicate more than a mild brain injury (more than concussion)
Best Practice
- don’t return to play same day
- physical/cognitive rest
- progress to dual-task
- return to play gradual
- pt should be asymptomatic and on no meds that may mask S/Sx
Progression of Rehab Stages
-only progress to next level if pt is asymptomatic for 2 hours
Principles of Rehab
- balance
- neurocognitive retraining
- reaction training
- avoid overloading sensory and motor systems
- maintain postural control during dual tasks
Gold Standard For Diagnosis
-none
