Concussion

Question 1

WHat is the pathophysiology of Concussion?

Answer 1

Increased levels of K+ => Na/K pump activated => Inc glucose demand
EC Glutamate inc => K+
Inc IC Ca++=> Dec Cere BF

Question 2

What is the role of ApoE in Concussion?

Answer 2

ApoE increased in response to injury
Assoc with worse outcomes
ApoE 4 =Alz
ApoE 3 = Recovery

Question 3

What type of head injury poses the greatest risk for concussion?

Answer 3

Unforseen impact such as in football/hockey/rugby

Top of head impacts (head down)

Question 4

What are the early symptoms of Concussion?

Answer 4

Confusion
Gross incoordination
Memory Deficits
Loss of Conciousness
Headache
Emotional Lability
Dizziness/vertigo
N/V, Seizures
Sleep Disturbances

Question 5

What are the late symptoms of Concussion?

Answer 5

Days to Weeks: Dec Attention and Conc, memory, irritabilty, sleep dist, headache, light headed, fatigue

Question 6

What is inclused in the DDx in Concussion?

Answer 6

Subdural Hematoma: Dec LOC, dec ms, LOC
Epidural Hematoma: Dec LOC, lucid, MSCh
Subarachnoid Hemorrhage
Intracerebral Hemorr

Question 7

What are the components of Sideline Eval?

Answer 7

Neuro: Orientation, Memory, Cog Assessment: count dn

Physical Exam: eyes, gait, pronator drift

Question 8

How is Concussion managed?

Answer 8

PHYSICAL and COGNITIVE rest until symptoms resolve => Graded program of exertion prior to medical clearance

Question 9

What are the objectives of the Return to play process by step?

Answer 9

1) Rest
2) Inc HR
3) Add Movement
4) Exercise, coordination, inc cog load
5) Restore Confidence and assess funct skills
6) Game Play