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Semester 5 PMNM Exam 6 > Concussion > Flashcards

Concussion Flashcards

1
Q

Concussions are a form of

A

TBI, and usually are classified as a mild TBI

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2
Q

Define concussion

A

Trauma induced alteration in mental status that may or may not involve a transient loss of consciousness

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3
Q

Concussion defined by the International Concussion Conference

A

Can be caused by a direct blow to the head, face, neck, or elsewhere on the body with an impulsive force transmitted to the head

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4
Q

Concussion is associated with what type of imaging

A

Grossly normal neuroimaging studies

Normal MRI and CT scans

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5
Q

Concussion reporting - most common reason to not report

A

did not think it was serious enough

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6
Q

Sport related concussions account for __% of ED visits for head injuries for children 8-13 yo

A

50%

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7
Q

Pathophysiology

A

cascade of neurochemical and neurometabolic alterations after injury to the brain may contribute to a concussion

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8
Q

Pathophysiology - increased levels of

A

K active ATP dependent Na/K pumps - creates a need for more glucose
Glutamate inc extracellularly

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9
Q

Pathophysiology - fuel need and fuel delivery mismatch

A

Brain needs glucose inc acutely and cerebral blood flow and oxidative metabolism are reduced
Disruption of metabolic autoregulation

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10
Q

Genetics

A

APOE and tau genes may play a role in brain injury

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11
Q

Genetics - Apo E is expressed

A

in response to neural injury and repair

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12
Q

APOE epsilon 4

A

is a risk factor for Alzheimer’s and for dementia pugilistica
More unfavorable cognitive recovery

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13
Q

APOE epsilon 3

A

promotes neurite growth and may aid in recovery

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14
Q

Risk Factors

A

Hx of previous concussion

Possible link of inc in those with learning disabilities

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15
Q

Risk factor - which football positions

A

defensive secondary
kick unit
running backs
linebackers

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16
Q

Mechanisms

A

Directly hit in head/helmet (most common)

Side/temporal area is the most common location

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17
Q

Mechanisms - most common cause in football

A

Helmet to helmet contact - getting hit in the side of a helmet by another helmet

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18
Q

Mechanisms - most common cause in soccer

A

head to head contact

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19
Q

Head down vs. Head up

A

Increased concussion in head down - Bringing head into alignment with body and allowing max force on head and neck

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20
Q

Early (min to hours) symptoms (confusion)

A 
Confusion
Vacant stare
Easily distracted
Slow to follow instructions or answer questions
Inability to focus
Disoriented 
Slurred or incoherent speech
Gross incoordination
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21
Q

Early symptoms (min to hours) Cont (memory)

A 
Memory deficits 
- keep asking same question
- can't remember events from before injury
- can't remember events after injury 
Loss of consciousness
Headache
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22
Q

Early symptoms (min to hours) Cont (Emotional)

A 
Emotional liability - outbursts of anger, cry for no reason
Dizziness, vertigo
Nausea, vomit
Seizures
Sleep disturbances
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23
Q

Late symptoms (days to weeks)

A 
Poor attn and concentration
Memory dysfunction
Irritable 
Sleep disturbances
Persistent HA
Light headed
Easily fatigued 
Vision difficulty 
Photo and Phonophobia
Anxiety, depression
Persistent cog deficits
Post concussion syndrome
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24
Q

Classification

A

Grading systems have fallen out of favor with most groups/physicians

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25
Q

Subdural hematoma

A

low pressure venous bleed into the space between the arachnoid and dura mater

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26
Q

Leading cause of death due to head injury with overall mortality rate of 35-50%

A

Subdural hematoma

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27
Q

Subdural hematoma presentation

A 
Dec level of conciousness
Lucid interval followed y declined mental status
HA
Maybe pupil inequality
Maybe motor deficits
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28
Q

Tx for subdural hematoma

A

prompt surgical evacuation

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29
Q

Epidural hematoma

A

High pressure arterial bleed between skull and dura mater (epidural space)

30
Q

Epidural hematoma - usually which artery

A

middle or other meningial

31
Q

Subdural hematoma caused by

A

brain movement within the skull

32
Q

Epidural hematoma caused by

A

direct blow to the head

33
Q

Epidural hematoma presentation

A

Dec level of conciousness followed by lucid interval
Deteriorating mental status with eventual LOC
HA
Confusion
Sleepy
Nausea and vomit

34
Q

Epidural hematoma - late signs

A

ipsilateral dilated pupil, contralateral mm weakness, coma

Lucid interval can lead to missed dx

35
Q

Subarachnoid hemorrhage

A

Bleeding between the arachnoid and pa mater into the CSF

36
Q

Traumatic SAH

A

Results from small tears of subarachnoid vessels

37
Q

Spontaneous SAH

A

Associated with intracranial aneurysms and AV malformations, sometimes associated with HTN

38
Q

SAH caused by

A

tensile or shearing forces

39
Q

SAH presentation

A 
Worst ever HA
Photophobia 
Nausea and vomit
Dizzy
COnfusion 
Neck stiffness
Focal deficits
40
Q

SAH has to be differentiated with

A

severe migraine and meningitis

41
Q

Intracerebral hemorrhage

A

Bleeding from small caliber arterioles within brain parenchyma

42
Q

Intracerebral hemorrhage - which lobes most affected

A

frontal and temporal

43
Q

Intracerebral hemorrhage - caused by

A

tensile or shearing forces that stretch the brain

44
Q

Intracerebral hemorrhage presentation

A 
LOC (50%)
HA
confusion
Nausea/vomit
Focal deficits
Sx may develop over hrs to days
45
Q

Field eval - what to do first

A

ABCs

46
Q

Field eval - neck

A

assume neck injury until proven otherwise

47
Q

Field eval - football

A

Do not remove the helmet - can hyperextend the neck when shoulder pads are in place

48
Q

Sdeline eval - neuro exam

A

Orientation - time, place, date

Memory - score, opponent, last play that was run

49
Q

Sideline eval - cog assessment

A

3 or 5 word recall
Subtract serial 7s
Months of yr backwards

50
Q

Sideline eval - physical exam

A

Speech
Eye motion
Gait assessment
Pronator drift

51
Q

Sideline eval - need to observe for

A

a period of 15 to 20 minutes

Take helmet away and prevent them from going back into the game

52
Q

Late/Delayed eval - head injuries should be reassessed within

A

24 hours

53
Q

Management - the cornerstone of concussion management is

A

physical and cognitive rest until sx resolve and then a graded program of exertion prior to medical clearance and return to play

54
Q

Management - tell them to limit

A 
Computer use
Reading (with tech)
TV
Video games
Phones - texting
Music
55
Q

Return to play - step wise process

A

1: Complete rest
2: Inc HR - intensity less than 70% (walking, stationary bike)
3: Add mvmnt (dribble, shoot - add resistance)
4: Exercise, coordination, inc cognitive load (passing drille)
5: Restore confidence and assess functional skills (full contact after medical clearance)
6: Game play

56
Q

Treatment - after a head injury - meds

A

Tylenol only for HA

Aspirin and NSAIDs can inhibit platelet function and inc risk of bleeding

57
Q

Second impact syndrome

A

Rapid brain swelling and herniation following a second head injury in an athlete still recovering from the initial head injury

58
Q

Post concussive syndrome

A

Characterized by persistence of late concussive symptoms for an extended period of time (weeks to months)

59
Q

Posttraumatic seizures - immediate concussive convulsions

A

Occurs seconds after injury

Seizures that occur within a minute of injury are said to be protective

60
Q

Post traumatic seizures - early seizures (less than 1 week)

A 
Might be partial or generalized
Most involve temporal lobe
Most associated with underlying pathology
Require long term anti convulsants 
Recurrence rate 20-25%
61
Q

Post traumatic seizures - late seizures (more than 1 week)

A

Require anti convulsive tx

Recurrence rate of 70%

62
Q

Chronic TBI (CTBI) is AKA

A

Dementia pugilistica or chronic traumatic encephalopathy

63
Q

CTBI represents

A

chronic and cumulative neurologic dysfunction after repetitive head trauma

64
Q

CTBI most often observed in who

A

boxers

65
Q

CTBI is characterized by

A

central nervous dysfunction that may include cognitive imapirment, parkinsonism, pyramidal tract defects, ataxia, bx changes

66
Q

Prevention of concussions - equipment

A

No clicnical evidence supporting protective equipment to prevent a concussion (NOT helmet, mouthguard, or headband)

67
Q

Prevention of concussions

A

Rule changes to reduce head injury
Equipment like size of ball
Education

68
Q

Neuropsych testing can be used to test

A 
cognitive function
speed of info processing
memory
attn and concentration
reaction time
scanning and visual tracking ability
problem solving
69
Q

Advantages to NPT

A

Can help assess head injury
Useful in monitoring recovery
Can help return to play decision
Can help detect concussion

70
Q

Disadvantages NPT

A

Financial
Can be too sensitive
Time and expertise to administer
Athletes intentionally score low pre season

Semester 5 PMNM Exam 6 (6 decks)

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