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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
Subdural hematoma
low pressure venous bleed into the space between the arachnoid and dura mater
26
Leading cause of death due to head injury with overall mortality rate of 35-50%
Subdural hematoma
27
Subdural hematoma presentation
``` Dec level of conciousness Lucid interval followed y declined mental status HA Maybe pupil inequality Maybe motor deficits ```
28
Tx for subdural hematoma
prompt surgical evacuation
29
Epidural hematoma
High pressure arterial bleed between skull and dura mater (epidural space)
30
Epidural hematoma - usually which artery
middle or other meningial
31
Subdural hematoma caused by
brain movement within the skull
32
Epidural hematoma caused by
direct blow to the head
33
Epidural hematoma presentation
Dec level of conciousness followed by lucid interval Deteriorating mental status with eventual LOC HA Confusion Sleepy Nausea and vomit
34
Epidural hematoma - late signs
ipsilateral dilated pupil, contralateral mm weakness, coma | Lucid interval can lead to missed dx
35
Subarachnoid hemorrhage
Bleeding between the arachnoid and pa mater into the CSF
36
Traumatic SAH
Results from small tears of subarachnoid vessels
37
Spontaneous SAH
Associated with intracranial aneurysms and AV malformations, sometimes associated with HTN
38
SAH caused by
tensile or shearing forces
39
SAH presentation
``` Worst ever HA Photophobia Nausea and vomit Dizzy COnfusion Neck stiffness Focal deficits ```
40
SAH has to be differentiated with
severe migraine and meningitis
41
Intracerebral hemorrhage
Bleeding from small caliber arterioles within brain parenchyma
42
Intracerebral hemorrhage - which lobes most affected
frontal and temporal
43
Intracerebral hemorrhage - caused by
tensile or shearing forces that stretch the brain
44
Intracerebral hemorrhage presentation
``` LOC (50%) HA confusion Nausea/vomit Focal deficits Sx may develop over hrs to days ```
45
Field eval - what to do first
ABCs
46
Field eval - neck
assume neck injury until proven otherwise
47
Field eval - football
Do not remove the helmet - can hyperextend the neck when shoulder pads are in place
48
Sdeline eval - neuro exam
Orientation - time, place, date | Memory - score, opponent, last play that was run
49
Sideline eval - cog assessment
3 or 5 word recall Subtract serial 7s Months of yr backwards
50
Sideline eval - physical exam
Speech Eye motion Gait assessment Pronator drift
51
Sideline eval - need to observe for
a period of 15 to 20 minutes | Take helmet away and prevent them from going back into the game
52
Late/Delayed eval - head injuries should be reassessed within
24 hours
53
Management - the cornerstone of concussion management is
physical and cognitive rest until sx resolve and then a graded program of exertion prior to medical clearance and return to play
54
Management - tell them to limit
``` Computer use Reading (with tech) TV Video games Phones - texting Music ```
55
Return to play - step wise process
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
Treatment - after a head injury - meds
Tylenol only for HA | Aspirin and NSAIDs can inhibit platelet function and inc risk of bleeding
57
Second impact syndrome
Rapid brain swelling and herniation following a second head injury in an athlete still recovering from the initial head injury
58
Post concussive syndrome
Characterized by persistence of late concussive symptoms for an extended period of time (weeks to months)
59
Posttraumatic seizures - immediate concussive convulsions
Occurs seconds after injury | Seizures that occur within a minute of injury are said to be protective
60
Post traumatic seizures - early seizures (less than 1 week)
``` Might be partial or generalized Most involve temporal lobe Most associated with underlying pathology Require long term anti convulsants Recurrence rate 20-25% ```
61
Post traumatic seizures - late seizures (more than 1 week)
Require anti convulsive tx | Recurrence rate of 70%
62
Chronic TBI (CTBI) is AKA
Dementia pugilistica or chronic traumatic encephalopathy
63
CTBI represents
chronic and cumulative neurologic dysfunction after repetitive head trauma
64
CTBI most often observed in who
boxers
65
CTBI is characterized by
central nervous dysfunction that may include cognitive imapirment, parkinsonism, pyramidal tract defects, ataxia, bx changes
66
Prevention of concussions - equipment
No clicnical evidence supporting protective equipment to prevent a concussion (NOT helmet, mouthguard, or headband)
67
Prevention of concussions
Rule changes to reduce head injury Equipment like size of ball Education
68
Neuropsych testing can be used to test
``` cognitive function speed of info processing memory attn and concentration reaction time scanning and visual tracking ability problem solving ```
69
Advantages to NPT
Can help assess head injury Useful in monitoring recovery Can help return to play decision Can help detect concussion
70
Disadvantages NPT
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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