Concussion

Question 1

Concussion

Answer 1

physiological dysfunction and neuro symptoms secondary to biomechanical forces in ABSENCE of macrostructural changes; MILD end of traumatic head injury

Question 2

Post Concussion Syndrome

Answer 2

persistent symptoms for 3+ mo and usually up to 1 yr; (rarely can be chronic - several yrs)

Question 3

Chronic Traumatic Encephalopathy

Answer 3

• accumulation of tau seen pathologically (implied linkage - not causal)

Question 4

Secondary Impact Syndrome

Answer 4

• if experience a second traumatic impact while still symptomatic from concussion; can lead to inc ICP –> herniation –> death (RARE)
  
  • Highest risk if 21 or younger and w/in 28 days

Question 5

Pathophysiology of Concussion

Answer 5

• Shear or strain to axons –> problems w/ energy production and use (inc demand and dec production) –> distort membranes and ionic flux (more K+ out and Na/Ca in) –> chronic depolarization/chronic glutamate (excitatory)
  
  • “Energy crisis”

Question 6

Concussion Signs/Symptoms

Answer 6

Headache, dizziness, cognitive slowing, depression/anxiety, fatigue, drowsiness, emotional, blurry vision, dbl vision, slurred speech, sleep abnormalities, loss of consciousness (10%) and amnesia (30-50%)

Question 7

Concussion Dx (evaluation tools & differential)

Answer 7

• Evaluation
  
  • IMPACT (may have baseline test to compare to)
  • SCAT-3
  • Pay attention to vestibular and visual testing - these problems most predictive of bad prognosis
• Differential
  
  • When to image? If LOC, focal weakness, focal neuro symptoms, persistent dec level of awareness, GCS < 15, concern for spinal injury

Question 8

Concussion Management & Tx

Answer 8

• For first 24 hrs…
  
  • Rest - physical and cognitive
  • Eat frequently and hydrate
  • Maintain regular sleep schedule
  • No prolonged visual or sensory stimulation
• Symptomatic Tx
  
  • Headaches - NSAIDs PRN, triptans if already have hx migraines, anti-nausea meds
  • Dizziness - vestibular therapy (PT for balance issues - may have to use anti-dizziness drugs aka benzos if too dizzy to even do PT)
  • Visual symptoms - also vestibular therapy; OR if really bad convergence - focus on convergence and accomodation
  • Cognitive - do not use stimulants right away but if symptoms persist try modanifil, amantidine, Ritalin for about 1 month
  • SSRIs, TCAs, cognitive behavioral therapy for mood
• Relative Rest - decide what to avoid based on what activities produce symptoms; very individualized
• Graduated Exertion - make sure no symptoms at rest THEN slowly start trying activities; only continue if no symptoms; gradually work up to contact sports