clin med IV > concussion > Flashcards

concussion Flashcards

(52 cards)

Study These Flashcards
1
Q

what is a sports related concussion

A
  • traumatic brain injury induced by biomechanical forces
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2
Q

what high school sports have highest rates of concussion

A
  • wrestling
  • ice hockey
  • girls soccer
  • football
  • boys basketball
  • lacrosse
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3
Q

primary injury in concussion

A
  • accel/decel injury: coup contrecoup
  • unrestricted head movement -> shear, tensile and compressive forces on brain
  • closed head injry
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4
Q

secondary injury in concussion

A
  • injury that happens immediately but clinical si/sx takes minutes or hours to manifest
  • neurochemical cascade
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5
Q

metabolic changes with concussion

A
  • hyperacute influx of K and Ca
  • release of excitatory neurotransmittors
  • acute hyperglycolysis
  • inflammation
  • decreased cerebral BF for days - weeks
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6
Q

sx associated with frontal injury

A
  • irritability

- inappropriate tearfulness

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7
Q

sx associated with parietal injury

A
  • HA

- nausea

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8
Q

sx associated with occipital injury

A
  • dizziness
  • disequilibrium
  • visual sx
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9
Q

sx assoc with injury to the top of the head

A
  • LOC
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10
Q

double hit

A
  • checked in head then hits the ice
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11
Q

second hit

A
  • previous unreported or undetected blow to head in same day/ game, or days-weeks prior
  • lowers threshold for more severe concussion
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12
Q

high risk mechanisms for concussion

A
  • double hit
  • second hit
  • trauma with rotational forces
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13
Q

lowered threshold for concussion

A
  • dehydration
  • fatigue or sleep deprivation
  • malnutrition
  • concurrent illness
  • illicit drug use
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14
Q

what are the hallmarks of concussion

A
  • confusion
  • amnesia
  • most often dont have LOC
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15
Q

when do si/sx of concussion occur

A
  • may be immediate

- may evolve over minutes/ hours

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16
Q

physical si/sx of concussoin

A
  • HA
  • N/V
  • balance problems
  • incoordination
  • dizziness
  • visual problems
  • phono/photophobia
  • numbness, tingling
  • neck pain
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17
Q

cognitive si/sx of concussion

A
  • confusion
  • disorientation
  • blank stare
  • difficulty concentrating
  • slurred, slowed speech
  • amnesia
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18
Q

emotional si/sx of concussion

A
  • irritability
  • sadness
  • emotional lability
  • nervousness
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19
Q

sleep related si/sx of concussion

A
  • drowsiness
  • sleeping too much
  • insomnia
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20
Q

assessment tools for concussion

A
  • helmet sensors- really just in research
  • SCAT-5
  • non-healthcare concussion recognition tool 5 (CRT5)
  • concussion assessment and response (CARE)
  • sideline assessment of concussion (SAC)
  • graded sx checklist
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21
Q

what is assessed on field with the SCAT5

Study These Flashcards
A
  • red flags
  • observable signs
  • memory assessment, maddock’s questions
  • glasgow coma scale
  • c spine assessment
22
Q

what is assessed off field with the SCAT5

Study These Flashcards
A
  • athlete background
  • sx eval
  • cognitive screening
  • neuro exam
  • delayed recall of list of words
  • decsions
23
Q

components of the typical neuro exam

Study These Flashcards
A
  • read and follow instructions
  • full ROM of neck pain free
  • finger to nose
  • tandem gait
  • modified balance error scoring system (mBESS)
  • CN testing
  • strength and sensation
24
Q

diagnosis of concussion

Study These Flashcards
A
  • clinical dx
  • hx of trauma
  • si/sx soon after injury
  • std assessment of sx, balance and neurocognitive function
  • exclusion of structural intracranial injuries
25
indications for ER evaluation with concussion
- prolonged LOC - possible c spine injury - risk of intracranial bleed - exam suggesting skull fx - post trauma seizure - vomiting - severe or increasing HA - increasing agitation, restlessness, combative - confusion - double vision - weakness, tingling - deteriorating condition
26
management for concussion in the ER
- neuro exam q 30 min - observe for 4 hours - can manage HA and nausea - dont usu need imaging, no abnormalities seen on imaging
27
indications for CT in concussion
- LOC - abnormal neuro findings - deteriorating condition
28
management of concussion
- prevent additional injury - never return to play same day - avoid recreational activities that cause head injury - no estab definition for brain rest - physical rest until no sx - can manage HA - adult observation 6-8 hours, no wake up
29
what is imPACT testing
- immed post concussion assessment and cognitive testing - tracks recovery - helps make decision about academic needs - baseline testing q2 years
30
return to learn
- occurs BEFORE return to play - 30-45 min of concentration on a task - limited course load - shortened classes/ school day - increased rest - supplemental tutoring - postponed testing - 504 plan
31
return to play
- sx free, off meds - normal neuro exam - graduated return - must be sx free during and after exertion at an activity lev before progressing to next level - remain at each stage for 24 hours - if sx then drop down a lev
32
post concussion syndrome
- sequelae of TBI - sx prolonged longer than usual - severity of injury doesnt correlate with PCS
33
sx of post concussion syndrome
- HA - dizziness - neuropsych sx - cognitive impairment
34
management of post concussion syndrome
- amitriptyline - infusions of dihydroergotamine and metoclopramide - occipital blocks - propranolol - indomethacin
35
second impact syndrome
- death or devastating neuro injury d/t massive brain swelling - second head injury before full recovery - 50% mortality
36
traumatic encephalopathy syndrome
- clinical syndrome assoc with CTE pathology - changes in mood, behavior, cognition, somatic sx - in severe cases: parkinson type sx and dementia
37
chronic traumatic encephalopathy (CTE)
- occurs in pts with multiple concussions | - extensive tau changes
38
where do tau proteins accumulate in CTE
- neurons and astroglia around small BV in cortical sucli
39
how is CTE dx
- post mortum | - neuropathologic dx
40
what are the types of intracranial bleeds
- subdural hematoma | - epidural hematoma
41
what causes subdural hematoma (SDH)
- forms between dura and arachnoid membranes - d/t tearing of bridging veins - rupture -> bleeding - bleeding stops d/t increased ICP or direct pressure from a clot
42
si/sx of SDH
- usu LOC or coma for acute onset | - insidious onset with chronic: HA, dizziness, cognitive impairment, seizures
43
acute SDH
- 1-2d after trauma
44
subacute SDH
- 3-14 d after trauma
45
chronic SDH
- > 15 d after trauma
46
dx of SDH
- CT - see crescent shape on imaging - MRI more sensitive for smaller bleed
47
managemetn of SDH
- acute= neuro emergency, often requires surgery - evacuation via burr hole or craniostomy - if small bleed/ stable dont need surgery
48
causes of SDH
- trauma- most common - MCV - falls - assaults
49
epidural hematoma (EDH)
- occur in space btwn dura and skull - d/t shearing and rotational forces, blows to the side of the head - usu on same side as blow - from meningeal arteries - more common in young pts
50
si/sx of EDH
- pt is usu lucid - rapid deterioration - severe HA - vomiting - seizure
51
dx of EDH
- CT imaging of choice - LP C/I - MRI for small bleeds
52
management of EDH
- neuro emergency - usu requires surgery- craniotomy or burr hole - small bleeds treated non-surgically - reversal of coag with unactivated prothrombin complex concentrates
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