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Clin Med III Exam 3 > Concussion > Flashcards

Concussion Flashcards

1
Q

Definition of concussion (mild TBI)

A

A traumatically induced alteration in mental status that may or may not involve loss of consciousness; FUNCTIONAL not STRUCTURAL

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2
Q

mild TBI are functional or structural

A

funcitonal!!

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3
Q

Epidemiology of concussion

A

M>F

MVA, contact sports, accidental falls, occupational hazards

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4
Q

Mild TBI criteria

A
  • GCS >13 (15 is highest)
  • No acute cranial or intracranial pathology (no structural injury)
  • non-focal neuro exam
  • no post-traumatic seizures

carefully manage “mild” TBI patients on anticoagulants

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5
Q

GCS criteria fields

A

Eye opening
Verbal response
Motor Response

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6
Q

need increased monitoring

A

anticoag patients

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7
Q

Pathophysiology of TBI

A
  • Caused by direct contact, acceleration/deceleration or “coup contrecoup” mechanism injury
  • Trauma causes cortical contusion, axonal inflammation, neurotransmitter signal disruption.
  • ”Brainbruise”
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8
Q

Acute sx of mild TBI

A

MAY BE SUBTLE

  • +/- transient LOC
  • retrograde amnesia
  • anterograde amnesia
  • slow speech
  • confusion
  • repetitive questions
  • HA
  • dizziness
  • decreased focus/attention
  • emotional volatility
  • sleep disturbance
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9
Q

Concerning findings for TBI

A
  • deterioration over time (ICH - epidural hematoma)
  • Precipitating sx (chest pain, dyspepsia, syncope, seizure sx, suddent HA, pleuritic chest pain)
  • concerning PMG (anticoag, DM, cardiac/syncopal dz, seizures, meds, etc, elderly, young)
  • lives alone, SUD, homeless
  • hx of other TBIs
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10
Q

Dx of mild TBI

A

CLINICAL

  • Sport concussion assessment Tool 5th Edition (SCAT5)
  • Standardized Assessment of Concussion (SAC)

others are to r/o illness/complicating factors:

  • labs prior to admission
  • CT to r/o structural injury
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11
Q

Disposition for mild TBI

A
  • close monitoring for 24 hours (outpatient usually vs. inpatient)
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12
Q

Inpatient admission for mild TBI

A
  • Unstable home situation
  • No reliable caregiver
  • Significant co-morbidities or other injuries
  • GCS<15
    • CT findings
    • post-traumatic seizure
  • Intractable vomiting
  • Focal neuro findings
  • Anticoagulant use
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13
Q

Outpt tx for mild TBI

A

2-5 days rest w/ light activity

return to school/work when you can tolerate 30-45 min of focus

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14
Q

Return to sports

A

graduated return

Return to Play protocol

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15
Q

Pharm tx for mild TBI

A

APAP, ibuprofen, melatonin

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16
Q

F/u for mild TBI

A

w/ PCP w/i 7 days

regular f/u until asymptomatic for athletes, peds

17
Q

Indications for further f/u, specialty referral

A

minimal improvement after 10 days
multiple TBIs, cumulative neuropsych s/sx
Clinical deterioration

18
Q

Long term sequelae

A

increased morbidity w/ recurrent TBI
epilepsy, sleep disturbance, mood/behavior disorders

Secondary syndromes:

  • postconcussive syndrome (PCS)
  • second impact syndrome
  • Chronic traumatic encephalopathy
19
Q

PCS

A

s/sx of head injury that last longer (worst in first 7-10days)
most recover by 30-90 days
supportive tx
MRI to r/o missed injury

20
Q

Tx for PCS

A

supportive (analgesics, sleep aide, anti-depressant)

Patient education!, modified work/school

21
Q

Second impact syndrome

A

2nd concussion before recovery from 1st

leads to increase in ICP, cerebral edema

22
Q

Treatment for second impact syndrome

A

non-specific
recognize and treat ICP
Neurology, neurosurgical consult

23
Q

Prevention of second impact syndrome

A

RTP protocol

24
Q

Chronic traumatic encephalopathy

A
  • due to repeated head trauma

- poorly recognized

25
Q

s/sx of chronic traumatic encephalopathy

A 
cognitive impairment
aggression
psych disorders
SI, HI
anxiety 
depresison
Parkinsonism
ALS
Dementia
Speech and gait disorders
26
Q

Pathophys of chronic traumatic encephalopathy

A

dysregulation of tau proteins

  • tau proteins are structural CNS proteins
  • damaged, dysfunction, immunoreactive proteins = inflammation and further dysregulation of CNS
27
Q

Dx of encephalopathy

A

+ MRI findings (not sensitive or specific)

definitive dx is post-mortem

28
Q

Tx for encephalopathy

A

symptomatic and non-specific

Clin Med III Exam 3 (3 decks)

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