Concussion and mTBI Flashcards
A concussion is a ____ induced by biomechanical forces resulting in an alteration in _____ that may or may not involve _____.
Mild TBI
Mental Status
Loss of consciousness
True or False: A concussion only occurs with impact to the skull.
FALSE
Can occur as a result of impact to any part of the body
What injury occurs as a result of a concussion?
Coup or contre coup injury
What 2 things increase and what 2 things decrease relative to the neurometabolic cascade that follows a concussion?
- Increase in ion channel activity
- Increase in glucose immediately after the injury followed by a rapid decline in glucose
- Decreased ATP production secondary to mitochondrial damage
- Decrease in cerebral blood flow
Describe the physical, cognitive, emotional, and sleep symptoms that may occur following a concussion.
- Physical: Headache, nausea, dizziness, postural instability
- Cognitive: foggy, difficulty with concentration and memory, confusion, forgetfulness
- Emotional: Irritability, sadness, more emotional, anxiety
- Sleep: Drowsiness, sleep more than usual, sleep less than usual
Concussion does not require _____. This only occurs in ___% of the cases and lasts less than ____ minutes.
Loss of consciousness
10% of cases
<30 minutes
What is a good indicator of the severity of a concussion?
Posttraumatic Amnesia
____ is an imaging technique used to assess white matter integrity.
DTI
What is the typical prognosis from a concussion?
Most people recover well, typically within a few weeks
_____can occur if at least ___ symptoms of concussion persist within a month following injury and remain impaired for at least ___ months.
Post concussion syndrome
3 symptoms
3 months
What are 3 types of post concussion disorders (PCD)?
- Physiologic: impaired cerebral metabolism
- Vestibulo-ocular: impaired oculomotor and vestibular function
- Cervicogenic: dysfunction in the cervicospinal system
Describe the pathophysiology, symptoms and physical exam characteristic of physiologic PCD.
- Pathophysiology – alterations in cellular function and cerebral blood flow
- Symptoms – headache – exacerbated during physical exercise, nausea, dizziness, vomiting, fatigue, difficulties with concentration
- Physical Exam – No focal neurologic changes; elevated resting heart rate; symptoms exacerbated during exercise
List 3 interventions used to manage physiologic PCD.
- Physical and cognitive rest
- School accommodations
- Sub-symptom threshold aerobic exercise
Describe the pathophysiology, symptoms and physical exam characteristic of vestibulo-ocular PCD.
- Pathophysiology – dysfunction with the vestibular and oculomotor system
- Symptoms – dizziness, vertigo, light-headed, nausea, gait instability, blurred/double vision, difficulty tracking objects, motion sensitivity
- Physical Exam – impairments on standardized balance testing, impaired VOR, problems with horizontal and vertical saccades, convergence
Patients with ___ PCD do not show symptoms on exercise programs.
Vestibulo-ocular PCD
List 3 interventions used to manage vestibulo-ocular PCD.
- Vestibular rehabilitation
- Vision therapy
- School accommodations
Describe the pathophysiology, symptoms and physical exam characteristic of Cervicogenic PCD.
- Pathophysiology – muscle trauma and inflammation, dysfunction of cervical spine proprioception
- Symptoms – neck pain, stiffness, decreased range of motion (ROM), occipital headaches (exacerbated during head movements), postural imbalance, lightheadedness
- Physical Exam – decreased lordosis and ROM, paraspinal and sub-occipital muscle tenderness, impaired head neck position sense
Patients with ___ PCD will reach exertion on exercise without symptoms.
Cervicogenic PCD
List 3 interventions used to manage Cervicogenic PCD.
- Cervical spine manual therapy
- Head-neck proprioception re-training
- Balance and gaze stabilization exercises
_____ can occur as a result of repetitive brain trauma due ___ and ____ impacts. This is commonly seen in ____.
Chronic traumatic encephalopathy
Sub-concussive and concussive impacts
Boxers
Chronic traumatic encephalopathy is characterized by deposition of _____ . _____ are only seen in a subject of cases.
Neurofibrillary tangles
Amyloid plaques sometimes seen
List 4 gross changes that occur as a result of chronic traumatic encephalopathy.
- Decrease in brain weight
- Larger lateral and third ventricles
- Thinning of corpus callosum
- Fenestrated cavum septum pellucidum
_____ is no longer recommended for treatment post concussion. What strategy is used to treat concussion?
Cocoon therapy is NO longer recommended
ACTIVE rehabilitation is encouraged
