Concussion/Brain injury Lecture Flashcards
What is the max score on the Glasgow Coma scale?
Minimum score?
Max= 15 pts
Min= 3 pts
A 15 point scale used to rate mental status and function
Used to rate severity of brain injury and to predict outcome
Glasgow Coma Scale
A score of under 9 on the Glasgow Coma Scale (GCS) indicates what severity of TBI?
Severe!
A score of 9-12 on the GCS indicates what severity of TBI?
Moderate
A score of 13-15 on the GCS indicates a TBI of what severity?
Mild
What 3 things are the Glasgow coma based on?
- Eye opening
- Verbal response
- Motor response
When should you do the Glasgow Coma Scale?
Do right at triage for a potential trauma pt
continuously repeat during evaluation
*** A DECEASE IN SCORE IS A VERY BAD SIGN
How many possible points are each section of the GCS worth?
(eye opening, verbal response, motor response)
Eye opening: 4 possible points
Verbal response: 5 possible points
Motor response: 6 possible points
How many points do the following findings receive?
A. Eyes open to speech
B. Eyes open spontaneously
C. Eye open to pain
D. Eyes do not open
Eyes open spontaneously= 4 points
Eyes open to speech= 3 points
Eyes open to pain= 2 points
Eyes do not open= 1 point
How many points do the following findings receive?
A. Incomprehensible sounds
B. Oriented, coherent and appropriate speech
C. No verbal response
D. Confused words..coherent but disoriented
E. Inappropriate words
Oriented, coherent and appropriate speech… 5 points
Confused, coherent but disoriented speech…4 points
Inappropriate words… 3 points
Incomprehensible sounds… 2 points
No verbal response…1 point
How many points do the following findings receive?
A. Can localize pain
B. Flexion/withdrawal from pain
C. Obeys commands
D. Abnormal flexion (decorticate)
D. Extension to pain (decerebrate)
E. No motor response
Obeys commands… 6 points
Can localize pain… 5 points
Flexion/withdrawl from pain… 4 points
Decorticate.. 3 points
Decerebrate.. 2 points
No motor response… 1 point
Abnormal flexion seen with brain injury
Decorticate
(flexion, towards the core)
Extension posturing seen with brain injury
Decerebrate
3 types of tissue deformation that can occur in primary injury?
- compresion
- tensile (stretching)
- shear (distortion when tissue slides over tissue)
Do you always get brain injuries with skull fractures, lacerations and hematomas?
NO..but must be suspicious of and must R/O!
Battle’s sign
Raccoon Eyes
CSH rhinorrhea or otorrhea
Hemotympanum
signs of?
Basilar skull fracture
Blood pooling behind ear
Battle’s sign
Pt with a mild TBI and any of the following…..
*GCS under 15, 2 hours after injury
*suspected skull fx
*any signs of basilar skull fx
*2+ episode of vomitting
*65+ yo
*amnesia before impact of 30+ mins
*dangerous MOI
what should you do?
Get a non contrast CT scan!
Complex pathophysiological process affecting brain
Induced by traumatic biomechanical forces
*may be caused by direct blow to head, face, neck or elsewhere with an impulsive force transmitted to the head
may or may not have LOC
rapid onset of short lived impairments that resolve spontaneously
Concussion
Vacant stare
Delayed verbal expression
Inability to focus
Disorientation
Slurred/incoherent speech
Gross observable incoordination
Inappropriate emotions
Memory deficits
Any LOC
Signs of concussion
*may evolve over mins to hours
Diffuse cerebral swelling that can increase ICP
rare but fatal!
*must be careful athletes do not return to play too quickly!
Second impact syndrome
Which concussion grade…
*LOC for less than 1 minute
OR
*post traumatic amnesia or other symptoms for 30+ mins, but less than 24 hours
Grade 2
athletes can return to play in 2 weeks asymp at rest and on exertion for 7 days
What concussion grade…
No LOC
Post traumatic amnesia or other signs lasting less than 30 mins
Grade 1
athlete may return to play if asymptomatic for 1 week
What concussion grade…
*LOC for greater than 1 minute
OR
*Post traumatic amnesia or other symptoms last for 24+ hours
Grade 3
athletes can return in 1 month if asymptomatic at rest and on exertion for 7 days
When can athletes return to play for grade 1, 2, and 3 concussions?
Grade 1: return to play if asymptomatic for 1 week
Grade 2: return to play in 2 weeks asymp at rest and on exertion for 7 days
Grade 3: return to play in 1 month asymp at rest and on exertion for 7 days
What is the difference bteween early post traumatic seizures and post traumatic epilepsy?
Early post traumatic seizures: within first week after injury
Post traumatic epilepsy: within 5 years of a traumatic event
(50% in first year, 80% in first two years)
(25% occur within first hour, 50% within first 24 hours)
Vertigo
Anosmia or hyposmia (no or decreased ability to smell)
Diplopia
Trigeminal/occipital neuralgia
Potential post-traumatic complications
Can occur even after mild TBIs (30-80% of time)
Occurs days to weeks after initial concussion
sxs: HA, dizziness, vertigo, memory problems, difficulty concentrating, sleep problems, restlessness, irritability, apathy, depression or anxiety
*can last for weeks
*more common in those with pre-existing psych disorders
Post-concussion syndrome
Dementia pugilistica
Chronic traumatic encephalopathy
Cerebral atrophy
Plaques, neurofibrillary tangles, tau proteins (similar to Alzheimer’s)
Cognitive defects from repeated TBIs
LOC, amnesia, confusion lasting seconds to minutes after a blunt trauma to head
Concussion
HA unlike anything before
LOC
Will often wake up with confusion and irritability
Subarachnoid hemorrhage (SAH)
- *Decreased** glucose
- *Increased** protein, and increased opening pressure
Bacterial meningitis
