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Neurology > Concussion Lecture > Flashcards

Concussion Lecture Flashcards

1
Q

True or false: concussions can result from blows to areas other than the head

A

True

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2
Q

Are concussions a functional disturbance, or a structural injury? What, then, are the usual imaging findings?

A

Functional disturbance (normal imaging)

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3
Q

What is the most common reason for not reporting concussions? Second most common?

A
  1. Did not think it was serious enough

2. Did not want to leave the game

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4
Q

What is the pathophysiology of concussions?

A

Increased levels of K probably activate ATP-dependent Na/K pumps, creating a need for more glucose and adding to the metabolic stress (fuel need/ fuel delivery mismatch)

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5
Q

What happens to glutamate with concussions?

A

Increases extracellularly, and may contribute to the increase K flux

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6
Q

What is the major excitatory neurotransmitter in the CNS? Inhibitory?

A

Glutamate

GABA

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7
Q

What are the metabolic disruptions that occur with concussions?

A

Brain’s need for glucose increases acutely, and cerebral blood flow and oxidative metabolism are reduced

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8
Q

What causes the regional reduction of cerebral blood flow in a concussion?

A

Increase in intracellular Ca

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9
Q

What is the role of APO-E?

A

APO-E genes encode for apolipoprotein production, which is responsible for lipid transport in the brain, maintaining neuronal structural integrity, and recovery after neurological injury

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10
Q

What is the role of APO-E epsilon 4 in the pathophysiology of concussions?

A

Risk factor for alzheimer’s–inhibits neurite growth

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11
Q

What is the most common risk factor for concussions?

A

h/o previous concussions

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12
Q

What is the most common area of the head that is hit with concussions?

A

Temporal region

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13
Q

Where do concussions come from with soccer?

A

Head to head contact–not head to ball

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14
Q

What happens to head velocity with concussed athletes?

A

Increased velocity

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15
Q

Where is the most risky area of the head to be hit in? Why?

A

Top of the head–Allows max force through the head and neck

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16
Q

Is there an association between the degree of amnesia and prognosis?

A

No

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17
Q

When are seizures particularly bad post concussion?

A

Later on–immediately after generally do not carry a bad prognosis

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18
Q

What is the role of grading systems in concussions? Why?

A

Have fallen out of favor–not useful, and recovery is very patient-dependent

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19
Q

What is in the ddx for concussion?

A

-Subdural hematoma

-

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20
Q

What are the s/sx of subdural hematomas?

A
  • Decreased LOC
  • HA
  • Pupil inequality
  • Motor deficits
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21
Q

Pupil inequality = ?

A

More serious than a concussion

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22
Q

What are the s/sx of epidural hematomas?

A
  • Decreased LOC followed b a lucid interval
  • other concussive syndromes
  • Late onset ipsilateral dilated pupil
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23
Q

What are the s/sx of subarachnoid hemorrhage?

A
  • Worst ever HA
  • Photophobia
  • n/v
  • Neck stiffness
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24
Q

What is the work up of subarachnoid hemorrhages?

A

head CT
Fundoscopic exam
LP

25
Q

Which lobes are most commonly affected with intracerebral hemorrhage?

A

Frontal lobes

26
Q

What is the mortality rate of intracerebral hemorrhages?

A

Low if pt presents conscious before intervention

27
Q

What are the immediate problems with intracerebral hemorrhages?

A
  • ABCs
  • Evaluate for C-spine
  • move if pt is conscious and without c-spine injury
28
Q

Should the helmet be removed with head injuries?

A

Hockey–yes unless goalie

Football–no

29
Q

What is the role of orientation questions (person, place, time) in checking for concussions?

A

Not as useful as memory questions

30
Q

What are the cognitive assessments immediate post concussion?

A
  • 3-5 word repetition
  • Serial 7’s
  • Months of year backward
31
Q

What are the findings of a pronator drift test with concussive pts?

A

More like romberg than actual pronator drift

32
Q

How do you prevent athletes from reentering the game?

A

Take away helmet

33
Q

What is the sideline test that can be performed for concussive pts?

A

SCAT 3

34
Q

What are the current recommendations with concussions?

A

No return to play same day, regardless of symptoms

35
Q

What is the management for concussions?

A

Physical and cognitive rest

36
Q

Why should there be physical rest post concussion?

A

Increased blood flow overloads area that is trying to heal, and irritation of the brain

37
Q

What should be avoided post concussion?

A

No fun (no music, no screens, no videogames/tv)

38
Q

What is the step-wise process to returning to play? (6)

A
  1. Rest
  2. Light aerobic exercise
  3. Sports specific
  4. Non-contact drills
  5. Full contact
  6. Game play
39
Q

How much time should take place between steps of returning to play?

A

24 hours

40
Q

What happens when HAs / s/sx occur along the continuum of return to play?

A

Drop them a level for 24 hours

41
Q

Does taking medication still count in the stepwise return to play?

A

Anything that is not at baseline is not allowable

42
Q

Concussion s/sx lasting longer than how long require further workup?

A

Weeks

43
Q

Why should waking up a post concussive patient be avoided?

A

REM sleep is healing

44
Q

Why are NSAIDs contraindicated with post-concussive s/sx?

A

Inhibit platelet function and increases bleeding risk

45
Q

What is second impact syndrome?

A

Rapid brain swelling and herniation following a second head injury in an athlete still recovering

46
Q

What is the prognosis for second impact syndrome?

A
  • 50% mortality

- If no, significant neurological symptoms

47
Q

Who gets SIS?

A

Young people d/t developing brain

48
Q

What is post concussive syndrome?

A

Concussion s/sx persist weeks later

49
Q

What are the medications that may be useful in post-concussive syndrome?

A

Anti-depressants

50
Q

What causes posttraumatic seizures?

A

Traumatic depolarizations of neurons

51
Q

Do immediate post concussive seizures usually require anti-epileptic seizures? How about ones that occur a week later?

A

No

Little before or after a Week later = need long term antiepileptic seizures

52
Q

What are the s/sx of CTE?

A

CNS dysfunction–parkinosnianism, ataxia, and behavioral changes

53
Q

What is the protein that is implicated in the pathogenesis for CTE?

A

Apolipoprotein epsilon 4

54
Q

Do helmet prevent concussions?

A

No–it is used to prevent other forms of head trauma

55
Q

Do mouthgaurds protect against concussions?

A

No–reduce dental trauma

56
Q

What is the problem with the Virginia tech study?

A

Based on hypothesis of some arbitrary velocity to cause concussions

57
Q

What is the best way to prevent concussions in sports?

A

Change rules to reduce injuries

58
Q

What is the role of neuropsych testing?

A

Tests measure a broad range of cognitive function–very expensive and not reliable

Neurology (23 decks)

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