Concussion- SG Flashcards
- A complex pathophysiological process affecting the brain induced by traumatic biochemical forces
- Mild traumatic brain injury (mTBI)
- May not actually involve head trauma
Concussion
Concussion
- ___ onset of neurologic dysfunction that resolves spontaneously
- Can result in pathological changes producing ___ rather than ____ injury
- Result is a graded set of sxs that may or may not include ___ and does NOT involve ___ abnormalities on neuroimaging.
- Rapid
- Functional, rather than structural injury
- LOC / structural
- Annual incidence of ___ exceeds other neuro dx (parkinson, stroke, MS, alzheimer dz)
- Do most TBIs result in concussions or not?
- TBI
- 75% of TBIs each year are concussions
3 age groups most likely to sustain TBI
- Children 0-4 yrs
- Adolescents 15-19 yrs (accidents / sports)
- Adults 65+ yrs (falls)
Which age group have the HIGHEST rates of TBI-related hospitalizations/death?
Adults > 75 yrs
Which gender is at highest risk of TBI/Concussion in all age groups?
Males
TBI/Concussions are major source of disability for which group of people?
Soldiers returning from Irag/Afghanistan
Why is it difficult to obtain estimates of yearly TBIs from sports injuries?
The injured not seeking care
- 4 sports associated w/ Concussions
- Which one has internationally the highest rate?
- Football
- Ice Hockey
- Soccer
- Rugby (highest rates)
What is the word for the movement of brain on:
- Initial impact?
- Secondary impact?
- Coup
- Contre-coup
3 states of confusion associated w/ Concussion
- Dazed
- Stunned
- Answers slowly
Types of memory loss from Concussions
- Retrograde amnesia
- Anterograde amnesia
2 visual disturbances associated w/ Concussions
- Double vision
- Light sensitivity
Post-Concussive Sxs last how long?
- What are they? (6)
Days - Months
- Chronic HA
- Short term memory difficulties
- Fatigue
- Difficulty sleeping
- Personality changes (irritable/mood swings)
- Sensitivity to light / noise
Post-Concussive Syndrome persists for more than ___.
1 week
Post-Concussive Syndrome is “clustering” of what 3 difficulties?
- Physical
- Somatic
- Sleep-related
Difficulties
3 cognitive difficulties of Post-Concussive Syndrome
- Memory
- Problem solving
- Decreased concentration
When should a patient w/ Concussion be evaluated clinically?
- At time of incident
- After incident (FU)
What tool is used for assessing concussions in athletes?
Sports Concussion Assessment Tool (SCAT5)
What imaging if any is recommended for concussions?
CT
Indications for CT after Concussion
- GCS < ___ how many hours after injury?
- Suspected ________
- Sign of ___ skull fx
- ___+ episodes of vomiting
- ___ y/o or older
- Amnesia for events occuring >__ mins prior to impact
- Dangerous mechanism
- Neuro deficit
- Seizures
- Bleeding diathesis or anticoagulant use
- *****Or if return visit for reassessmen of head injury*****
- 15
- open/depressed skull fx
- Basilar
- 2+
- 65
- 30
4 signs of Basilar Skull Fx
- Racoon eyes
- Battle sign
- Hemotympanum
- CSF rhinorrhea
Tx of Concussion
- First thing is: ______
- Rest and ___ for HA
- Gradual increase to _____
- Can pt return to play that day?
- Return to play: not until ____
- # 1: removal from event / activity
- acetaminophen
- full athletic activity
- AZ law: must be evaluated before returning to sport
- all sxs are gone and no meds required
DO NOT give which 2 medications for concussions?
- NSAIDS: increase risk of bleed
- Morphine: sedates/decreases level of consciousness
3 Intracranial (CNS) Tumors
- Astrocytoma (benign usually)
- Glioblastoma
- Meningioma
CNS tumors arise from cells within CNS or from ____ cancers that have _____.
systemic / metastasized to CNS
CNS Tumors
- ___ and ____ account for 2/3 of primary adult brain tumors
- ____ is most common in children
- ____ is most common in adults w/ median age of ___ y/o
- Meningiomas & Glial Tumors
- Low-grade astrocytoma
- Glioblastoma / 64 yrs
CNS Tumors
- Slight ___ predominance in malignant tumors
- Slight ___ predominance in meningiomas
- Male
- Female
3 CNS tumors of higher prevalence in black population
- Meningioma
- Pituitary tumors
- Craniopharyngioma
What classification is used for CNS tumors?
WHO
5 most common metastatic tumors –> CNS
- lung
- breast
- renal
- melanoma
- colorectal
A mass of well differentiated, non-invading, non-metastasizing cells
benign tumor
- Capable to grow, invade, and spread
- Anaplasia: cells w/ poor differentiation, losing morphological characteristics of mature normal cells
Malignant
- Develops from epithelial cell
- Tissues that line surfaces
- Endodermal, mesodermal, & ectodermal layers
Carcinoma
- From mesenchymal origin
- Cancerous bone, cartilage, fat, muscle, vascular, hematopoietic cells
- (connective tissues)
Sarcoma
- Benign tumor of epithelial tissue w/ glandular origin
Adenoma
- _____ can be useful to decrease edema, thus decreasing symptomatic effects of tumors
Steroids:
Dexamethasone
2 main clinical manifestations of CNS tumors
1: Focal seizures (50-80%)
4 Focal Signs/Sxs of CNS tumors
- Weakness
- Sensory loss
- Aphasia
- Visual spatial dysfunction
****3 signs of Increased Intracranial Pressure (ICP) from CNS tumors***
- Headache
- Nausea/Vomiting
- Papilledema
What imaging would you order for CNS tumor?
Brain MRI with contrast
Imaging for screening for systemic malignancy
CT
- chest
- abdomen
- pelvis
CNS tumor eval
- Get an LP if ____ is suspected
leptomeningeal seeding
What imaging for “some lesions”
(imaging is equivocal and non-neoplastic etiologies are being considered)
MR spectroscopy (type of MRI)
CNS Tumor Diagnosis
- Requires ____
- Type of procedure depends on what 4 things?
- ____ is used as adjunct for tumors in delicate areas (pt is awake)
- ____ performed in OR to determine preliminary biopsy results and help surgeon decide whether or not to proceed w/ extensive resection
- tissue sample for histopathologic / molecular study
- Tumor: Type, Grade, Location, Operability
- Functional MRI
- Frozen Section
