Concussion-trong Flashcards
What is a concussion?
defined as brain injury and is a complex pathophysiological process affecting the brain, induced by mechanical forces
What can a concussion be caused by?
direct blow to head or elsewhere with impulsive forces transmitted to the head
What does a concussion result in?
rapid-onset of short-term neurological symptoms which typically resolve spontaneously
What are risk factors for concussion?
- prior concussions
- higher in females
- trauma focused sports
- young athletes
- ADD, mood disorders, learning disorders, migraines
(blank) athletes more prone to longer recovery periods and more severe catastrophic injuries
younger
What do you do when you see a downed athlete?
check ABCs
- immobilize neck, evauate for C-spine injury or brain injury
- transfer to EF
Tools that can be used to evaluate at the sideline include,,,,?
physical examination, symptom checklist, balance tests, cognitive evaluation
What is the sideline assessment?
no same day return to play for athlete diagnosed with concussion
When should you get imaginig?
only for those whom pathology is suspected
How do you evaluate concussion?
Symptom testing
Cognitive testing
Balance testing (BESS)
Neuropsychological testing
What are the physical signs and symptoms of concussion?
Physical symptoms
- Headache
- Nausea
- Vomiting
- Balance problems
- Dizziness
- Fatigue
- Phonophobia / photophobia
- Visual problems
What are the congitive signs and symptoms of concussion?
Not “feeling right” Mental fogginess Difficulty concentrating Difficulty remembering things Confusion about recent events Answering questions slowly Repeating questions
What are some other symptoms of concussion?
Other symptoms Irritability Sadness Nervousness Emotionality Drowsiness Sleeping more or less than usual Difficulty falling asleep
How do you cognitive evaluate for a concussion?
orientation
past and immediate memory
learning
concentration
What are the orientations for eval of concussion?
Standardized assessment of concussion (SAC)
Maddock questions
What are these: Where are we? What quarter is it right now? Who scored last in the practice / game? Who did we play last game? What was the score last game?
Maddock questions
How do you check balance?
Balance Error Scoring System
-involves 3 stances
-maintain stance for 20 seconds with hands on hips and eyes closed
(points deducted for open eyes, lifting hands off hi, stumbling)
(blank) impairment after concussion may last longer than subjective symptoms
Cognitive
How do you objectively measure occult cognitive impairment?
evaluates several domains of cog, focus on memory, cog speed and reaction time -> computerize neuropsychological test
(blank) Should be used as part of comprehensive concussion management strategy and never in isolation to diagnose concussions
Neuropsychological testing
What is neuropsychological testing able to detect?
postconcussive cog deficits
by comparing to baseline done idealy prior to having concussions
T or F
For the vast majority of the time, neuroimaging not indicated
T
Only warranted if concern for intracranial pathology such as bleed, herniation, bony fracture, etc.
Can you see a concussion on CT/MRI?
no
(blank) scan measure cerebral glucose intake and regional cerebral blood flow. How?
PET/SPECT
inject radioisotope
How do you treat concussion?
Should engage in relative physical and cognitive rest
Should avoid physical/cognitive activities that increase symptoms in the early stages of concussion
In acute phase (0-10 hrs after injury) shuld avoid (blank) medications
mental status altering
After the acute phase, what can you do?
treat symptomatically
Is there any particular med for treatment of acute symptoms of concussion? What should you do?
no
- can use acetaminophen for headaches
- could have risk for bleed
- relax, ice, massage
If headaches linger past (blank) days may consider abortive medications
3-4
With concussions, sleep disturbances are common but you shouldnt use (blank)
sleep promoting meds or stimulants
(blank) disturbances also common as well, but again, medications not indicated in acute setting
Mood
What is the return to play protocol?
- Athlete should be symptom free at rest and at exertion before full participation in sports
- should have norm cognitive and balance exam
- stepwise increase in phys demand
- may take days to months before final clearance
If an athlete has symptoms at any step of the return to play protocal what should you do?
make them stop and rest until asymptomatic at which time may begin the protocal again at the previous step
Prior to clearance, athletes should be (blank)
evaluated by licensed healthcare professional
Is there a guidline for when an athlete should return to school?
no
if they have cognitive difficulties you should give them extra time in school and such
What happens if you return an athlete to play before readY, thus what are the short term sequelae of concussion?
at risk for second impact syndrome (resulting in death)
or decreased reaction time leading to prolongation or increased risk for recurrent concussion
In postconcussion syndrome-the majority of symptoms (80-90%) resolve in (blank) days. Occasionally, symptoms do last from (blank) to (blank)
7-10
weeks to years
What are the symptoms of postconcussion syndrome?
Headache, dizziness, insomnia, cognitive dysfunction, depressed mood, irritability, anxiety, fatigue, noise/light sensitivity
Is there a correlation b/w severity of concussion and likelihood of development of postconcussion symptoms?
NO!
What is the treatment of postconcussion syndrome?
time
How should you approach post-concussion syndrome?
Comprehensive neuropsychological evaluation
Cognitive therapy, neurorehabilitation programs
Supervised progressive exercise programs
What is second impact syndrome?
Diffuse cerebral swelling thought to be secondary to dysregulation of blood supply to brain, leading to increase in intracranial pressure, brain herniation, and possibly coma/death
What is the long-term sequelae of concussions?
Chronic traumatoc encephalopathy (CTE) and chronic neurocognitive impairment
What is this:
neurodegenerative disease associated with repetitive brain trauma and characterized pathologically by accumulation of tau protein in specific areas of the brain
Associated with memory impairment, depression, poor impulse control, cognitive dysfunction
Chronic Traumatic Encephalopathy
CTE is a neurodegenerative disease associated with repetitive brain trauma and characterized pathologically by accumulation of (blank) in specific areas of the brain
tau protein
How can you diagnose CTE?
Diagnosis can only be definitively made by confirmatory histopathology after death
T or F
not all athletes diagnosed with CTE have reported concussions during play. SO why CTE then?
T
Proposed effect of subconcussive blows and/or other factors, including possibly genetic predisposition
What is this:
May present with postconcussion syndrome, but may manifest years afterwards
Can be demonstrated by neuropsychological testing
Higher incidence of mild cognitive impairment and depression in former NFL players with concussion compared to those without
Chronic Neurocognitive Impairment
When is a permanent disqualification due to concussion warrented?
no really evidence based quidelines, must be evaluated and determined on a case-by-case basis
How do you prevent concussion?
No real way
DO mouth guards or helmets help prevent concussion?
No
What is secondary prevention for concussion?
may be possible with good return-to play managment
Where can you get info on concussions?
CDC
NCAA
NFL
