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Neurology > Concussions > Flashcards

Concussions Flashcards

1
Q

Concussions are also known as?

A

mild traumatic brain injury

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2
Q
  1. What kind of trauma are concussions due to? 3
  2. Due to what kind of pathology?
  3. How do most resolve?
  4. Full recovery in how long?
A

1.

  • direct blow,
  • countercoup, or
  • rotational/acceleration injury
  1. Due to changes in brain physiology rather than structural changes
  2. 80–90% resolve in a short period (7–10 days)
  3. Most HS athletes fully recovered in 14-21 days
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3
Q

Define the following:

  1. Coup?
  2. Countercoup?
  3. Rotational?
  4. Can it happen without trauma?
A
  1. Coup- direct blow – skull driven into brain
  2. Countercoup- brain driven into far skull
  3. Rotational-features of both
  4. yes, deceleration injury
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4
Q

What do concussions impair?
3

What will CT, MRI and EEG show?

A
  1. Glucose metabolism
  2. Cerebral blood flow
  3. Axonal Function

structural changes are rare (normal imaging)

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5
Q

Diagnosis of concussion?

5

A
  1. history,
  2. signs and symptoms,
  3. exam findings, 4. neurocognitive testing,
  4. balance testing
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6
Q

Loss of consciousness seen in only 10%

Presence of ________ more predictive of symptoms and neurocognitive deficits than loss of consciousness.

A

amnesia

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7
Q

Cognitive symptoms of concussion?

6

A
  1. Feeling ‘dinged, foggy, or dazed’ – not ‘with it’
  2. Inability to focus attention – easily distracted
  3. Cognitive slowing, confusion, amnesia
  4. Memory dysfunction: disorientation
    - —-Repeatedly asking the same question
  5. Inappropriate emotionality: sadness, irritability, anger
  6. Fatigue
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8
Q

Physical Symptoms of concussion?

8

A
  1. Double vision,
  2. seeing stars,
  3. light sensitivity
  4. Headaches,
  5. ringing in the ears,
  6. nausea
  7. Balance problems and dizziness
  8. Difficulty falling asleep or sleeping less than usual
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9
Q

Physical Signs of concussion?

8

A
  1. Vacant stare
  2. Poor coordination or unsteady gait
  3. Slow to answer questions or follow commands
  4. Poor concentration
  5. Slurred or incoherent speech
  6. Behavior or personality changes
  7. Diminished ability or reckless playing behavior
  8. Loss of consciousness or seizure
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10
Q

How should we test mental staus? 3

A
  1. Orientation
  2. Concentration
  3. Memory
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11
Q
  1. How should we test orientation? 4
  2. How should we test concentration? 2
  3. How should we test memory? 2
A
    • time,
    • place,
    • person,
    • situation
    • subtraction
    • months backwards
    • details of contest
    • recent newsworthy events
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12
Q

How should we test for gait and balance?

3

A
  1. Have patient walk away and back - look for imbalance
  2. Tandem gait: heel-toe on a straight line
  3. Romberg: feet together and close eyes positive if they lose their balance
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13
Q

Signs Demanding Emergency Action

6

A
  1. Increasing headache, nausea, vomiting
  2. Progressive impairment of consciousness
  3. Gradual rise in blood pressure
  4. Diminution of the pulse rate
  5. Blown pupil
  6. Disorientation
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14
Q

Head injury referral: Emergent?

6

A
  1. Suspicion for hematoma
  2. C-spine injury
  3. Worsening LOC
  4. Focal motor weakness
  5. Transient quadriparesis
  6. Seizure
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15
Q

Head injury referral: General?

5

A
  1. Persistent headache > 7 days
  2. Post concussion syndrome lasting > 2 wks
  3. Abnormal neuropsych testing
  4. History of multiple high grade concussions
  5. Clinical judgment
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16
Q

Concussion Can Mimic Other Disorders such as?

6

A
  1. Substance Abuse/Dependency
  2. Intermittent Explosive Disorder
  3. Suicidal Ideation/Tendencies
  4. Depression
  5. Mood Disorder
  6. Impulse Control
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17
Q

Severe Head injuries that can be associated with concussion?

5

A
  1. Focal Neurologic Deficit
  2. Increased Intracranial Pressure
  3. Skull Fracture
  4. Hematoma
  5. Spinal Cord Injury
18
Q

What are the clinical features of increased intracranial pressure?
4

A
  1. Headache,
  2. vomiting,
  3. papilledema,
  4. brain stem herniation
19
Q

Onfield evaluation?

3

A
  1. ABCs always come first
  2. Any loss of consciousness, treat as cervical spine injury
  3. Any signs of neurologic deficits, immediate transfer to ER
20
Q

Any loss of consciousness, treat as cervical spine injury. So what do we do? 2

A
  1. C-spine precautions

2. immobilization

21
Q

Sideline evaluations?

3

A
  1. Signs, symptoms
  2. Mental status
  3. Gait assessment & balance
22
Q

What are the problems with sideline evaluation?

4

A
  1. Players/coaches/parents know consequences of concussion – no play
  2. Can happen on all plays, injury may not be seen
  3. Concussions don’t only happen on big hits
  4. Dx difficult if athlete doesn’t report and changes are not noted
23
Q

Post Game Evaluation

4

A
  1. Can determine if additional testing needed- emergent or not
  2. Should include take home instructions
  3. Coordinate the care and follow-up of the injured athlete
  4. Discuss status of athlete with parents, ATs, coaching staff
24
Q

Indications for Transfer to Emergency Department

5

A
  1. Loss of consciousness
  2. Possible cervical spine injury or skull fracture
  3. High risk for intra-cranial bleed
  4. Post-traumatic seizure
  5. Acute worsening of mental status
25
Q

Treatment of Mild Concussions

5

A
  1. While symptomatic – rest, fluids, and good nutrition
  2. Physical rest – sleep is good (no training, playing, exercise)
  3. Cognitive rest (no TV, video games, texting, studying)
  4. Avoid NSAIDs first 48 hours
  5. Avoid recreational activities that have risk for head injury
26
Q

Why should we avoid NSAIDS in the first 48 hours?

A

Increases the risk of bleeding

better to take acetometaphin

27
Q

Describe the rule of 3s for concussions.

A

1 concussion: out of game/full practice for several days

2 concussions: out for the season

3 concussions: out of the sport

28
Q

Progression for Return

6

A
  1. Recurrence of symptoms at any point, drop back
  2. Aerobic exercise – light walking, biking
  3. Sport-specific activities without opponent
    - —Dribbling, shooting, throwing, kicking
  4. Non-contact drills
  5. Full-contact drills
  6. Return to Game Play
29
Q
  1. What is second impact syndrome?
  2. Occurs following what?
  3. Occurs before what?
A
  1. Second impact to the brain during the vulnerable metabolic cascade – sudden, severe swelling
  2. Occurs following a head injury/concussion
  3. Occurs prior to healing of initial injury
30
Q

Why is this second impact syndrome serious and dangerous?

2

A
  1. May be a minor/ incidental injury BUT

2. Can lead to worsening mental status and death

31
Q

Prevention of concussions?

7

A
  1. Cannot condition the brain – can strengthen the neck muscles
  2. Rule changes if there is a clear cut cause – spearing in football
  3. Protective equipment may lead to more risky behavior
  4. Promote fair play and respect and develop team awareness
  5. Teach players to play under control, how to fall, how to protect selves
  6. Helmets do decrease risk of skull fracture and intracranial hemorrhage
  7. Mouth guards decrease risk of dental and oral trauma
32
Q

ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) 8

A
  1. Computer based neurophysiologic testing
  2. Records players symptoms
  3. Scores verbal & visual memory, processing speed, reaction time
  4. Need baseline testing every two years (SD2 – freshmen, juniors)
  5. Administered by trained personnel – usually ATs
  6. Random variation of forms to inhibit learning the test
  7. Athletes can game the test
  8. Time & dollar costs are high
33
Q

SCAT2: Sport Concussion Assessment Tool 2
Standardized test to measure what?
4

A
  1. symptoms,
  2. verbal
  3. motor
  4. cognitive
34
Q

SAC: Standardized Assessment of Concussion

6

A
  1. Orientation
  2. Immediate memory
  3. Concentration
  4. Exertional maneuvers
  5. Delayed recall
  6. Neurologic screening
35
Q

Consequences of Repetitive Injury: After suffering one concussion what are they at risk for?
5

A
  1. Athletes 3 – 6 times more likely to have a second one
  2. Second impact syndrome
  3. Don’t recover as quickly or fully from another concussion
  4. Additional concussions tend to be more severe
  5. 4 – 7 times more likely to get knocked unconscious
36
Q

Consequences of Repetitive Injury: What are they more likely to recover?
4

A
  1. Post concussive syndrome
  2. Headaches and sleep disorders
  3. Depression and dementia
  4. Chronic traumatic encephalopathy
37
Q

Post Concussive Syndrome

8

A
  1. Chronic cognitive and behavioral symptoms following injury
  2. Headaches,
  3. fatigue,
  4. sleep difficulties,
  5. concentration issues,
  6. emotional problems,
  7. dizziness
  8. Beware of depression
38
Q

Treatment of post concussion syndrome?

A

physical and cognitive rest

39
Q

What is Chronic Traumatic Encephalopathy?

How can you diagnosis it? 2

A
  1. A progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury
  2. Can only be diagnosed posthumously via autopsy
  3. Characteristic streaks of a protein called tau
    found on the brain (DARK)
40
Q

What is CTE linked to?

8

A

Linked to

  1. memory loss,
  2. confusion,
  3. impaired judgment,
  4. paranoia,
  5. impulse control problems,
  6. aggression,
  7. depression
  8. progressive dementia
41
Q

What are the key provisions in Dylan Steiger’s Law? 3

A
  1. Educate coaches, athletes, parents on dangers of concussions
  2. May not play with signs, symptoms, or behaviors of a concussion
  3. Must get medical clearance before returning to play/practice
42
Q

Concussive effects are cumulative…..

A

!!!!

Neurology (18 decks)

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