Concussions

Question 1

Define Concussion

Answer 1

Temporary loss of brain function due to head injury

Question 2

Mechanisms of Injury

Answer 2

Coup
Countercoup
Rotational
Deceleration

Question 3

How to diagnose

Answer 3

History
Signs
Symptoms
Exam findings
Neurocognitive testing
Balance testing

Question 4

Cognitive Symptoms

Answer 4

Feeling "dinged/foggy"
Inability to focus attention
Cognitive slowing, confusion, amnesia
Memory dysfunction
Inappropriate emotions
Fatigue

Question 5

Physical symptoms

Answer 5

Double vision, seeing stars
Headaches, tinnitis
Dizziness, nausea
Balance problems
Sleep disturbances
Vacant stare
Poor coordination
Slow to follow commands/answer question
Poor concentration
Slurred or incoherent speech
Behavior/personality changes
Reckless playing behavior
Loss of consciousness

Question 6

Initial Evaluation- Mental status testing

Answer 6

Orientation
Concentration (subtraction from 100)
Memory (details of contest)

Question 7

Initial Evaluation- Gait Assessment

Answer 7

Have patient walk
Tandem gait
Romberg

Question 8

Signs demanding emergency action

Answer 8

Increasing headache, N/V
Progressive impairment of consciousness
Gradual rise in BP
Diminution of the pulse rate
Blown pupil
Disorientation

Question 9

Emergent Referrals

Answer 9

Suspicion for hematoma
C-spine injury
Worsening LOC
Focal motor weakness
Transient quadriparesis
Seizure

Question 10

Referral

Answer 10

Persistant headache >7 days
Post concussion syndrome >2 weeks
Abnormal neurpsych testing
Hx of multiple concussions
Clinical judgement

Question 11

Other disorders concussions can mimic

Answer 11

Substance abuse/dependency
Intermittent explosive disorder
Suicidal ideation/tendencies
Depression
Mood disorder
Impulse control

Question 12

On field evaluations

Answer 12

ABC’s
Loss of consciousness (cervical spine injury)
Signs of neurological deficits (ER transfer)

Question 13

Sideline evaluations

Answer 13

Signs, symptoms
Mental status
Gait assessment & balance

Question 14

Problems with sideline evaluations

Answer 14

Everyone wants to know consequences of concussion
Can occur on any play
Dx difficult if athlete doesn’t report

Question 15

Post game evaluation

Answer 15

Similar to sideline
Determine if additional testing needed
Take home instructions
Coordinate care and follow up of athlete
Discuss status of athlete with parents, coaching staff, AT

Question 16

Indications for transfer to emergency department

Answer 16

Loss of consciousness
Possible cervical spine injury
Possible skull fracture
High risk for intra-cranial bleeding
Post-traumatic seizure
Acute worsening of mental status

Question 17

Treatment of Mild Concussions

Answer 17

Rest, fluid, good nutrition
Physical rest
Cognitive rest (no TV, video games, texting, music)
Avoid NSAIDs
Avoid activities with risk for head injury

Question 18

Exertion protocol

Answer 18

Must pass exertion tests without symptoms
Is athlete eager to return
Consider protective equiptment
Career ending

Question 19

Rule of 3’s

Answer 19

1 concussion- out of game/practice for several days
2 concussions- out for season
3 concussions- out of the sport

Question 20

Return progression

Answer 20

Symptoms at any point, regress to previous step
Aerobic exercise
Sport specific activities without opponent
Non-contact drills
Full-contact drills
Return to game play

Question 21

Second Impact Syndrome

Answer 21

Second impact to the brain while recovering from first concussion
May be minor/incidental injury
Can lead to worsening mental status

Question 22

Prevention

Answer 22

Can't condition the brain
Rule changes if clear cut cause
Protective equipment
Promote fair play
Teach players to play under control, how to fall, protect self

Question 23

Repeated Injury

Answer 23

Post concussive syndrome
Headaches/sleep disorders
Depression or dementia
Chronic traumatic encephalopathy

Question 24

Post concussive syndrome

Answer 24

Chronic cognitive and behavioral symptoms
Headaches, fatigue, sleep difficulties, concentration issues, emotional problems, dizziness
Affect sport, academics and life
Need physical and cognitive rest
PT may be helpful
Beware of depression

Question 25

Chronic Traumatic Encephalopathy (CTE)

Answer 25

A progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury

Question 26

CTE linked to?

Answer 26

Memory loss
Confusion
Impaired judgement
Paranoia
Impulse control problems
Aggression
Depression
Progressive dementia

Question 27

Defining point on autopsy

Answer 27

Tau bodies