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Clin Med IV Exam II > Concussions > Flashcards

Concussions Flashcards

1
Q

Risk factors for concussions

A
  • dehydration
  • fatigue or sleep deprivation
  • malnutrition
  • concurrent illness
  • illicit drug use

lower threshold

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2
Q

Primary injury mechanism of concussions

A
  • acceleration/deceleration injury to the brain

- unrestricted head movement leads to shear, tensile and compressive forces on the brain

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3
Q

Is force alone predictive of concussion

A

only slightly

high forces from linear acceleration and rotational acceleration are associated with higher incidence of concussion

BUT low forces can produce concussions and high forces may not

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4
Q

Location of the impact can help predict what in concussions

A

signs and symptoms

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5
Q

S&S of frontal concussion

A

irritability, inappropriate tearfulness

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6
Q

S&S of parietal concussion

A

HA. nausea

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7
Q

S&S of occipital concussion

A

dizziness, disequilibrium, visual sxs

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8
Q

Which type of impact is more likely to cause LOC

A

top of the head impact

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9
Q

High risk mechanisms for concussions

A
  • double hit hockey player
  • trauma with rotational forces
  • second hit
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10
Q

Secondary injury mechanism of concussions

A
  • injury happens immediately but clinical S&S take time to appear
  • caused by neurochemical cascade
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11
Q

Metabolic alterations that cause secondary concussion injury

A
  • hyper acute ionic flux (K,Ca)
  • indiscriminate release of excitatory NT
  • acute hyperglycolysis
  • sub acute metabolic depression
  • inflammation
  • decreased cerebral blood flow
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12
Q

Halmark of secondary concussion injury

A

confusion and amnesia

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13
Q

4 categories of concussion symptoms

A

physical, cognitive, emotional, sleep

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14
Q

Physical symptoms of concussion

A
  • LOC
  • HA
  • N/V
  • balance/coordiantion problems
  • dizziness, visual problems
  • photo/phonophobia
  • neck pain
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15
Q

Cognitive symptoms of concussion

A
  • confusion/disorientation
  • blank or vacant stare
  • difficulty concentrating
  • speech problems
  • difficulty with memory
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16
Q

Emotional symptoms of concussion

A
  • irritability
  • sadness
  • emotional lability
  • nervousness
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17
Q

Sleep symptoms of concussion

A
  • drowsiness
  • sleeping too much
  • insomnia
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18
Q

Who is the SCAT5 used by? Used for who?

A

designed for use by physicians and licensed healthcare professionals for people 13 and older

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19
Q

Components of SCAT5

A
  • immediate assessment
  • athlete background
  • symptoms evaluation
  • cognitive screening
  • concentration
  • neurologic exam
  • delayed recall
  • decision
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20
Q

What is looked for/ assessed in the immediate assessment in SCAT5

A
  • red flags
  • observable signs of concussion
  • memory assessment (Maddocks questions)
  • GCS
  • cervical spine assessment
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21
Q

What questions do you ask about the athlete during SCAT5

A

diagnosed concussions?
when? recovery time?

headaches or migraines? ADD or ADHA?

medications

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22
Q

Cognitive screening during SCAT5

A
  • orientation to date, time, month, year

- immediate memory (list of words and repeat)

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23
Q

Concentration screening during SCAT5

A
  • digits backwards

- months in reverse order

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24
Q

Neurologic exam part of SCAT5

A
  • read aloud and follow instructions
  • full ROM of neck
  • look side to side
  • finger to nose
  • tandem gate
  • mBESS
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25
Q

Helmet sensors. Good? Bad?

A

not shown to be helpful in diagnosis of concussions

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26
Q

Linear acceleration >___ and rotational acceleration > ___ are associated with increased concussion risk

A

> 100G

> 5500 m/sec

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27
Q

Indications for ER evaluation of concussion

A
  • prolonged LOC
  • concern for C spine injury
  • high risk mechanism for intracranial bleed
  • exam suggesting skull fracture
  • post trauma seizure
  • deteriorating condition
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28
Q

Management of concussion in ER

A
  • history
  • neruo exam, restest q30mins
  • pain meds for HA
  • anti emetics for nausea
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29
Q

GCS is commonly used to measure what

A

severity of neurologic injury in concussion patients or mTBI

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30
Q

GCS immediately after injury? s/p injury?

A

ranges from 3-15 immediately after injury

should improve to 15 within 2 hours

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31
Q

When do you do a CT for a concussion pt

A
  • LOC
  • abnormal neuro findings
  • deteriorating condition
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32
Q

What should be done 24 to 48 hours after concussion injury

A

“brain rest”

restrictions on cognitive and physical activity

avoid loud music, prolonged screen time, activities that require concentration

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33
Q

A pt with a concussion should have physical rest until when

A

no symptoms are present

mostly after 7 days

34
Q

Management of HA associated with a concussion

A

NSAIDs or APAP

35
Q

What medications should be avoided in patients with concussions

A

meds that alter cognition

opiods, tramadol, muscle relaxants, benzos, alcohol, illicit drugs

36
Q

How long should a concussion pt be observed for?

A

6-8 hours by a responsible adult to check and make sure there is no distress

37
Q

What shouldn’t you do to a sleeping concussion patient? Why?

A

wake them up

interferes with cognitive rest

38
Q

Post concussion syndrome includes what things

A
  • HA
  • dizziness
  • neuropsychiatric symptoms
  • cognitive impairment
39
Q

Correlation of severity of concussion with PCS

A

no correlation

40
Q

Different theories behind PCS

A
  • structural
  • biochemical
  • psychogenic
41
Q

Management of PCS is geared towards what

A

major complints

42
Q

Management of HA in PCS

A
  • amitriptyline
  • dihydroergotamine and metoclopramide infusions
  • ocipital blocks
  • propranolol
  • indomethacin
43
Q

What is second impact syndrome

A

death or devastating neurological injury attributed to massive brain swelling in athletes who sustain a second head injury before full recovery of the first

44
Q

What does imPACT testing help with?

A

helps healthcare providers track recovery

helps educators make decision about academic needs after concussion

45
Q

When are imPACT tests done

A

baseline every 2 years

after a suspected concussion to assess damage or changes

46
Q

What does imPACT test measure

A
  • player symptoms
  • attention span
  • working memory
  • sustained and selective attention time
  • response variability
  • non verbal problem solving
  • reaction time
47
Q

Who should be notified that a student has a concussion

A
  • teachers
  • school counselor
  • school nurse
  • athletic trainer
  • coach
48
Q

Can students return to school after a concussion?

A

yes, but with academic alterations

  • limited course load
  • shortened class or school day
  • increased rest time
  • supplemental tutoring
  • postponement of high stakes testing
49
Q

Requirement of return to play protocol

A
  • successful return to school
  • symptom free and off meds
  • normal neuro exam
  • back to baseline balance and cognitive performance measures
50
Q

Athletes must be what before progressing to the next level

A

symptom free during and after exertion at an activity level

51
Q

How long should an athlete remain at a stage in RTP protocol?

A

no less than 24 hours

52
Q

How many days should pass before an athlete returns to full competition

A

minimum of 5 days

53
Q

What happens if a patient experiences symptoms during RTP protocol

A
  • rest until resolved

- attempt protocol again at previous level of symptom free exertion

54
Q

RTP decision is a ___

A

medical decision!

55
Q

What is chronic traumatic encephalopathy

A

perament changes in mood, behavior, cognition, somatic symptoms and in severe cases Parkinson type symptoms and dementia

56
Q

Who does chronic traumatic encephalopathy occur in

A

pts with multiple concussions sustained over the course of an athletic career

57
Q

Neuropathology of CTE

A

accumulation of abnomrla hyperphosphorylated tau in neurons and astroglia distributed around small blood vessels at the depths of cortical sulci

58
Q

CTE is a what diagnosis

A

post mortem

59
Q

What differentiates CTE from other tauopathies

A

distribution of tau protein

CTE–> superficial cortical layers

60
Q

What is the “look up line”

A

warning track in hockey, warns players to keep their heads up when going into the boards

61
Q

Take home messages about concussions

A
  • they are evolving injuries
  • no diagnostic tests
  • clinical diagnosis
62
Q

What are intracranial bleeds

A

TBIs

not concussions!

63
Q

Where does a subdural hematoma occur

A

between the dura and arachnoid membranes

64
Q

What causes a subdural

A

tearing of bridging veins that drain from the surface of the brain to the dural sinuses

65
Q

What stops venous bleeding in a subdural

A

rising in intracranial pressure or direct pressure from a clot

66
Q

Acute SDH. Subacute. Chronic.

A

Acute–> one to two days after trauma

Subacute–> 3 to 14 days after trauma

Chronic–> greater than 15 days

67
Q

Imaging for SDH? How does it appear

A

head CT

crescent shaped

MRI is more sensitive for smaller bleed

68
Q

Acute, symptomatic SDH is a what?

A

neurologic emergency

often required burr wholes or craniotomy

69
Q

Most common cause of a subdural

A

Trauma–> MVC, falls, assault

70
Q

Acute subdural presents with what

A

LOC or coma

71
Q

Presentation of chronic subdural

A

insidious onset

HA, dizziness, cognitive impairment, seizures

72
Q

Decision to operate on a pt with a SDH is based on what

A
  • GCS
  • head CT findings
  • neurologic exam
  • clinical stability
  • acuity of SDH
  • presence of comorbidities
  • age
73
Q

Where do epidural hemoatomas occur

A

in the space between the dura and the skull

74
Q

Causes of an epidural hematoma

A

most often trauma

can occur spontaneously or d/t epidural abscess, infection or cancer

75
Q

Where does the bleed come from in an EDH? Due to what?

A

meningeal arteries from a shearing and rotational forces and blows to the side of the head

76
Q

What often coexists with an EDH

A

skull fracture

77
Q

Clinical presentation of epidural hematoma

A
  • pt typically lucid–> followed by rapid deterioration
  • severe HA
  • vomiting
  • seizure
78
Q

Diagnostics for EHD

A

head CT

LP in C/I’d

79
Q

Treatment of EDH

A

neurologic emergency that requires craniotomy of burr whole evacuation

80
Q

When do you do surgery in a patient with an EDH

A
  • > 30cm or mls reguardless of GCS

- GCS <9 and pupillary abnormlaities

81
Q

Once the burr wholes are made or craniotomy is done what do you need to do next

A

give unactivated prothrombin complex concentrates to reverse coagulation

Clin Med IV Exam II (8 decks)

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