Concussions

Question 1

What is a concussion (mild TBI)?

Answer 1

Traumatically induced alteration in mental status that may or may not involved LOC
FUNCTIONAL not STRUCTURAL injury

Question 2

How to be considered a mild TBI

Answer 2

GCS>13
No acute cranial or intracranial pathology (no structural injury)
Non-focal neuro exam
No post traumatic seizures

Question 3

What does trauma to the head cause?

Answer 3

Cortical contusion, axonal inflammation, neurotransmitter signal disruption

Question 4

Presentation of mild TBI

Answer 4

Acute sxs may be subtle:
transient LOC, retrograde/anterograde amnesia, slow speech, confusion, repetitive questions, HA, dizzy, decreased focus and attention, emotional volatility, sleep disturbance

Question 5

What could lucid phase followed by decreased mental status mean with TBI?

Answer 5

Intracranial hemorrhage, specifically epidural hematoma

Question 6

3 times to always be conservative based on history with TBI

Answer 6

Anticoagulation
Lives alone
Hx of prior TBIs

Question 7

How should the exam be in a mild TBI

Answer 7

Improving memory and psych deficits over time (unlikely to have full recollection of events)
Nonfocal neuro exam
No sxs of basilar skull fracture or palpable cranial defect
Cleared C-spine
Head to toe exam to r/o other injury

Question 8

Diagnosis of mild TBI

Answer 8

No specific test or series of tests (only done to r/o other diseases)

Question 9

General rule for management of TBI

Answer 9

They need close monitoring for 24 hrs

Question 10

Outpatient tx for mild TBI

Answer 10

Cognitive rest (2-5 days and light activity at home)
Physical rest before returning to sports

Question 11

Pharm treatment for mild TBI

Answer 11

Symptomatic,APAO, ibuprofen, melatonin

Question 12

When to follow up with mild TBI?

Answer 12

With PCP within 7 days

Regular f/u until asymptomatic for athletes and peds

Question 13

Indications for further follow up

Answer 13

Minimal improvement after 10 days
Multiple TBIs, particularly with cumulative neuropsych sxs
Clinical deterioration

Question 14

Secondary and chronic syndromes of mild TBI

Answer 14

Postconcussive syndrome
Second impact syndrome
Chronic traumatic encephalopathy

Question 15

What is post concussive syndrome?

Answer 15

Prolonged concussion sxs over 1 week to 1 month (usually better by 90 days)
HA, dizzy, mental fog, mild cognitive impairment, neurobehavioral changes

Question 16

Tx for post concussive syndrome

Answer 16

Supportive (address sxs)
Analgesics, sleep aides, anti-depressants
Pt education

Question 17

Second impact syndrome

Answer 17

Rare but really bad: when have second concussion prior to full recovery from prior TBI
There is an uncontrolled increase in ICP, cerebral edema in context of second injury

Question 18

Tx for second impact syndrome

Answer 18

Treat increased ICP

Neuro consult

Question 19

Chronic traumatic encephalopathy

Answer 19

Sxs and patho findings seen with repeated head trauma

Hallmark: cumulative but often delayed or poorly recognized, neuropsych deficits

Question 20

Diagnosis of chronic traumatic encephalopathy

Answer 20

MRI findings but not sensitive or specific
Can suspect clinically
Only definitive post-mortem

Question 21

What is Cushing reflex?

Answer 21

Sign of increasing ICP

HTN, bradycardia, irregular breathing

Question 22

When do you see Cushing reflex?

Answer 22

Terminal phases of acute head injury (poor prognosis)