Concussions Flashcards
What is a concussion (mild TBI)?
Traumatically induced alteration in mental status that may or may not involved LOC
FUNCTIONAL not STRUCTURAL injury
How to be considered a mild TBI
GCS>13
No acute cranial or intracranial pathology (no structural injury)
Non-focal neuro exam
No post traumatic seizures
What does trauma to the head cause?
Cortical contusion, axonal inflammation, neurotransmitter signal disruption
Presentation of mild TBI
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
What could lucid phase followed by decreased mental status mean with TBI?
Intracranial hemorrhage, specifically epidural hematoma
3 times to always be conservative based on history with TBI
Anticoagulation
Lives alone
Hx of prior TBIs
How should the exam be in a mild TBI
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
Diagnosis of mild TBI
No specific test or series of tests (only done to r/o other diseases)
General rule for management of TBI
They need close monitoring for 24 hrs
Outpatient tx for mild TBI
Cognitive rest (2-5 days and light activity at home) Physical rest before returning to sports
Pharm treatment for mild TBI
Symptomatic,APAO, ibuprofen, melatonin
When to follow up with mild TBI?
With PCP within 7 days
Regular f/u until asymptomatic for athletes and peds
Indications for further follow up
Minimal improvement after 10 days
Multiple TBIs, particularly with cumulative neuropsych sxs
Clinical deterioration
Secondary and chronic syndromes of mild TBI
Postconcussive syndrome
Second impact syndrome
Chronic traumatic encephalopathy
What is post concussive syndrome?
Prolonged concussion sxs over 1 week to 1 month (usually better by 90 days)
HA, dizzy, mental fog, mild cognitive impairment, neurobehavioral changes
Tx for post concussive syndrome
Supportive (address sxs)
Analgesics, sleep aides, anti-depressants
Pt education
Second impact syndrome
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
Tx for second impact syndrome
Treat increased ICP
Neuro consult
Chronic traumatic encephalopathy
Sxs and patho findings seen with repeated head trauma
Hallmark: cumulative but often delayed or poorly recognized, neuropsych deficits
Diagnosis of chronic traumatic encephalopathy
MRI findings but not sensitive or specific
Can suspect clinically
Only definitive post-mortem
What is Cushing reflex?
Sign of increasing ICP
HTN, bradycardia, irregular breathing
When do you see Cushing reflex?
Terminal phases of acute head injury (poor prognosis)
