Head Injuries Flashcards
what condition results in functional but not structural abnormalities of the brain leading to neuropathologic changes
concussion
most concussions resolve spontaneously within how many weeks in adults and how many weeks in children/adolescents?
2 weeks - adults
4 weeks - children/adolescents
what is the pathophysiology of injury induced vulnerability after concussion?
fuel demand - fuel delivery mismatch (brain’s need for glucose increases acutely and cerebral blood flow and oxidative metabolism are relatively reduced at the same time
why does the brain need more glucose after a concussion?
increase in extracellular K - leads to activation of ATP dependent na/K pump , which increases energy consumption
increase in what intracellular ion may contribute to regional reduction of cerebral blood flow after concussion?
calcium
between what two layers does a subdural hematoma develop?
arachnoid and the dura mater
what is the hallmark symptoms of sport related concussion?
confusion
a patient sustains head trauma followed by AMS, then a lucid interval, followed by headache, unilateral weakness. what is the most likely diagnosis?
subdural hematoma
between what two layers is an epidural hematoma found?
between skull and dura
t/f the lucid interval seen in epidural hematoma may last several hours and can lead to false reassurance and misdiagnosis
true
what is the treatment for epidural and subdural hematoma in the majority of cases?
surgical evacuation
in the setting of epidural hematoma with temporal lobe shift, what compression is responsible for dilated pupil ?
oculomotor nerve compression
in a brain herniation, compression of what spinal pathway is responsible for contralateral paresis, deep tendon hyperreflexia and Babinski sign?
corticospinal tract
what two lobes of the brain are most affected by intracerebral hemorrhage?
frontal and temporal
which cause of bleeding in the brain is often associated with aneursym, AVM, hypertension and arteriosclerosis?
SAH
which site of intracerebral hemorrhage causes ipsilateral limb ataxia without hemiparesis?
cerebellar hemorrhage
what drug class may be used after SAH to prevent vasospasm?
CCB
what is the first step in sideline evaluation for a patient with head injury during play?
ABCDE
t/f neck pain, double vision, weakness or tingling of the extremities, increasing headache, convulsions, vomiting, agitation are “red flags” if seen at time of head injury
true
the glasgow coma score evaluates what three major categories?
eye, verbal, and motor
after a head injury, there is bony cervical tenderness and restricted c-spine ROM. what are the next 3 steps?
- protect the airway
- immobilize c spine
- transport to trauma center
off field assessment following head injury should evaluate what three major domains?
- cognitive function
- mental status
- postural stability
raccoon eyes from basilar skull fracture will be in the absence of what other eye examination finding?
there will be no conjunctival injection present
what is Battle’s sign?
posauricular hematoma
what tool is used as part of the SCAT to assess balance in the setting of sports related concussion?
mBESS
which questionnaire is part of the SCAT and is used for acute recognition of sports related concussion?
SAC - sideline assessment of concussion
what component of the vestibular ocular motor screening (VOMS) is most useful for assessing oculomotor function?
near point convergence
the Berlin 5th International conference defines persistent concussion symptoms as lasting longer than how many days in adults and children, respectively?
> 2 weeks in adults
4 weeks in children
light activity after sports related concussion is appropriate starting at what time period?
24-48 hours (if the athlete has a low level of symptoms)
t/f all guidelines on concussion agree that no same day RTP for an athlete diagnosed with concussion is appropriate
true
t/f any athlete with symptoms from concussion should not be allowed full return to play
true
what are the two strongest and most consistent predictors of slow recovery after concussion?
- symptom burden
- severity acutely post-injury
what are the three time categories of post-traumatic seizure?
immediate, early and late
how do you classify early and late post-traumatic seizures?
early: < 1 week
late >1 week
after concussion / head trauma
what is the most widely described risk factor for CTE
repetitive heat impact and multiple concussions
