Head Injuries

Question 1

what condition results in functional but not structural abnormalities of the brain leading to neuropathologic changes

Answer 1

concussion

Question 2

most concussions resolve spontaneously within how many weeks in adults and how many weeks in children/adolescents?

Answer 2

2 weeks - adults
4 weeks - children/adolescents

Question 3

what is the pathophysiology of injury induced vulnerability after concussion?

Answer 3

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

Question 4

why does the brain need more glucose after a concussion?

Answer 4

increase in extracellular K - leads to activation of ATP dependent na/K pump , which increases energy consumption

Question 5

increase in what intracellular ion may contribute to regional reduction of cerebral blood flow after concussion?

Answer 5

calcium

Question 6

between what two layers does a subdural hematoma develop?

Answer 6

arachnoid and the dura mater

Question 7

what is the hallmark symptoms of sport related concussion?

Answer 7

confusion

Question 8

a patient sustains head trauma followed by AMS, then a lucid interval, followed by headache, unilateral weakness. what is the most likely diagnosis?

Answer 8

subdural hematoma

Question 9

between what two layers is an epidural hematoma found?

Answer 9

between skull and dura

Question 10

t/f the lucid interval seen in epidural hematoma may last several hours and can lead to false reassurance and misdiagnosis

Answer 10

true

Question 11

what is the treatment for epidural and subdural hematoma in the majority of cases?

Answer 11

surgical evacuation

Question 12

in the setting of epidural hematoma with temporal lobe shift, what compression is responsible for dilated pupil ?

Answer 12

oculomotor nerve compression

Question 13

in a brain herniation, compression of what spinal pathway is responsible for contralateral paresis, deep tendon hyperreflexia and Babinski sign?

Answer 13

corticospinal tract

Question 14

what two lobes of the brain are most affected by intracerebral hemorrhage?

Answer 14

frontal and temporal

Question 15

which cause of bleeding in the brain is often associated with aneursym, AVM, hypertension and arteriosclerosis?

Answer 15

SAH

Question 16

which site of intracerebral hemorrhage causes ipsilateral limb ataxia without hemiparesis?

Answer 16

cerebellar hemorrhage

Question 17

what drug class may be used after SAH to prevent vasospasm?

Answer 17

CCB

Question 18

what is the first step in sideline evaluation for a patient with head injury during play?

Answer 18

ABCDE

Question 19

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

Answer 19

true

Question 20

the glasgow coma score evaluates what three major categories?

Answer 20

eye, verbal, and motor

Question 21

after a head injury, there is bony cervical tenderness and restricted c-spine ROM. what are the next 3 steps?

Answer 21

1. protect the airway
2. immobilize c spine
3. transport to trauma center

Question 22

off field assessment following head injury should evaluate what three major domains?

Answer 22

1. cognitive function
2. mental status
3. postural stability

Question 23

raccoon eyes from basilar skull fracture will be in the absence of what other eye examination finding?

Answer 23

there will be no conjunctival injection present

Question 24

what is Battle’s sign?

Answer 24

posauricular hematoma

Question 25

what tool is used as part of the SCAT to assess balance in the setting of sports related concussion?

Answer 25

mBESS

Question 26

which questionnaire is part of the SCAT and is used for acute recognition of sports related concussion?

Answer 26

SAC - sideline assessment of concussion

Question 27

what component of the vestibular ocular motor screening (VOMS) is most useful for assessing oculomotor function?

Answer 27

near point convergence

Question 28

the Berlin 5th International conference defines persistent concussion symptoms as lasting longer than how many days in adults and children, respectively?

Answer 28

> 2 weeks in adults
4 weeks in children

Question 29

light activity after sports related concussion is appropriate starting at what time period?

Answer 29

24-48 hours (if the athlete has a low level of symptoms)

Question 30

t/f all guidelines on concussion agree that no same day RTP for an athlete diagnosed with concussion is appropriate

Answer 30

true

Question 31

t/f any athlete with symptoms from concussion should not be allowed full return to play

Answer 31

true

Question 32

what are the two strongest and most consistent predictors of slow recovery after concussion?

Answer 32

1. symptom burden
2. severity acutely post-injury

Question 33

what are the three time categories of post-traumatic seizure?

Answer 33

immediate, early and late

Question 34

how do you classify early and late post-traumatic seizures?

Answer 34

early: < 1 week
late >1 week
after concussion / head trauma

Question 35

what is the most widely described risk factor for CTE

Answer 35

repetitive heat impact and multiple concussions