Head Injuries

Question 1

Brain Injuries

Answer 1

• direct blow, sudden snapping of the head forward
• May or many not result in LOC
• may be life threatening
• assume cervical injury (if unconscious)

Question 2

History

Answer 2

• MOI
• look for impairments of any kind
• retrograde amnesia (who did we play last week?)
• antegrade amnesia (can you remember walking off the field)
• pain in your neck?
• tinnitus?

Question 3

Observation

Answer 3

• disoriented?
• blank or vacant stare?
• slurred or incoherent speech?
• normal emotional response
• CSF in the ears?

Question 4

Palpation

Answer 4

• neck and skull for point tenderness and deformity

Question 5

Special Tests used

Answer 5

• neurologic exam: cranial nerve testing, sensory and reflex testing
• eyes: PEARL, tracking, nystagmus, blurred
• Balance: romberg, balance error scoring system
• coordination: finger to nose, heel-to-toe walking

Question 6

Special Tests used

Answer 6

• neurologic exam: cranial nerve testing, sensory and reflex testing
• eyes: PEARL, tracking, nystagmus, blurred
• Balance: romberg, balance error scoring system
• coordination: finger to nose, heel-to-toe walking
• Cognitive tests: assess cognitive function and obtain objective measuress to assess pt. status and improvement

Question 7

Neuropsychological assessments

Answer 7

• Sport Concussion Assessment Tool (SCAT3)

- standardized way of assessing head injuries

Question 8

Neuropsychological assessment

Answer 8

• Standardized assessment of concussion (SAC)

- orientation, immediate memory recall, concentration, and delayed recall on and off the field

Question 9

Skull Fracture

Answer 9

• blunt trauma
• severe headache and nausea
• palpation may reveal a defect in skull
• Battle’s sign
• CSF
• immediate hospitalization and referral to neurosurgeon

Question 10

Cerebral Concussions (Mild Traumatic Brain Injury)

Answer 10

• major health concern
• direct blow, acceleration/deceleration forces producing shaking of the brain
• headache
• feeling “in a fog”
• emotional

Question 11

CTE

Answer 11

• chronic traumatic encephalopthy

Question 12

TBI sings and symptoms

Answer 12

• LOC, behavioral, cognitive impairment

- sleep disturbance/drowsiness

Question 13

Concussion Grading

Answer 13

• glasgow coma scale

- don’t “grade” them anymore

Question 14

Concussion management

Answer 14

• LOC = pt. has to be removed from play
• spine injury in LOC
• return to baseline requires approx. 3-5 days
• recurrent concussions = cumulative injuries
• determine the need for physician referral

Question 15

Management con’t

Answer 15

• dual task rehab: rehab and cognitive work

Question 16

Post-Concussion Syndrome

Answer 16

• athlete complains of a range of post-concussion problems
• can last for a few weeks or a few months
• can start right after injury or later on

Question 17

Second Impact Syndrome

Answer 17

• rapid swelling of the brain from a second head injury before symptoms of the initial head injury have resolved
• not usually a LOC, but athlete can look stunned
• within 15 seconds to several minutes of injury athlete’s condition deteriorates rapidly

Question 18

Management for Second Impact Syndrome

Answer 18

• life-threatening injury that must be addressed very quickly (within 5 minutes)
• immediate EMS activation and transport to hospital
  9-1-1

Question 19

Cerebral Contusion

Answer 19

• when head strikes a stationary object
• LOC followed by a very talkative state
• hospitalization; CT and MRI

Question 20

Malignant Brain Edema Syndrome

Answer 20

• occurs in young population
• caused by intracranial clot
• increased pressure
• rapid neurologic deterioration
• 9-1-1

Question 21

Subdural Hematoma

Answer 21

• veins bleed
• may be acute (rapidly progressing)
• chronic (due to venous bleeding)
• LOC doesn’t usually happen
• dilation of one pupil (same side as injury)
• headache, sleepiness
• 9-1-1
• CT/MRI

Question 22

Epidural Hematoma

Answer 22

• arterial bleed
• blow to the head or skull fracture
• pressure, blood accumulation and creation of hematoma occur rapidly
• LOC followed by period of lucidity
• urgent neurosurgical care

Question 23

Migrane Headaches

Answer 23

• disorder characterized by recurrent attacks of severe headache
• exact cause unknown
• visual or GI problems
• flashes of light
• throbbing pain
• prescription medications help

Question 24

Scalp Injuries

Answer 24

• blunt trauma
• bleeding is often extensive
• cut hair if necessary to expose area
• stiches