Lecture 4: Traumatic Brain Injury Flashcards
What are the 3 essential elements of the Lystedt Law for head injuries in athletes?
1) Atheletes, parents and coaches must be educated about dangers of concussions each year
2) If young athlete is suspected to have concussion, he/she must be removed from game/practice and not be permitted to return to play
3) A licensed health care professional must clear the young athlete to return to play in subsequent days or weeks
During a TBI the pathophysiology involves rotational forces around a defined axis which damage which tracts/nuclei and result in what type of injury?
- Damage deep white matter tracts and gray matter nuclei
- Result in diffuse AXONAL injury
The diffuse axonal injury associated with TBI’s can be visualized with what imaging modality?
3-D diffusion tensor image
What type of memory deficits are a major complaint in pts with a TBI?
Involve what brain system?
- Working memory deficits
- Dopaminergic system
What are 4 major functions of the serotonin pathways of the brain?
- Mood
- Memory processing
- Sleep
- Cognition
Motor function (fine tuning), compulsion, and perservation are major functions of which neural pathway?
Dopamine pathways
Dopaminergic system is modulated by which type of fibers to the prefrontal cortex?
Dopaminergic afferents
Define the 3 components that comprise TBI assessment.
- Detailed neuro exam: to include mental status
- Gait and balance
- Cognitive function
What are 3 major cognitive deficits associated w/ TBI?
- Impaired attention
- Memory
- Decreased executive function
What is one of the most frequently reported behavioral sequelae associated w/ TBI?
Depression
What 5 tests can be used to assess gait and balance in pt with TBI?
- Romberg
- Romberg Sharpened
- Single leg standing
- Heal-Toe walking
- Normal gait
When someone has sustained a TBI (i.e., concussion) immediate CT scan should be considered under what 4 conditions?
- Prolonged LOC (>60 seconds)
- Post-concussive seizures
- Major neuro deficits, especially motor deficits
- Significant lethargy or rapidly progressive worsening of sx’s
3-D tensor image for TBI has shown some promise due to it being able to demonstrate what in these pts?
- Post-traumatic gliosis and fractional anisotropy in the periventricular white matter adjacent to both lateral ventricles
- AXONAL injuries
What is the only known effective treatment for a concussion?
REST
An athlete with concussion cannot return while symptomatic and must be asymptomatic in what 3 areas before returning?
- At rest
- With cognition
- With exertion
What are the 3 key elements that must be normal before beginning return-to-play protocol?
- Neurocognitive
- Symptoms
- PE
What are the 6 stages of return-to-play protocol following concussion?
- Cognitive and physical rest UNTIL asymptomatic
- Light aerobic exercise
- Sport-specific aerobic exercise
- Noncontact drills; light resistance training
- Full-contact training if medically cleared
- Game play
At least how much time must be spent in each of the 6 stages involved in return-to-play following concussion?
If returning from a more severe concussion or if multiple have occurred in season how long should be spent in each stage?
- 24 hours for EACH stage
- If severe/multiple consider making each stage 2-3 days
If sx’s return during any of the 6 stages of return-to-play following concussion what are the 3 options for the athlete?
- Return to previous stage
or
- Rest an additional 1-3 days
or
- Return to stage 1
Progress to the next stage of the 6 stages of return-to-play following concussion may ONLY occur when?
If asymptomatic (24 hrs/stage)
Post-concussion syndrome is the persistence of concussion-induced symptomatology for how long?
>3 months post-injury
Who is at the highest risk of 2nd impact syndrome?
- Younger athletes
- Majority occurs in those <20 yo
2nd impact syndrome is a complication associated with a second concussion during what period?
Leads to?
- During the “vulnerable period” = before complete resolution of sx’s from intial impact
- Leads to profound engorgement, massive edema, and ICP
- Results in brain herniation –> coma –> death
What are some of the “concussion modifiers” which may predict prolonged recovery?
- Severe sx’s or duration >10 days
- LOC > 1 min or amnesia
- < 18 yo
- Co-morbidities: migraine, depression ADHD, LD, sleep disorders
- Psychoactive drugs, anticoagulants
- Contact/collision sport (i.e., boxer), high sporting level
