Midterm Review Flashcards by Hannah Brule

Who was the first former NFL player diagnosed with chronic traumatic encephalopathy?

Mike Webster

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What does CTE stand for?

Chronic traumatic encephalopathy

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“Concussion” is derivative of two Latin terms: concutere, concussus.
What do these mean?

Shaken violently
Action of striking together

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“Concussion” is derivative of the French term “commotio cerebri”.
What does this mean?

Shaking of the brain

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“Concussion” is believed to have been coined as a term in ___

16th century Europe

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Concussion is a subdivision of a broader term: ___

traumatic brain injury

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Concussion is considered the most common type of ___

TBI (traumatic brain injury)

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According to the CDC, what is the method of injury for a concussion?

“a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth”

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According to the CDC, how does the brain moving rapidly back and forth hypothetically lead to concussion?

The brain bounces around or twists in the skull, stretching and damaging the brain cells and creating chemical changes in the brain

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Amsterdam 2022

What is a sports related concussion?

TBI caused by direct blow to the head, neck, or body resulting in an impulsive force being transmitted to the brain during sports or exercise-related activities

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Concussion initiates a ___ cascade, with possible ___, ___, and ___ affecting the brain

neurotransmitter and metabolic cascade, with possible axonal injury, blood flow change, and inflammation affecting the brain

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When do concussion symptoms and signs present?
When do they commonly resolve?

May present immediately, or evolve over minutes to hours
Commonly resolve within days, but may be prolonged

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Amsterdam 2022

What abnormalities are seen on standard structural neuroimaging studies in those with concussion?

No abnormality seen

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Standard structural neuroimaging studies in those with concussion have found no abnormalities.
Which studies are more likely to display abnormalities for those with concussion?

Functional, blood flow, or metabolic imaging studies

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SRC results in a range of clinical symptoms and signs.
Do these concussions involve loss of consciousness?

May or may not

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A single definition for concussion remains elusive.
Using broad language, what is a concussion?

Disturbances of neurological function as a result from acceleration-deceleration forces imparted to the head, neck, or elsewhere on the body

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Concussion comes with a wide array of symptoms, but what is the most common?

Headache

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True or False

The number of symptoms and their severities are correlative to the severity of the injury itself.

False

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True or False

Clinical symptoms and signs of concussion can often be explained by drugs, alcohol, medication use, other injuries, or other comorbidities.

False

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Who was the first to use the term “cerebral concussion” to distinct severe brain trauma from more subtle head injuries?
Where and when was this distinction made?

Razi
Ancient Persia c. 900 AD

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King Henry VIII was not always a crazy, cantankerous monarch.
What may have led to his change in demeanor?

2 serious head injuries from jousting:

1524 struck above the right eye, leading to regular severe headaches
1536 knocked off his horse, which fell on him, lost consciousness for 2 hours

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What is the meaning of dementia pugilistica?

Punch drunk syndrome

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Which patients experience dementia pugilistica?

Discovered in boxers in the 1920s
Occurs in people who have suffered multiple concussions

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Dementia pugilistica occurs in people who have suffered multiple concussions.
How does it commonly manifest?

Dementia, memory problems, and Parkinsonism

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Who is a popular figure that serves as an example of dementia pugilistica?

Muhammad Ali

Dr. Harrison Martland in the Journal of American Medical Association described dementia pugilistica in 1928 as displaying:

tremors, slowed movements, confusion, and speech problems

___ concussions were reported in 2012

3.8 million

How does the frequency of concussion diagnosis compare between 2002 and 2012?

Doubled in ten years

Concussions have ___ among teens between 2002 and 2012.

risen 200%

___% of all sports concussions occur in practice

33%

How much of cumulative concussions have shown to increase risk of catastrophic head injury leading to permanent neurological disability?

39%

___% of sports concussions are related to football

47%

What portion of high school athletes will sustain a concussion during the season?

1 in 5

How many sports related concussions occur annually?

4-5 million, rising in middle school ages

According to the CDC, how many Americans live with TBI related disabilities?

3.2-3.5 million

___% of diagnosed concussions do not involve loss of consciousness

90%

What is a subconcussion?

Cranial impact not resulting in known or diagnosed concussion on clinical grounds

How does subconcussion occur?

Rapid acceleration-deceleration to the body or torso when the brain is free to move, creating "slosh" phenomenon

Subconcussion has its greatest effect through ___ whereby ___ becomes deleterious

**repetitive occurrences** whereby **cumulative exposure** becomes deleterious

What are symptoms of post concussion syndrome?

Variable symptoms: headaches, dizziness, fatigue, insomnia, irritability, memory difficulties, problems with concentration

Post concussion syndrome is a complex disorder with variable symptoms. When do these symptoms present and how long might they persist?

Occur within the first 7-10 days and go away within three months, though can persist for a year or more

What is second impact syndrome?

Very rare condition in which a second concussion occurs before a first concussion has properly healed Causes rapid and severe brain swelling and often catastrophic results, including death

What is the mechanism of injury for second impact syndrome?

Even a mild concussion occurring days or weeks after an initial concussion Second impact may be minor involving only a blow to the chest or torso

What is chronic traumatic encephalopathy? What causes it?

Progressive neurodegenerative syndrome that can be caused by single, episodic, or repetitive blunt force impacts to the head

How does CTE present?

Presents after prolonged latent period of time as a composite syndrome of mood disorders and neuropsychiatric and cognitive impairment, with or without sensorimotor impairment

How is a CTE diagnosis confirmed definitively?

Direct brain tissue histochemical and immunohistochemical analyses (autopsy)

What are the four major categories of concussion symptoms?

* Cognitive * Physical * Emotional * Sleep

What is the most current biomechanical theory of concussion and brain injury?

Coup-countrecoup phenomenon

What is the coup-countrecoup phenomenon theory?

Initial injury to brain at location of force impact (coup) as well as the damage produced as the momentum of the brain causes it to slam into the opposite side of the inside of the skull (countrecoup)

The coup-countrecoup phenomenon can also be referred to as ___

slosh effect or brain slosh

The coup-countrecoup phenomenon results in direct brain injury in addition to ___

shearing and damaging of brain cells (at cellular level)

It is believed that the symptoms of concussion are largely due to ___ rather than ___

due to **transient functional disturbances of neuronal and parenchymal cells (glia)** rather than frank neuronal destruction

#True or False In concussions, brain injury is not visible to the naked eye, but diagnostic imaging will always reveal pathology.

False, imaging may not reveal any pathology

#diffuse axonal injury Different areas and layers have different properties and densities. This allows axons to ___, causing ___

**move at different speeds**, causing **shearing forces**

#diffuse axonal injury What is axonal shearing?

Shearing forces cause transverse axons to stretch, tear, and/or separate from the cell bodies

Diffuse axonal injury by shearing leads to the initiation of ___

**neurometabolic cascade** breakdown in communication between the neurons

#neurometabolic cascade Cerebral blood flow ___ after a head injury.

decreases

#neurometabolic cascade The brain uses more ___ in attempt to increase cerebral blood flow

ATP

#neurometabolic cascade The brain uses more ATP in attempt to increase cerebral blood flow. What is the purpose of trying to increase blood flow?

Increase glucose and oxygen, therefor ATP, so the brain can heal

#neurometabolic cascade In an effort to restore the neuron's normal resting membrane potential, the ___ works overtime, increasing the amount of energy (ATP) used and triggering a jump in glucose metabolism.

N-/K+ pump

#neurometabolic cascade In an effort to restore the neuron's normal resting membrane potential, the N-/K+ pump works overtime, increasing the ___ and triggering ___

increasing the **amount of energy (ATP) used** and triggering **a jump in glucose metabolism**

#neurometabolic cascade What events precede the energy crisis?

* Axonal shearing * K+ outflow * Release of neurotransmitters, EAA (glutamate) * Influx of Ca++

#neurometabolic cascade What events follow the energy crisis?

* Decreased cerebral blood flow * Mitochondrial dysfunction and apoptosis * 7-10 days symptoms return to normal * Metabolic changes last longer than symptoms appear

#immunoexcitotoxicity After a TBI, microglia become agitated and release ___, ___, and ___

pro-inflammatory cytokines, chemokines, and excitotoxins

What structures are damaged by immunoexcitotoxicity?

* Neuronal cell membranes * Dendrites * Synapses * Mitochondria * DNA

At what point after impact does immunoexcitotoxicity occur?

Less than an hour

Microglia are agitated by immunoexcitotoxicity after TBI. When will they enter a reparative phase?

Over several days

What is secreted by microglia to help shut down the inflammatory reaction of immunoexcitotoxicity after TBI?

Neurotrophic factors and anti-inflammatory cytokines

Which cells clean up debris and help repair damaged cells after immunoexcitotoxicity has occurred?

Phagocytes

How long after a mild to moderate concussion can evidence appear in a simple blood test?

Up to 7 days

If a blood test is meant to detect concussion, what is it measuring?

Specific brain proteins, mainly derived from glial cells

Blood tests may expand the window for diagnosing concussions, especially in patients who experience ___

a delayed onset of symptoms

#True or False Grading systems for classifying concussions have been mostly abandoned.

True

In which cases should an athlete with a suspected concussion call a doctor or go to the ER?

* Symptoms increase or there are new symptoms * Increase H/A * Seizure * Trouble with balance * Trouble with vision * Neck pain/numbness

Which patients tend to experience longer recovery times from concussion symptoms?

* Adolescents * Females > Males

Which school subject is most likely to cause more concussion symptoms?

Math

How does continuing activities that increase symptoms affect recovery?

Delay recovery

What are nine factors that may call for emergency management of a concussion?

* Glascow <15 * Decreased mental status * Loss of consciousness * Decreased pulse, increased respiration * Increased BP * Spinal injury or skull fracture * Increasing signs and symptoms * Vomiting * Seizures

What is being assessed by Maddock's questions?

* Memory * Orientation * Concentration

What are the five Maddock's questions?

1. Who do you play for? 2. What day is it? 3. What quarter/period is it? 4. Count 50-30 backwards 5. Repeat 5 words and remember them

Midterm Review Flashcards

Lectures 1-10 summarized