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Neuro > Post concussion > Flashcards

Post concussion Flashcards

1
Q

definition: short-term alternation of consciousness due to a trauma that caused movement of the brain inside the skull

A

concussion

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2
Q

(true/false) concussions involve metabolic changes

A

true

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3
Q

What is the regular recovery time period for concussions?

A

2-4 weeks

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4
Q

definition: A constellation of concussion symptoms that persist beyond 4 weeks

  • May involve multiple separate pathologies or “diagnoses”
  • Mood and sleep disturbances
  • Physical symptoms such as visual changes, HA, and dizziness
  • visual and cognitive difficulties
A

post concussion syndrome

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5
Q

definition: A decrease in glucose which may be neuro protective

A

metabolic cascade

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6
Q

How long does it take metabolic cascade with post concussion syndrome to normalize?

A

couple days

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7
Q

Where did the idea of multiple week rest periods originate from? Why?

A

Metabolic cascade because there is a greater risk of increased brain injury if a second concussion occurs before normalizing (second impact syndrome)

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8
Q

If dizziness, neck pain and/or headaches persist for more than 10 days, ________ rehabilitation is recommended.

A

cerebrovestibular reha

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9
Q

(true/false) If symptoms persist beyond 4 weeks in children and adolescents, active rehabilitation and collaborative care may be of benefit.

A

true

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10
Q

For children, adolescents and adults with dizziness/balance problems, either _____ rehabilitation or _______ rehab. may be of benefit.

A

vestibular or cervicovestibular rehab

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11
Q

What are on-field assessments used to detect concussion?

A

SCAT 6 (GOLD STANDARD)
Cognitive assessments
Balance and tandem walk
King Devick (reading saccades) –> a baseline is needed prior to play
oculomotor testing

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12
Q

Who developed the IMPACT test?

A

UPMC

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13
Q

What age range is IMPACT testing validated for?

A

12-59 y/o

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14
Q

A patient with a concussion should rest until symptoms resolve but not more than ___ days due to the risk of physical deconditioning and reactive depression.

–> follow step-wise approach for RTA

A

3 days

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15
Q

(true/false) School age children kept out of school 5 days vs 2 days had more post concussive symptoms and had longer time of recovery

A

true

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16
Q

Pt’s with predominant symptoms were (less/more) likely to remain symptomatic 10 days after injury if they were prescribed rest

A

more

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17
Q

Patients with physical signs such as LOC, confusion and POST traumatic amnesia, benefitted from relative rest for ____ days

A

5 days

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18
Q

___% of individuals who experience a concussion normally have no symptoms after 1 month

A

80%

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19
Q

What should you start with when evaluating a patient with a concussion/post-concussion syndrome?

A

Post concussion grading score (PCGS)

–> physical, cognitive, emotional, and sleep disturbance symptoms

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20
Q

What are questionnaires to use when considering referral to another provider?

A

DHI: Dizziness Handicap Index
BVQ: Binocular Vision Questionnaire
GAD 7: General Anxiety Disorder Assessment
PHQ 9: Patient Health Questionnaire for depression
Pittsburg Sleep Quality Index

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21
Q

What high-tech tool is the gold standard for assessment of balance in a concussion patient?

A

Neurocom smart balance master

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22
Q

Where was the Balance Error scoring system (BESS) developed? Why?

A

UNC
–> designed to be sensitive to mild static balance instability

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23
Q

When is the BESS tool most useful?

A

Most useful as Pre/post concussion or Rehab to detect large differences in ability.

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24
Q

What are contraindications for participation in exercise after a concussion?

A

SBP > 140
DBP > 90
BMI > 30

25
Q

What is a priority post-concussion when exercising?

A

Controlling post-concussive HA

26
Q

What are the criteria for return to play?

A
  • Tolerates BCTT to exhaustion without increase in symptoms and tolerates 85-90% max HR.
  • Resting HR return to normal
  • HR Recovery is WNL (2-5 minutes)
27
Q

(Males/females) are at greater risk for concussions

A

females

28
Q

For every ___ pound increase in neck strength, there is a 5% decrease in concussion risk.

A

1 pound

29
Q

____ areas of the brain play a part in vision. There are _____ intracortical connections between those areas.

A

32; 300

30
Q

Visual, Vestibular, somatosensory inputs all cross at the _______ in the mid brain.

A

superior colliculus

31
Q

What occurs if visual, vestibular, and somatosensory systems are not organized properly?

A

dizziness

32
Q

What does VOMS (Vestibular oculomotor screen) assess for?

A

binocular vision disorders

33
Q

A VOMS score above ___ indicates possible concussion and should be further evaluated.

A

2

34
Q

What symptoms are indications for a possible binocular vision disorder?

A
  • Difficulty with near work
  • Words jump on page/ can’t keep place
  • Scrolling on computer bothers patient
  • Eye strain head ache , blinking or watering eyes
  • Blurry vision or double vision (variable)
  • Anxiety with near or far tasks
  • Nausea
  • Difficulty with motion sensitivity in crowds, visually stimulating situations and driving
35
Q

What indicates a Abducens nerve (VI) palsy?

A

eye does not abduct resulting in double vision particularly during lateral gaze

36
Q

What indicates an oculomotor nerve (III) palsy?

A

eye deviated out and down

37
Q

What indicates a trochlear nerve (CN VI) palsy?

A

Up and out, vertical diplopia, head tilt

38
Q

definition: horizontal deviation of the eye(s) with cover test

A

tropia

39
Q

definition: horizontal or vertical movement with uncover test

A

large phoria

40
Q

definition: a misalignment of the two eyes when a patient is looking with both eyes uncovered.

A

tropia

41
Q

When does phoria appear?

A

only appears when binocular viewing is broken (breaking fusion).

What the eye does when it is covered

42
Q

What can affect eye alignment?

A

nerve injury
underlying strabismus or former uncompensated injury

43
Q

What test assesses for tropia?

A

cover test

44
Q

What test assesses for phoria?

A

uncover and cross cover tests

45
Q

What test is more sensitive for phorias (especially vertical phorias)?

A

Maddox Rod

46
Q

definition: Either one or both eyes do not adduct resulting in diplopia or monocular vision.

A

near-point convergence

47
Q

definition: once near point convergence achieved eyes do not return to normal position as the target gets further away. (takes more than 2 cm to recover single vision)

A

convergence spasm

48
Q

What test is recognized as the Standard for stereo depth perception testing?

A

Stereo fly test

49
Q

What was the stereo fly test designed for?

A

designed for the evaluation of both gross stereopsis and fine depth perception

–> poor near vision = test failure

50
Q

What is our most used central visual task? What test uses this?

A

Saccades –> king deverick

51
Q

You should refer a patient to another professional if they have a lack of progress with reasonable effort or symptoms that persist after at least ___.

A

1 month

52
Q

(true/false) Vertical phoria is indicative for referral

A

true

53
Q

What oculomotor deficits are beyond our scope?

A
  • abducens nerve palsy
  • oculomotor nerve palsy
  • trochlear nerve palsy
  • visual field cuts
    -persistent symptoms without progress
  • passing standardized functional tests with continuing functional deficits
  • tropias
  • phorias
  • skew deviation
  • double vision in one eye
  • resting/intermittent nystagmus
  • pupil irregularities
  • ptosis
  • acuity troubles
  • eye fatigue w/o nystagmus
54
Q

Incidence of BPPV is > ___% post-concussion

A

> 5%

55
Q

What are s/s of migraine?

A
  • PMH
  • disabling throbbing/pulsating
  • photosensitivity
  • nausea
  • increased with mild exertion
  • rebound HA after visual stimulation/exertion
56
Q

Prevalence of Migraine post concussion is HIGH – Particularly when symptoms last post ____ weeks.

A

6 weeks

57
Q

What medications are recommended for management of migraines?

A

anti seizure, beta blockers and antidepressants

58
Q

(true/false) Post concussive symptoms very similar to PTSD, GAD, MDD, and Somatization disorder

A

true

59
Q

(true/false) The presence of anxiety disorders in PCS pt’s more than 3 months after concussion was higher than PTSD and presence of life stressors

A

true

Neuro (45 decks)

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