Seizures and Concussion Flashcards
1
Q
seizures
A
- Seizure is the result of aberrant electrical activity in the brain
- Numerous causes include metabolic, traumatic, infections, tumors, meds/drugs, congenital defects…
- Epilepsy is a disease characterized by the presence of recurrent seizures
- Everybody talks at the same time (cells)
2
Q
theories behind seizures and concussion
A
- Altered membrane permeability
- Ion distribution – if the cells were abnormally permeable to ions, you may have unusual electrical activity
- Changes in neuronal excitability/channel activity
- Neurotransmitter imbalance
3
Q
types of partial seizures
A
- Simple: no impairment of consciousness (one hemisphere)
- Complex: Consciousness impaired
4
Q
Focal (partial) seizures
A
- the concern about partial seizures is that they can become generalized seizures
- Most common type is temporal lobe
- Most common form is complex partial (involving disruption of consciousness)
- Focal seizure can “generalize” to involve entire cortex and a secondary generalized seizure (1/3)
- Usually manifest as staring for up to 120 seconds
5
Q
seizure differential
A
- Movement disorders, MHA, sleep disorders, syncopy, behavioral and psych issues can mimic
- Can be acquired condition after brain injury, thorough history required
- Work up: must include neuro consult for any concerning events/behaviors (EEG, Laboratory evaluation, Imaging)
- Seizures can be related to masses or brain malformation
6
Q
treatment of seizures
A
- AED – numerous trials have failed to show much benefit of one over others (Pretty universally effective!)
- Generally started after second unprovoked seizure – you can throw a singular seizure and never have one again
- Type of seizure and its origins are important
- Therapy usually for period of YEARS
- Most drugs impair cognition to some degree
- Surgical remedies must be evaluated if epileptic focus can be established via testing/imaging
7
Q
generalized seizures
A
- Most common in young children
- Involve both hemispheres at outset (Absence – nonconvulsive (no twitching, etc.), Atonic – “drop”, Myoclonic – jerking, Tonic-clonic – oppositional muscle group seizure activity)
8
Q
types of seizures
A
- Absence – nonconvulsive: very short episodes of conscious detachment, may occur 10s-100s per day (Complex or generatlized)
- Atonic – “drop” – loss of muscle tone leading to fall
- Myoclonic – rigidity – sustained contraction
- Tonic-clonic – “classic” seizure
9
Q
post-ictal period
A
- HALLMARK OF SEIZURE
- Brain recovery
- Variable period of suppressed consciousness and confusion
- Severe fatigue
- Pt may have focal defects
- Usually awareness and energy improves gradually
10
Q
leading causes TBI - youth
A
- Auto Accidents
- Sports Injuries
- American Academy of Neurology (2010)
- Athletes receiving injury removed and evaluated by doctor
- Certified athletic trainer at all sporting events (including practice)
11
Q
concussion
A
- Physiological, not structural injury
- Not necessarily from direct head trauma
- Multiple injuries may lead to permanent damage
- YOU ARE DOING A CAT SCAN TO SEE BLEED, NOT TO SEE CONCUSSION!!! You can’t see the concussion!
12
Q
post concussive syndrome
A
Characterized by continuation of 3 of: HA, dizziness, insomnia, irritability, fatigue, impaired memory, lowered tolerance to light and noise.
- Initial neuro exam and CT usually completely normal.
- Incidence 2-4M/yr in US; NFL 2009: 4% diagnosed, 50% reported
- HS athletes 3x more likely to suffer second
- M>W
- 50% between 15-34
13
Q
PCS
A
- HA with mixed characteristics of MHA, tension, opthalmic migraine, cluster, etc.
- CN signs: dizziness, vertigo, tinnitus, blurred vision, diplopia, photophobia
- Psych: anxiety, irritability, insomnia, depression, decreased libido, fatigue
- Cognitive: memory impaired, reduced concentration/attention, reaction time, information processing
14
Q
managment of concussion
A
- Prevention: WEAR HELMETS
- Brain metabolism is slowed for weeks after head trauma
- Any increase in brain metabolic activity puts strain on the organ
- Management: Post-concussive patients should be placed on COMPLETE rest until symptom free then advance slowly back to normal activity
15
Q
Complete brain rest
A
- Initial Treatment (No activity until asymptomatic – books on tape or soft music ok for short periods)
- Step 1 (Short periods of reading, focusing or school attendance)
- Step 2 (When full school day tolerated: Low impact activity – walking/stationary bike, increase intensity as tolerated)
- Step 3 (Aerobic activity specific to sport OK)
- Step 4 (Non-contact drills)
- Step 5 (Full contact OK in practice setting (though full contract practices are discouraged in general))
- Must tolerate each stage without symptoms to advance to next stage, if stage induces symptoms, fall back after rest to 24 hr symptom free
