Sport Concussion Flashcards
Concussion
- aka
- what?
- time to resolution
aka= mild traumatic brain injury
what: direct blow(coup), countercoup, or rotational/acceleration injury, whip lash (MVA deceleration injury); changes in brain physiology rather than structural changes.
Resolution: usually takes 7-10days
Concussion pathophysiology
neuronal depolarization leading to release of excitatory NT; K+ efflux and Ca2+ influx.
Impairment of glucose metabolism, cerebral blood flow, and axonal function.
Concussion Dx
- Hx, Signs and Symptoms, exam findings, neurocognitive testing, balance testing
- imaging is usually normal so its not required
The presence of ____ is more predicitive of sx and neurocognitive deficits than ____.
presence of amnesia is more predictive of sx and neurocognitive deficits than LOC
Concussion signs and sx
sx:
- HA, confusion, foggy, may or may not involve LOC/amnesia, dizziness, tinnitus, inability to focus, memory dysfunction, inappropriate emotionality , double vision, nausea, difficulty falling asleep.
-vacant stare, poor coordination, unsteady gait, slow to answer/follow commands, poor concentration, slurred speech, personality changes, diminished ability or reckless playing behavior, seizure
Concussion evaluation: describe what is all done in the following:
- mental status testing
- gait/balance
Mental status:
- orientation q’s
- concentration (subtraction, months backwards)
- memory
Gait:
- walk normally
- tandem gait
- romberg
Concussion signs Demanding emergency action
-Increasing HA, nausea, vomiting
-progressive impairment of conciousness
-gradual rise in BP
-diminution of pulse rate
-blown pupil
-disorientation (worsening of mental status)
-suspicion for hematoma
-C-spine injury
-focal motor weakness
-transient quadriparesis
-seizure
-high risk of intracranial bleed
-
Concussion: signs of non-emergent referral to neurology
presisent HA greater than 7 days
post concussion syndrome lasting greater than 2 weeks
abnormal neuropsych testing
Hx of multiple high grade concussions
clinical judgement
Concussion can mimic what other disorders?
- substance abuse/dependency
- intermittent explosive disorder
- suicidal ideation/tendencies
- depression
- mood disorder
- impulse control
On field evaluation of concussion
- ABC’s first!!!
- any LOC treat as C-spine injury
- any signs of neurologic deficits, immediate transfer to ER
Sideline eval of concussion
Post-game eval of concussion
- check out signs and symptoms, mental status
- assess gait and balance
Post Gamee:
- similar to sideline
- should include take home instructions
- discuss status of athlete with parents and coaching staff
Young and adolescent Athletes w/ concussion
-how long until they can return to play?
-use a longer symptom-free period before starting exertion protocol b/c their symptom resolution may take longer.
Tx of Mild concussion
- rest, fluids. and good nutrition
- -sleep
- -no training, playing, exercise, chores
- -cognitive rest; no tv, video games, texting, music
-avoid NSAIDS for first 48hrs d/t increased bleeding (better to take tylenol)
When can players return to play post concussion?
- must be fully recovered, usually 7-10days.
- must pass exertional test w/o sx
- consider the rule of 3’s
1. one concussion= out of the game and practice for several days
2. 2 concussions = out for the season. :(
3. 3 concussions = out of the sport…forever. :( :(
Describe the progression for return of the EXERTIONAL TEST.
- recurrence of sx at any point drop back.
- aerobic exercise- light walking, biking
- sport specific activities w/o opponent
- non-contact drills
- full contact drills
- return to the game
Second Impact Syndrome
- what is this?
- may lead to what?
What: second impact to the brain during the vulnerable metabolic period of first concussion recovery. Sudden and severe swelling
May lead to worsening mental status and death.
Concussion Prevention
strengthen the neck muscles
protective equipment
teach players control, how to fall, how to protect selves
helmets
mouth guards
What is ImPACT?
immediate post concussion assessment and cognitive testing
-computer neuropsych test that gives athletes baseline cognitive function so if they ever have concussion they can compare.
After suffering one concussion an athlete is more likely to develop?
Post concussive syndrome
HA & sleep disorders
Depression & Dementia
Chronic Traumatic encephalopathy
Athletes who have suffered one concussion are more likely to have a second and do not recovery as quickly or fully the second time around, T/F?
True. Athletes are 3-6x more likely to have a second one.
They do not recover as quickly or fully from another concussion. these are generally more severe.
What is post concussive syndrome?
- sx
- tx
- chronic cognitive and behavioral symptoms following injury, may take months to resolve. If these sx persist longer than 2 weeks they require non-emergent referral.
sx: HA, fatigue, sleep difficulties, concentration issues, emotional problems, dizziness
Tx: need physical and cognitive rest
-PT may be helpful; balance, proprioception, and canalith repositioning
THose with concussion are more likely to develop depression, T/F?
True
Chronic Traumatic Encephalopathy
- what is this?
- sx
- dx
What: progressive degenerative disease found in individuals who have had multiple concussions.
sx: memory loss, confusion, impaired judgement, paranoia, impulsse control problems, aggression, depression, dementia
dx: autopsy, tau proteins
