Traumatic Brain Injury

Question 0

What are the three spheres of concussion symptoms?

Answer 0

Physical- dizzy, nusea, light/sound

Cognitive- concentration, memory, reading, foggy

Emotional- giddy, flat, irritable, nervous, sad

Question 1

What is a concussion?

Answer 1

Any neurological symptom due to an impulse to the brain, not necessarily a direct blow

Rotational force is worse

Question 2

What are you most worried about after a concussion?

Answer 2

A second impact within 7-10 days

Question 3

What is second impact syndrome?

Answer 3

Multiple hits accelerate inflammation of the BBB of the first concussion

Question 4

What is post concussive syndrome?

Answer 4

Concussive symptoms hat last for over 10 days

Question 5

What is CTE?

Answer 5

When your brain deteriorates even when the impacts stop maybe even years later

Question 6

When can you go back to sport after a concussion?

Answer 6

They must get back to baseline without ongoing accommodation

Question 7

How do you manage concussions?

Answer 7

Anti-emetics
Sleep aid
Anti anxiety or depression
Close follow up
PT
Anti migraine therapy

Question 8

What is MN statute 121A.37?

Answer 8

Anyone suspected of a concussion must be removed until a doctors note is given

Coaches must have this training

Only for schools that charge a fee

Question 9

What is the role of standardized testing?

Answer 9

The person or witness must be educated
Also the parents

Coaches get sued so they usually comply

Question 10

What is King-Devick?

Answer 10

Test of visual tracking, and reading

Should take less than a minute
Reading (eyes, brainstem, occipital lobe, frontal lobe)

Question 11

What is SCAT2?

Answer 11

Hard, long, requires some skill

Question 12

What is ImPACT testing?

Answer 12

A computer based program

Attention span
Reaction time
Memory
Problem solving

Word recognition

Question 13

What is needed for An ImPACT test to be good?

Answer 13

Need a baseline of the test

Do it a few days later

Question 14

What do you see in season testing for concussions?

Answer 14

Subconcussion

Question 15

Why do women suffer worse concussions even though impacts are less violent?

Answer 15

More ligament laxity leads to more rotational motion (also girls may be more honest)

Question 16

For professional boxing when does atrophy occur and where does it start?

Answer 16

15 fights before atrophy occurs

Starts in the thalamus and amygdala

Question 17

How can you notice brain atrophy first?

Answer 17

Imaging

Atrophy appears on imaging before lower performance

Question 18

What is the physiology of concussion?

Answer 18

• disruption of cell function - ion channels leak, Ca influx, cell dysfunction and damage
• physical disruption to axon (tensor MRI) micro bleeds
• energy mismatch, don’t get metabolism in the injured cells, SPECT abnormalities outlast clinical symptoms

Question 19

What is the recovery of concussion?

Answer 19

Rewiring to make up for lost cells

Question 20

What is CTE?

Answer 20

Chronic (progressive) traumatic encephalopathy

Behavioral changes long term
Subsets show features of Parkinsonism or ALS

Question 21

What accumulates and how in CTE?

Answer 21

Tau protein inside the axons

It gets outside the axon and the body phosphorylates it, creates space, and then inflammation

Question 22

What are places you see tau aggregation in CTE patients?

Answer 22

Basal ganglia
Amygdala
Thalamus
Crypts of the sulcal depths (peri vascular space)

Question 23

What is BBB protein (HMGB1)?

Answer 23

Antibody blocks inflammatory changes seen with TBI

Question 24

Is CTE genetic or enviornmental?

Answer 24

2 NFL players have tau in there brain
1 had dementia

Really both

Question 25

What are the two patient groups of CTE?

Answer 25

Young - mood and behavioral changes

Older - cognitive decline, dementia (Parkinson’s, ALS)

Question 26

How do CTE and PCS differ?

Answer 26

CTE is a disease, progressive, does not resolve

PCS waxes and wanes and may go away, not progressive (unless trigger for CTE)

Question 27

Why may some people commit suicide?

Answer 27

Lose fear of suicide and death

Take more risks

Question 28

How many concussions is too many?

Answer 28

21 suicide, 4 concussions since 16. Brain showed early tauopathy

4 concussive events in 4yrs each with symptoms lasting longer than 7-10 days
Or
3 or more concussive events with progressively increasing defects by both duration and severity

Question 29

Does hyperbaric oxygen work?

Answer 29

No

Question 30

When are concussions more likely to happen?

Answer 30

With ADD patients

Question 31

When do CSF injury markers peak and normalize after a concussion?

Answer 31

Peak at 2 weeks

Did not normalize after 36 weeks!