Traumatic Brain Injury Flashcards
What are the three spheres of concussion symptoms?
Physical- dizzy, nusea, light/sound
Cognitive- concentration, memory, reading, foggy
Emotional- giddy, flat, irritable, nervous, sad
What is a concussion?
Any neurological symptom due to an impulse to the brain, not necessarily a direct blow
Rotational force is worse
What are you most worried about after a concussion?
A second impact within 7-10 days
What is second impact syndrome?
Multiple hits accelerate inflammation of the BBB of the first concussion
What is post concussive syndrome?
Concussive symptoms hat last for over 10 days
What is CTE?
When your brain deteriorates even when the impacts stop maybe even years later
When can you go back to sport after a concussion?
They must get back to baseline without ongoing accommodation
How do you manage concussions?
Anti-emetics Sleep aid Anti anxiety or depression Close follow up PT Anti migraine therapy
What is MN statute 121A.37?
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
What is the role of standardized testing?
The person or witness must be educated
Also the parents
Coaches get sued so they usually comply
What is King-Devick?
Test of visual tracking, and reading
Should take less than a minute
Reading (eyes, brainstem, occipital lobe, frontal lobe)
What is SCAT2?
Hard, long, requires some skill
What is ImPACT testing?
A computer based program
Attention span
Reaction time
Memory
Problem solving
Word recognition
What is needed for An ImPACT test to be good?
Need a baseline of the test
Do it a few days later
What do you see in season testing for concussions?
Subconcussion
Why do women suffer worse concussions even though impacts are less violent?
More ligament laxity leads to more rotational motion (also girls may be more honest)
For professional boxing when does atrophy occur and where does it start?
15 fights before atrophy occurs
Starts in the thalamus and amygdala
How can you notice brain atrophy first?
Imaging
Atrophy appears on imaging before lower performance
What is the physiology of concussion?
- 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
What is the recovery of concussion?
Rewiring to make up for lost cells
What is CTE?
Chronic (progressive) traumatic encephalopathy
Behavioral changes long term
Subsets show features of Parkinsonism or ALS
What accumulates and how in CTE?
Tau protein inside the axons
It gets outside the axon and the body phosphorylates it, creates space, and then inflammation
What are places you see tau aggregation in CTE patients?
Basal ganglia
Amygdala
Thalamus
Crypts of the sulcal depths (peri vascular space)
What is BBB protein (HMGB1)?
Antibody blocks inflammatory changes seen with TBI
Is CTE genetic or enviornmental?
2 NFL players have tau in there brain
1 had dementia
Really both
What are the two patient groups of CTE?
Young - mood and behavioral changes
Older - cognitive decline, dementia (Parkinson’s, ALS)
How do CTE and PCS differ?
CTE is a disease, progressive, does not resolve
PCS waxes and wanes and may go away, not progressive (unless trigger for CTE)
Why may some people commit suicide?
Lose fear of suicide and death
Take more risks
How many concussions is too many?
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
Does hyperbaric oxygen work?
No
When are concussions more likely to happen?
With ADD patients
When do CSF injury markers peak and normalize after a concussion?
Peak at 2 weeks
Did not normalize after 36 weeks!
