Traumatic brain injury

Question 1

concussion definition

Answer 1

-any trauma induced alteration in mental status (with or without loss of consciousness)

Question 2

Lystedt Law

Answer 2

protects young athletes from returning to play too soon!!

• athletes, parents, couches educated about concussions each year
• “when in doubt, sit them out”
• licensed health care professional must clear the athlete to return to play!!

Question 3

TBI- by gender

Answer 3

• Males > females
• females 2x the rate of concussion
• females- drowsiness, noise sensitivity, higher post-concussion symptoms score 3 months post-injury
• males- cognitive deficits, amnesia

Question 4

TBI- groups at highest risk

Answer 4

• ages 0-4 yrs
• 15-19 yrs
• > 65 yrs

Question 5

TBI- pathophysiology

Answer 5

• deep white matter tracts!!
• diffuse axonal injury!!- seen on 3D diffusion tensor image
• cortex
• hippocampus

Question 6

dopaminergic system

Answer 6

memory deficit!

-depression sequela- pts self-medicate with stimulants

Question 7

PE

Answer 7

• neuro exam, mental status
• gait and balance
• cognitive fxn

Question 8

chronic traumatic encephalopathy

Answer 8

• tauopathy

- progressive degenerative dz from repetitive brain trauma

Question 9

Immediate imaging when?

Answer 9

• prolonged loss of consciousness (>60 seconds)
• post-concussive seizures
• major neurological deficits, esp motor deficits
• lethargy, or rapidly progressive worsening of symptoms

Question 10

3D diffusion tensor image

Answer 10

• post-traumatic gliosis

- white matter and axonal injuries!!!

Question 11

concussion management

Answer 11

-REST!!!- only known effective treatment

Question 12

concussion management- encourage?

Answer 12

• frequent breaks from studying

- good hydration and nutrition

Question 13

concussion management- medication

Answer 13

• tylenol for headaches
• NSAIDs safety
• no sedating meds

Question 14

NO ONE returns while??

Answer 14

-still symptomatic!!
-must be asymptomatic:
at rest, with cognition, with exertion!!

Question 15

Return to play- stages

Answer 15

24 hrs for each stage; return to previous stage if sxs return; progress to next stage ONLY if asymptomatic!!!!!!

• 1- cognitive and physical rest- until asymptomatic!
• 2- light aerobic exercise
• 3- sport specific aerobic exercise
• 4- noncontact drills
• 5- full contact training only if medically cleared
• 6- game play

Question 16

post concussion syndrome

Answer 16

-persistence of symptoms >3 months

Question 17

2nd impact syndrome

Answer 17

• vulnerable period- before complete symptomatic resolution of initial impact
• profound engorgement
• edema
• inc intracranial P
• brain herniation- coma, death!

Question 18

Refer to neurology when?

Answer 18

• getting injured more easily
• prolonged (2-3wks), complicated, or severe symptoms
• notable change in baseline cognitive fxn
• concussive convulsions
• repeated concussions close together, or requiring less force