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PCM III, Exam One > Traumatic Brain Injury - Dougherty > Flashcards

Traumatic Brain Injury - Dougherty Flashcards

1
Q

Who must clear a young athlete to return to play?

A

A licensed health care professional.

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2
Q

Self-reporting of TBI in females.

A
  • Drowsiness and noise sensitivity.

- Longer post-concussion symptoms - higher score 3 months post-injury

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3
Q

Self-reporting of TBI in males.

A

*Cognitive deficits and amnesia

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4
Q

What is morbidity v. mortality?

A

Morbidity are long term effects post-injury.

Mortality is death.

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5
Q

What 3 ages are most likely to sustain TBI?

A
  1. Children (MALES) AGED 0-4
  2. Older adolescents aged 15-19yo
  3. Adults aged 65yo and older (falls)
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6
Q

What age group has highest rates of TBI-related hospitalization and death?

A

Adults, 75+yo

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7
Q

What are the respective results of diffuse neurodegeneration in the 1) cortex and 2) hippocampus?

A
  • ESP. MALES+dopamine involvement
    1. Cortex=cognitive impairment
    2. Hippocampus = memory impairment
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8
Q
  • *Define the frontal and temporal poles: coup and contrecoup.
  • Where does the major injury occur?
A

Coup - site of injury

Contrecoup - site diametrically opposite (site of major bleeding/injury)

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9
Q

What is the difference between hemorrhage of brain tissue in a wedge-shaped area: subacute v. remote contusion?

A

Subacute - contusion and necrosis

Remote contusion - can cause depressed area of cortex and plaque formation.

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10
Q

What is one of the initial pathophysiological changes in TBI? Ultimately leads to what?

A

Axolemmal permeability/mechanoporation, leading to Ca influx and subsequent calpain activation.
Ultimately: swelling in contiguous axons and finally, secondary AXOTOMY
TWISTING OF AXONS&raquo_space; TANGLES = inability to resolve

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11
Q

What is significant about c-Jun N-terminal Kinases?

A

**THE REPAIR SQUAD - negatively affected by TBI = no recovery.
- Neurite outgrowth and elongation, brain development, apoptosis, axonal injury.
(Plays a role in normal growth and apoptosis necessary for recovery.)

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12
Q

Memory deficits in 1) mild TBI and 2) Severe TBI.

A

Mild - transient deficits

Severe - permanent morbidity

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13
Q

Neurons in what cortex have “memory fields”?

A

Prefrontal cortex (PFC) + dopamine

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14
Q

What happens to dopaminergic afferents to the PFC pyramidal neurons after contusive brain trauma?
What can this subsequently lead to?

A
  • Expression increased in PFC anywhere from 3hrs to 3days after injury.
  • Can lead to depression-type sequella (dop and effects on 5Ht)
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15
Q

What are the major things a licensed health care professional must evaluate to clear in a young athlete in order for them to return to play?

A
  1. Comprehensive hx and PE&raquo_space; Neuro/mental status exam, Gait/Balance, Cognitive function
  2. Clinical status determination (improvement v. deterioration)
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16
Q

How long can neuropsychiatric sequelae last after TBI?

What are 2 manifestations/sequelae?

A
  • For up to 3 months, some event for years.

- 1) Cognitive Deficits and 2) Behavioral manifestations

17
Q

What are 3 cognitive deficits?

A

Cognitive Deficits: Imparied attention, memory, decreased executive function

18
Q

What is one of the most frequently reported behavioral sequelae in TBI?

A

Major depression

19
Q

**What are 5 tests in the Gait and Balance Assessment?

A
  1. **Romberg
  2. **Romberg S (F shoulder/arm to 90, pronate/supinate, then touch nose with shoulder still F+ABD)
  3. Single leg standing
  4. Heal-toe walking
  5. Normal gait
20
Q

What does SCAT2, ImPACT, etc. test?

A

Neurpsych evaluation - Used to develop a baseline and future assessment.

21
Q

What is the timeline for neurocognitive/psych testing?

A
  • BASELINE taken before concussion occurs.
  • Post concussion: testing at 24-72 hours, then again at Day 5-10.
  • Must be BACK TO BASELINE before return to play.
22
Q

What are 8 domains measured with neurocognitive testing?

A 
Combine: Baseline score
Memory,
Working Memory
Attention
Reaction time
Mental speed
Verbal memory
Visual memory
Processing speed
23
Q

Under what 4 conditions should an IMMEDIATE CTscan be considered?

A
  1. Prolonged LOC (>1min)
  2. Post concussive prolonged seizures
  3. Major neuro deficits (esp motor)
  4. Significant lethargy or rapid/progressive worsening of symptoms.
24
Q

What do CT or PET scans show in majority of cases?

What can functional MRI reveal?

A
  • CT/PET unremarkable.

- fMRI can reveal tangles/decreased cortical blood flow to PFC during acute post-concussion.

25
Q

What is the only known effective treatment for a concussion?

A

REST

26
Q

What meds can be given?

A
  • Tylenol for HA - drug of choice
  • NSAIDs (not in lg amounts bc TBI is a bruise)
  • No sedating meds
27
Q

Under what three condictions must athletes be asymptomatic in order to return to play?

A

At rest + With cognition + With exertion = ASYMPTOMATIC ALL THE TIME

28
Q

After what time frame marks probable longer recovery times?

A

More 5-15 minutes of mental status changes/”being out of it” after the concussion occurs.
(v. 5 min)

29
Q

3 components that need to be NORMAL before athlete can return to play?

A
  1. Neurocognitive
  2. Symptoms
  3. Physical Exam
30
Q

***Protocol for return to play?

What are the stages?

A
  1. Cognitive and physical rest until asymptomatic
  2. Light aerobic exercise
  3. Sport-specific aerobic exercise
  4. Non-contact drills; light resistance training
  5. Full-contact training if medically cleared.
  6. Game play
31
Q

Is the time frame for returning to play?

A
  • At least 24 hours for each stage (1 week total), but CONSIDER MAKING EACH STAGE 2-3 DAYS for severe or multiple concussions.
32
Q

What three things should happen if sxs recur with exertion?

A

1) return to previous stage OR
2) rest for additional 1-3 days OR
3) Return to stage 1

33
Q

***What are 2 complications of concussions?

A
  1. Postconcussion Syndrome -persistence of concussion sxs for >3mo post injury (neurophys/neuropath changes dt tangles/twisting)
  2. 2nd Impact Syndrome - vulnerable period, especially in athletes
34
Q

**Describe 2nd Impact Syndrome

A

Before brain has fully healed, get another concussion, resulting in…

  • profound engorgement, massive edema, increased ICP
  • BRAIN HERNIATION, COMA, DEATH
  • MORBIDITY = 100%
  • MORTALITY = 50%
35
Q

At what point do you consider a neurology referral for an athlete?

A
  • Increasingly getting injured more easily
  • SX GREATER THAN 2-3 WEEKS of complicated or severe symptom course.
  • Change in baseline cognitive function
  • Convulsions
  • Repeated concussions (proximity or requiring less force)
36
Q

7 things that MAY predict a prolonged recovery.

A
  • Severe sx/duration more than 10 days
  • LOC more than 1 min
  • Less than 18yo
  • Co-morbidities (migraine, depression, ADHD, LD, sleep disorders)
  • Psychoactive drugs, anticoagulants
  • Dangerous style of play
  • Contact/collision sport, high sporting level

PCM III, Exam One (5 decks)

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