1: Head Injuries

Question 1

Direct force at point of contact may not be solely responsible for _____ of injury. Especially if there is a high rotational component.

Answer 1

Direct force at point of contact may not be solely responsible for severity of injury. Especially if there is a high rotational component.

Question 2

T/F PE for concussions should include looking for fluid from ears/nose.

Answer 2

True

Question 3

What is the Concussion QuickCheck App?

Answer 3

Designed by AAN to help coaches, parents and athletes evaluate for concussion. Includes:
Common signs and symptoms of concussion.
Things the athlete may tell you.
What to do if an athlete has a head injury or concussion during a game.
When an athlete should return to play.
State laws on concussion.
Neurologist GPS search.

Question 4

Why is postconcussive syndrome controversial?

Answer 4

Absence of objective neuro findings.
Inconsistent presentation.
Poorly understood patho.

Question 5

T/F While a player is on the sidelines with a concussion, repeat exam q 15 minutes until symptoms are cleared.

Answer 5

True

Question 6

Cognitive S/S of concussions (4).

Answer 6

Irritability
Nervousness/anxiety
Depression
Emotional lability

Question 7

The effects of multiple concussions over time remains significant. It can result in long-term neuro and functional deficits. What is this called?

Answer 7

Repetitive head injury

Question 8

Significant sway on Romberg tests suggests _____.

Answer 8

Significant sway on Romberg tests suggests persistent injury.

Question 9

Persistent vomiting, worsening headache, increasing disorientation, and changing LOC are signs of what?

Answer 9

Elevated ICP

Question 10

When should a player be allowed to return to play after treatment for concussion?

Answer 10

Must be completely asymptomatic. Have pt jog, sprint, or perform sit-ups to see if symptoms return.

Question 11

Why are children more susceptible to shear injuries?

Answer 11

Brain is unmyelinated in infants and young children.

Question 12

Amnesia can be present with concussions. _____ is generally very brief. _____ can be seconds to minutes.

Answer 12

Amnesia can be present with concussions. Retrograde is generally very brief. Anterograde can be seconds to minutes.

Question 13

Mechanism of injury:

Direct injury to brain at point of contact (coup).

Answer 13

Compressive forces

Question 14

Why are children more prone to injury from shaking?

Answer 14

Children’s brains have higher water content (88% vs 77%). More prone to acceleration-deceleration injuries.

Question 15

What is the most common type of traumatic brain injury (TBI)?

Answer 15

Concussion 75%

Question 16

Physical S/S of concussions (6).

Answer 16

Headache
N/V
Dizziness
Ataxia
Fatigue
Photo/phonophobia

Question 17

What are the highest-risk sports for concussions by sex?

Answer 17

Boys: Football and hockey
Girls: Soccer and basketball

Question 18

When is a CT vs MRI chosen for concussions?

Answer 18

CT: Typical in ER. Can quickly r/o bleeds.
MRI: Prolonged symptoms. Detects more subtle changes not seen on CT.

Question 19

T/F Child should be closely monitored for the next 24 hours. Parent should wake the child q 4 hours.

Answer 19

False. Parent should wake the child q 2 hours, as neuro deterioration can occur during sleep.

Question 20

Mechanism of injury:

Can result in shearing of axons.

Answer 20

Rotational forces

Question 21

With the exception of _____, concussion rates are higher during games than practices. Some sports have higher incidences of concussion based on position played.

Answer 21

With the exception of volleyball, concussion rates are higher during games than practices. Some sports have higher incidences of concussion based on position played.

Question 22

What is second-impact syndrome?

Answer 22

Second head injury occurs before symptoms from first injury heal. LOC not required for diagnosis.

Question 23

Red flags of concussions (13).

Answer 23

Weakness, numbness, or decreased coordination.
Worsening headaches.
Repeated n/v.
Slurred speech.
Anisocoria (unequal pupils).
Seizures.
Inability to wake pt or drowsiness.
Increasing confusion, agitation, restlessness.
Focal neuro signs.
Inability to recognize people/places.
Neck pain.
Unusual behavior changes.
LOC over 30 seconds.

Question 24

Helmets can help prevent concussions. What is the issue with them?

Answer 24

Study found only 15% fit properly.

Question 25

When is a pt sent for imaging with a concussion (4)?

Answer 25

Focal neuro signs Signs of increased ICP Low Glasgow coma scale score Seizures related to trauma

Question 26

Postconcussive syndrome is most commonly accepted as occurring within what timeframe after initial injury?

Answer 26

Several weeks

Question 27

When should a player be allowed to return to play from the sidelines?

Answer 27

If symptoms or physical exam results return to normal within 15 minutes.

Question 28

What age range has the most head injuries with recreational activities?

Answer 28

10-14 yo

Question 29

Why can infants and young children tolerate increased ICP better?

Answer 29

Unfused sutures

Question 30

Mechanism of injury: | Injury at point opposite contact (contrecoup) because axons and nerves are stretched.

Answer 30

Tensile forces

Question 31

When is chronic postconcussive syndrome usually seen?

Answer 31

Boxing

Question 32

There is no consensus on return-to-play guidelines, but most agree that symptoms must resolve both at _____ and with _____ before clearance to play is granted.

Answer 32

There is no consensus on return-to-play guidelines, but most agree that symptoms must resolve both at rest and with exertion before clearance to play is granted.

Question 33

What is the largest cause of head injuries?

Answer 33

MVAs 27-37% | Suspected abuse 30-40% (esp children under 2)

Question 34

What is the risk with second-impact syndrome?

Answer 34

SIS can cause cerebral edema and herniation, leading to death.

Question 35

Postconcussive syndrome symptoms (8).

Answer 35

``` Headache Dizziness Fatigue Irritability Emotional lability Impaired memory and concentration Insomnia Lower tolerance for noise and light ```

Question 36

A trauma-induced alteration in mental status that may or may not involve loss of consciousness.

Answer 36

Concussion

Question 37

A _____ is a type of mild traumatic brain injury.

Answer 37

A concussion is a type of mild traumatic brain injury.

Question 38

Sleep S/S of concussions (2).

Answer 38

Sleeping more/less than usual | Trouble falling asleep

Question 39

What is the treatment for postconcussive syndrome?

Answer 39

Nonnarcotic analgesics | Antiemetics