Concussion-Tran

Question 1

What is a concussion?

Answer 1

as brain injury and is a complex pathophysiological process affecting the brain, induced by mechanical forces
**can be direct blow to head or hit elsewhere in the body–impulses transferred to the head

Question 2

T/F There is an increased rate of concussions in high school athletes.

Answer 2

True.

Question 3

What are the risk factors for concussions?

Answer 3

hx of prior concussion
female
young
ADD
mood disorders
learning disorders
migraines

Question 4

What is involved in on-field management of concussions?

Answer 4

check ABCs
evaluate for a cervical spine injury or serious brain injury
C-spine injurY: immbolize neck & go to ED
Serious Brain Injury: transfer to ED if see deteriorating mental status or focal neuro exam findings

Question 5

WHat are the tools used to check for a concussion when a player is sidelined?

Answer 5

symptom checklist
balance tests
cognitive evaluation
neuropsychological testing
sometimes imaging
**monitor

Question 6

T/F It is okay for an athlete to return same day after concussion concern if they do not worsen throughout the day.

Answer 6

False. No same day return to play

Question 7

What are the physical signs & symptoms of concussions?

Answer 7

Physical symptoms:
Headache
Nausea
Vomiting
Balance problems
Dizziness
Fatigue
Phonophobia / photophobia
Visual problems

Question 8

What are the cognitive symptoms of a concussion?

Answer 8

Not “feeling right”
Mental fogginess
Difficulty concentrating
Difficulty remembering things
Confusion about recent events
Answering questions slowly
Repeating questions

Question 9

Any other concussion symptoms?

Answer 9

Irritability
Sadness
Nervousness
Emotionality
Drowsiness
Sleeping more or less than usual
Difficulty falling asleep

Question 10

What is involved in cognitive evaluation?

Answer 10

orientation (SAC & Maddocks)
past & immediate memory
learning
conc’n

Question 11

What is involved in BESS–Balance Error Scoring System?

Answer 11

3 stances: narrow double leg, single leg, tandem
2 surfaces: flat firm, medium density foam
20 seconds for each stance w/ hands on hips & eyes closed

Question 12

What is involved in neuropsychological testing?

Answer 12

memory, cognitive speed, reaction time

computerized

Question 13

T/F No appreciable signs of concussion on CT/MRI

Answer 13

True.

Question 14

When would CT/MRI be warranted?

Answer 14

if concerned about intracranial path

bleed, herniation, bony fracture

Question 15

What is PET/SPECT scan?

Answer 15

measures cerebral glucose intake & regional cerebral blood flow
injected radioisotope

Question 16

What is the treatment for a concussion?

Answer 16

relative physical & cognitive rest

Question 17

When can you start treating concussions symptomatically?

Answer 17

after 10 hours of injury
acetaminophen-headache **better than NSAIDS
ice massage etc.

Question 18

If headaches linger past 3-4 days…what can be done?

Answer 18

consider abortive meds

Question 19

Should meds be given for sleep disturbances & mood disturbances after a concussion?

Answer 19

nope

Question 20

What is the return to play protocol after a concussion?

Answer 20

symptom free at rest & exertion before full participation in sports
normal cognitive & balance exam
could take days-months

Question 21

What are the protocols for return to school following a concussion?

Answer 21

if you suffer cognitive exertion–longer test times, days off, reduced workload

Question 22

How do you make the diagnosis for chronic traumatic encephalopathy?

Answer 22

diagnosis only confirmed after death
proposed effect of sub concussive blows
could have a genetic predisposition for this

Question 23

What is good primary prevention for concussions?

Answer 23

enforcement of rules
helmets–limited help
mouth guards-limited help

Question 24

What is good secondary prevention for concussions?

Answer 24

good return-to-play management

Question 25

Chronic neurocognitive impairment related to concussion is determined how?

Answer 25

could be present with post-concussion syndrome

demonstrated w/ neuropsychological testing

Question 26

What is chronic traumatic encephalopathy?

Answer 26

neurodegenerative disease–repetitive brain trauma
accumulation of tau protein in specific areas of the brain
**associated with memory impairment, depression, poor impulse control, cognitive dysfunction

Question 27

WHat is post-concussion syndrome?

Answer 27

most symptoms resolve w/i 7-10 days
some last from weeks-years
vague symptoms, headache, dizziness, insomnia, cognitive dysfunction, depressed mood, irritability, anxiety, fatigue, noise & light sensitivity

Question 28

What is second impact syndrome?

Answer 28

diffuse cerebral swelling secondary to dysregulation of blood supply to brain
increase in intracranial pressure, brain herniation or coma
second hit is bad!!!

Question 29

What are 2 potential long-term sequelae from concussions?

Answer 29

chronic traumatic encephalopathy

chronic neurocognitive impairment