Traumatic Brain Injury Flashcards
The Lystedt law protects young athletes in all sports from returning to play too soon. What are 3 elements of Lystedt Law?
Athletes, parents, and coaches must be educated about dangers of concussions each year
If a young athlete is suspected of having a concussion, he/she must be removed from a game or practice and not be permitted to return to play; “When in doubt, sit them out”
A licensed health care professional must clear the young athlete to return to play in the subsequent days or weeks
TBI statistics by gender
In every age group, males > females
Males tend to complain of cognitive deficits + amnesia
Females tend to complain of drowsiness + phonophobia
Females have a higher post-concussion symptom score 3 months post-injury
Age groups at highest risk of TBI
Children age 0-4 [males age 0-4 have highest rates of TBI-realted ER visits, hospitalizations, and deaths]
Older adolescents aged 15-19
Adults aged 65+ [adults over 75 have the highest rates of TBI-related hospitalization and death]
Describe pathophysiology of damage that occurs with concussion (at the cellular level)
Rotational forces around a defined axis are thought to be responsible for damage to:
Deep white matter tracts —> DIFFUSE AXONAL INJURY [seen on 3D diffusion tensor image]
Deep gray matter nuclei
[results in diffuse neurodegeneration in the cortex (cognitive impairment) and hippocampus (memory impairment)]
Most common sites of brain injury with TBI
Frontal and temporal lobes
Major complaint with damage to dopaminergic system
Working memory deficits
[mild TBI results in transient deficits but severe TBI can have permanent morbidity — this is because the ability to transiently maintain information over a time delay relies on integration in prefrontal cortex in “memory fields” — modulated by DOPAMINERGIC AFFERENTS]
What is the most concerning potential neuropsychiatric sequelae to TBI?
Chronic traumatic encephalopathy (CTE)
[tauopathy consisting of progressive degenerative disease found in those who have suffered repeated brain trauma]
Gait and balance assessment is an important part of the PE following a TBI. What are some elements of this assessment?
Romberg
Single-leg standing to test balance
Heel-toe walking
Normal gait
When should immediate imaging with CT be considered for TBI?
Prolonged loss of consciousness (>60s)
Post-concussive seizures
Major neuro deficits, especially motor
Significant lethargy or rapidly progressive worsening of symptoms
Describe use of CT, PET scans, and fMRI in TBI
CT and PET are unremarkable in majority of cases
fMRI has revealed decreases in cortical blood flow to the mid-dorsolateral prefrontal cortex during acute post-concussive state
What type of imaging shows some promise in diagnosing degree of cellular damage in TBI? What does it show?
3D diffusion tensor image
Demonstrates post-traumatic gliosis and fractional anisotropy in the periventricular white matter adjacent to both lateral ventricles
In some cases of prolonged deficits, has detected evidence of micostructural white matter and AXONAL injuries
What is th eonly known effective treatment for concussion?
REST
Can also encourage frequent study breaks, good hydration, good nutrition, Tylenol for headache sxs, NO sedating meds, counsel on NSAID safety
Methods to facilitate cognitive rest during TBI recovery
Trial and error
Tailor activities to minimize symptoms: drive to school, reduce length of school day, rest periods as needed, reduce homework, longer time for tests, delayed tests, minimize background noise and excess light
If symptoms recur with cognitive activity, time off from school may be needed
Involve teacher, school nurse, principal, coach
6 stages for returning to game play after TBI
- Cognitive and physical rest until asymptomatic
- Light aerobic exercise
- Sport-specific aerobic exercise
- Noncontact drills; light resistance training
- Full-contact training if medically cleared
- Game play
ONLY PROGRESS TO NEXT STAGE IF ASYMPTOMATIC — allow at least 24 hours for each stage; consider making each stage 2-3 days if returning from a more severe concussion or multiple
Define post-concussion syndrome
Persistence of concussion-induced symptomatology for greater than 3 months post-injury
