9/28 Concussion - Womack Flashcards Preview

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Flashcards in 9/28 Concussion - Womack Deck (17):
1

concussion

complex pathophys process induced by trauma and affecting brain

  • caused by direct blow to head/face/neck/elsewhere with IMPULSIVE FORCE transmitted to head
  • rapid onset of short-lived impairment of neuro fx which resolves spontaneously
  • might see neuropatho changes BUT acute clinical sx reflect fx disturbance rather than structural injury
  • graded set of clinical syndromes that may or may not involve loss of consciousness
  • typical neuroanatomical imaging shows no abnormality

concussions will gradually get better if you leave alone! shouldnt see better-worse-better-etc cycles → thats prob something else

2

concussion as mild traumatic brain injury

 

diffuse or acute?

what's the root cause?

  • diffuse brain injury without structural change
  • due to rotational, shearing, counter-coup forces

3

pathophysiology of concussion

1. concussed brain is in hypermetabolic state

  • fuel use : fuel delivery ratio is out of balance (glucose utilization : cerebral blood flow)
  • dramatic incr in glucose metabolism in first minutes to days

2. increased Ca influx → decreased cerebral blood flow

  • decr blood flow puts cells in a state of vulnerability
  • cells not dead, but trying to recover! low flow → cell death and worse prognosis

4

clinical presentation of concussion

+/- loss of consciousness

retro/anterograde amnesia (not remembering plays)

inappropriate activity

emotional lability

confusion, dazed-ness

headache, dizziness, blurry vision

5

signs that should make you suspect concussion

symptoms

  • somatic: headache
  • cognitive: feeling "in a fog"
  • emotional: lability

physical signs

  • loss of consciousness
  • amnesia

behavioral changes (ex. irritability)

cognitive impairment (slowed rxn time)

sleep disturbance (ex. drowsiness)

6

concussion: after the fact

 

symptoms seen after concussion

  • confusion
  • difficulty concentrating
  • recurrent headache
  • slowed speech/comprehension
  • sleep disturbance
  • emotional lability
  • photo/phonophobia
  • dizziness

 

***vomiting

***worsening sx

***changes in consciousness

7

acute physical exam

ABC (airway, breathing, circulation)

cervical exam

neuro exam

SCAT3 test (sport concussion assessment tool)

8

link between concussion sx and severity

 

confusion

antergrade amnesia

retrograde amnesia

LOC

confusion +/-

antergrade amnesia +

retrograde amnesia ++

LOC +/-

9

imaging choices?

1. CT scan should be 1st choice if worried about more severe traumatic brain injury

2. MRI if prolonged sx and not improving

10

Nexus 2 mnemonic

BEAN BASH

 

Behavior (abnormal)

Emesis (intractable)

Age > 65

Neuro deficit

 

Bleeding

Altered mental status

Skull fracture

Hematoma on scalp

11

treatment for concussion

conrnerstone of tx right now: complete cognitive and physical rest

 

12

provocative tests

use only when asymptomatic (normally done on sideline if unsure of concussion)

  • shake head, tap head
  • run 40yd
  • 5 situps/pushups
  • 5 kneebends

 

testing coordination, multiple limbs

13

cutting edge of concussion testing

  • balance testing (tends to get better with fitness...older more exp athletes have better balance than younger/less exp)
  • ocular examination
  • tablet based testing

14

rules for return to play

no return unless asymptomatic at rest and exertion

  • NOTE: 20-30% of nonconcussed athletes have headache

any LOC or amnesia = out for the day

repeated assessment is the standard

continuing/worsening sx? ED!

15

second impact syndrome

occurrence of a catastrophic (often fatal) brain injury following relatively minor initial injury

  • can occur when athlete returns to play while still symptomatic from initial injury
  • in this period, brain's ability to regulate blood flow is affected → disordered cerebral vascular regulation
    • rapid cerebral edema and brainstem herniation can occur (under 5min)
  • 50% mortality, 100% morbidity
  • happens in high school and younger
  • best treatment: PREVENTION

many guidelines/protocols established based upon this risk

16

post concussive syndrome

days-weeks later, late symptoms:

 

  • persistent headache
  • lightheadedness
  • poor attn/concentration
  • memory dysfx
  • fatiguability
  • irritability
  • diff reading/studying
  • inapprop/repetitive action
  • loss of appetite
  • behavior changes
  • diff focus/conc
  • etc

 

17

multiple concussions

repeated injury can cause long-term fx impairment in some individuals

  • lingering sx and neuropsych deficits

data suggests that those with prior intracranial lesions shoudl be prohibited from contact sports

 

CTE (same neurofibrillary plaques and tangles assoc with AD but at MUCH younger age)

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