Ch53 Concussion, High-Altitude cerebral oedema, cerebrovascular injuries

Question 1

What is the difference between minor TBI and concussion?

Answer 1

Concussion is a subset of minor TBI, but has normal imaging and is a clinical diagnosis made shortly after a head injury based on post-traumatic alteration in orientation, balance, speed of reactions, learning and memory.

Question 2

What is SCAT3?

Answer 2

Sports concussion assessment tool 3rd edition. Commonly used for sideline assessment of sport concussion.

Question 3

What is second impact syndrome?

Answer 3

A rare condition described primarily in athletes who sustain a second head injury while still symptomatic from an earlier one. Classically, the athlete walks off the field under their own power after the second injury, only to deteriorate to coma within 1–5 minutes and then, due to vascular engorgement, develops malignant cerebral edema that is refractory to all treatment and progresses to herniation. Mortality: 50–100%

Question 4

What are the grades of DAI?

Answer 4

Grade 1 - Axonal injury in cerebral hemispheres
Grade 2 - focal lesion in Corpus callosum
Grade 3 - Focal lesion in brainstem

Question 5

How do you grade concussion?

Answer 5

Revised classification by Cantu et al

Grade 1 - No loss of consciousness, posttraumatic amnesia/ postconcussion signs or symptoms <30 mins

Grade 2 - Loss of consciousness <1 minute or posttraumatic amnesia >30 min but <24 hours, or postconcussion signs or symptoms >30 min but <7 days

Grade 3 - Loss of consciousness ≥1 minute or post-traumatic amnesia ≥24 hours, postconcussion signs or symptoms >7 days

Question 6

Can athletes return to play the same day following a concussion?

Answer 6

No!

Question 7

What are the treatments for vertebral dissection?

Answer 7

Anticoagulate with heparin or start aspirin

Endovascular stenting or occlusion