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Flashcards in Chapter 4 Deck (30)
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1

When did concussion begin to be tied to physiologic changes in the brain?

1839

2

athletes at greatest risk for second impact syndrome

under the age of 24 who are returned to play while still neurologically at risk

3

what symptom may be indicative of a more significant injury process immediately following a head injury?

rapid progressive headache

4

Two important guidelines to follow after mTBI

1. persons with mTBI who have headaches, dizziness, or sleep disturbance after injury should seek immediate help to decrease the liklihood of subsequent injuries and pain syndromes
2. if other symptoms have not resolved within the first 2-4 weeks after injury, it is strongly recommended that care be sought by clinicians who are appropriately trained and have clinical skills to manage the underlying causes of persistent symptoms

5

Important neuropsych things to evaluate after mTBI

1. screen for anxiety, depression, and PTSD
2. obtain full psych history
3. obtain comprehensive hx of psychological responses to past injuries
4. compare recovery to natural history expectations
5. Administer neuropsych evaluations PRN
6. evaluate history of substance abuse
7. assess functional progress and behavior in therapy or other tx modalities
8. determine presence of potential secondary gains

6

mTBI represents what percentage of all TBIs that occur in the US annually

75%
True incidence is likely higher due to many people not seeking medical attention

7

Mild TBI criteria

-normal structural imaging
-LOC 0-30 min
-alteration of consciousness from one moment up to 24 hours
-post traumatic amnesia 0-1 day
-GCS 13-15

8

metabolic alterations

adverse chemical changes in brain as a result of transfer of kinetic energy to the soft tissue of the brain

9

most common form of damage to brain structure

diffuse axonal injury

10

axonal shearing

process of axons being twisted and disconnected

11

does diffuse axonal injury show up on imaging?

not readily

12

glutamate

-toxic to the brain in high levels
-affects balance of sodium and potassium
-involved in excitatory processes as neurotransmitter

13

Percentage of people who experience persistent problems after 2-4 weeks after mTBI

10-15%

14

Physical/somatic mTBI symptoms

headache
fatigue
seizure
nausea
numbness
poor sleep
light sensitivity
noise sensitivity
impaired hearing
blurred vision
dizziness/LOB
neurologic abnormalities

15

cognitive symptoms of mTBI

inattentiveness
diminished concentration
poor memory
impaired judgment
slowed processing speed
executive dysfunction

16

behavioral/emotional symptoms of mTBI

depression
anxiety
agitation
irritability
aggression
impulsivity

17

frontal release

syndrome from damage to frontal areas of brain that results in disinhibition and abnormal behaviors

18

occipital neuralgia

most typical extra cranial trigger for migraine-like headaches
-casued by direct trauma or secondary sensitization from recurring central headaches
-associated with pain in the back of the head that worsens as the day progresses
-worsened by stress and tightening of the neck muscles

19

trigeminal nucleus

connection from upper spinal cord to this nucleus causes pain from occipital neuralgia to radiate to the forehead or behind the eyes

20

common forms of sleep disturbance following mTBI

sleep apnea
insomnia

21

Addressing fatigue post-mTBI

ensure restful sleep
gradual return to ADLs/IADLs

22

Sensory systems most prone to hypersensitivity following mTBI

hearing
vision
*important to rule out optic or auditory nerve damage

23

What 3 mTBI symptoms are most important to address in order to avoid subsequent injuries and pain syndromes

headaches
dizziness
sleep disturbance

24

post-concussion syndrome/persistent post-concussive symptoms (PCS/PPCS)

persistence of mTBI symptoms weeks to months after mTBI
-PPCS is preferred term to describe this

25

Predictive risk factors for PPCS

-pending litigation
-over 40
-hx of substance misuse
-low SES
-traumatic injury
-female
-previous psych history

26

Post-injury factors that increase risk of PPCS

headache
dizziness
nausea
post-traumatic amnesia lasting greater than 1 hour
GCS score of 13 or 14

27

consensus about cumulative effects of concussions

cumulative effect exists, it is important to obtain a thorough history of previous BI's, including stroke and anoxia

28

Chronic Traumatic Encephalopathy (CTE)

rare, progressive, degenerative condition of the CNS, typically seen after repetitive brain trauma

29

cascade of events leading to CTE

-diffuse axonal injury causes release of Tau proteins
-Tau proteins create a state of chronic inflammation in brain
-Affects neighboring neurons, which spreads continuously throughout a person's life
-may begin in childhood with contact sports

30

focal seizures most common in what part of brain?

temporal lobe