Clinical Perspective - Clinical Sports Related Head Trauma

Question 1

What is the mechanism of a concussion?

Answer 1

Rapid acceleration-deceleration of the head due to a direct or indirect injury. Rotational acceleration in the primary mechanism of injury.

Question 2

Chronic traumatic encephalopathy can only be diagnosed post-mortem. What histologic changes will be seen in a patient with CTE?

Answer 2

Phosphorylated tauopathy in the form of neurofibrillary tangles

Question 3

What is the mechanism of the Q collar in concussion prevention?

Answer 3

The collar compressed the internal jugular vein to restrict venous outflow from the cerebrum. This causes slight enlargement of the brain that increases turgor and prevents movement

Question 4

How long must symptoms last for a diagnosis of post-concussion syndrome?

Answer 4

4 weeks

Question 5

How long does concussion recovery take in most patients?

Answer 5

7-10 days

Question 6

An individual is rear-ended while stopped at a red light. They are diagnosed with a concussion after being transported to the ER. Is this a (direct/indirect) injury?

Answer 6

Indirect injury

Question 7

True/False. Indications of a concussion may show on an fMRI.

Answer 7

True. However, a CT and MRI will appear normal, with no structural changes.

Question 8

What signs warrant immediate removal from sports activity following a traumatic head injury?

Answer 8

Loss of consciousness, seizure, ataxia, confusion, behavioral changes, amnesia

Question 9

Concussions occur due to rapid acceleration/deceleration of the head. What is the primary mechanism of injury?

Answer 9

Rotational acceleration of the brain

Question 10

True/False. Anticipation of a collision reduces head acceleration and risk of injury.

Answer 10

True. However, increased neck strength and mass in and of itself is not proven to prevent concussions

Question 11

What are the limitations of star-rated helmets in concussion prevention?

Answer 11

They do not change the overall energy the brain is exposed to during impact. These helmets reduce impact injuries (skull fracture), but have limited ability to prevent concussions

Question 12

The on-field assessment involves what steps?

Answer 12

Airway, breathing, circulation, disability (consciousness), cervical injury

Question 13

What complications (syndromes) may arise from repeated head trauma and/or premature return to normal functioning?

Answer 13

Post-concussion syndrome, chronic traumatic encephalopathy

Question 14

True/False. Mouthguards are an effective means of preventing concussion due to head injury.

Answer 14

False. Mouthguards have been repeatedly proven to be ineffective in preventing concussions. They only protect teeth.

Question 15

What is the definition of a sports concussion?

Answer 15

A traumatic brain injury that occurs during sports or exercise-related activity that results in rapid, short-lived impairment of neurological functioning that resolves spontaneously

Question 16

What is neuropsychological testing?

Answer 16

A standardized test of cognition that creates a baseline for comparison during concussion recovery

Question 17

True/False. It is recommended that patients take NSAIDs for symptom management following a concussion.

Answer 17

False. Acetaminophen is recommended for the first 48 hours. After this, NSAIDs may be used. There is concern for bleeding if NSAIDs are used immediately following injury

Question 18

An athlete is approved to return to physical activity gradually. They have no symptoms following cycling and wish to join their team in sprints on the same day. What is the physician’s recommendation to this patient?

Answer 18

The patient cannot participate in sprints. This is a more rigorous form of physical activity. 24 hours must be taken between phases of recovery to ensure symptoms do not reappear

Question 19

What symptoms should be assessed during the on-field assessment?

Answer 19

Headache, head pressure, nausea, dizziness, photophobia, phonophobia, blurred vision, fogginess, “out of it”, “does not feel right”

Question 20

A football player is tackled and hits their head forcefully on the ground. This is an example of a (direct/indirect) injury.

Answer 20

Direct injury

Question 21

Sideline assessment tools for concussion test…?

Answer 21

Symptoms, cognition, neurologic functioning

Question 22

True/False. The plan for returning to regular functioning is patient-specific.

Answer 22

True. Still, the plan should ALWAYS involve gradual return to activity