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Neuro 1 > concusions > Flashcards

concusions Flashcards

1
Q

concussion phys

A

stretched axons –> excess of neurotransmitters –> increase in Na/k pump = increase energy requirements

increase energy + decrease BF = metabolic crisis

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2
Q

dizzyness and concussion

A

negative prognostic factor = slower recovery

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3
Q

cog/fatigue s/s

A

a) Fatigue
i) Due to metabolic cascade
b) HA
c) End of day
d) Often see sleep disturbances

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4
Q

cog/fatigue exam findings

A

vestibular/ocular - normal

neurocog - mild but global
deficits with retrieval

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5
Q

cog/fatigue Qs

A

i) Generalized HA that increases as day progresses
ii) More fatigued at end of day
iii) Feel more distractible in school/work

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6
Q

cog/fatigue Tx

A

physical/cog breaks thoughout day
meds
cog tharapy
monitored exercises progression

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7
Q

ocular/visual risk factors

A

personal/family Hx of ocular dysfunction

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8
Q

ocular/visual s/s

A

a) Frontal HA by visual work
b) Difficulty with visual based class, assignments, or activities
c) Pressure behind eyes
d) Visual focus issues
e) Blurry vision
f) Double vision
NO PHOTOSENSITIVITY

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9
Q

ocular/visual exam fidings

A

vision/occulomotor

i) Potentially may see + smooth pursuit, saccades
ii) Convergence difficulties
(1) Insufficiency
(2) Spasm/excess
iii) Accommodative insufficiency
iv) Strabismus
(1) Tropias
(2) Phorias

neurocog

  • reaction time
  • visual
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10
Q

vergence dysfunction
s/s
common problems
most common?

A

convergence most common

s/s
intermittent/constant diplopia
asthenopia (eye strain) - reading
frontal HA
letters appear to float/move

prblms

  • convergence insufficiency
  • convergence excess
  • convergence spasms
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11
Q 
accommodative dysfunction
accommodation?
dysfunction? 
spasm?
what does it lead to? 
tasks struggle with?
A

1) accommodation = adjust the eye as obj distant varies
a) Achieved by changes in LENS

2) Reduction in ability to focus at near
a) May prematurely need reading glasses

3) Accommodative spasm
a) Over focusing at near

4) Struggle to coordinate accommodation and vergence, leading to difficulty in spatial awareness
5) Computers/phone/near work

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12
Q

Tx for ocular/visual

A

ocular motor training
PA ok
- non stim enviroment

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13
Q

Vestibular risk factor

A

PMHx of car sickness/motion sensitivity, migraine, anxiety

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14
Q

triad of disorders

A

vestibular, traumatic migrane, anxiety

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15
Q

vestibular S/s

A

a) Vertigo
b) Dizzy
c) Blurry vision
d) nystagmus
e) N/V – ANS involv
f) Sweating – ANS involv
g) Overwhelmed in visually stim enviro
h) Balance impairments
i) Broad stance
i) Tinnitus
j) Hearing loss

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16
Q

causes of vestibular

TBI type 5

A 
labyrinthine concussion
skull Fx
hemorrhage into labyrinth
hemorrhage into brain stem
increased ICP
17
Q

labyrinthine concussion manifestation

A

Ataxia, imbalance, BPPV may be present

MOST COMMON

18
Q

Skull Fracture manifestation

A

Unilateral vestibular loss or bilateral vestibular loss (partial or complete)
Conductive hearing loss
May have mixed peripheral and central lesions

common w/ blows to the occiput

19
Q

Hemorrhage into Labyrinth manifestation

A

May create post traumatic hydrops (Meniere’s type syndrome)

Damage to labyrinth, may create acute vertigo and Unilateral hearing loss

20
Q

Hemorrhage into brainstem manifestation

A

Oculomotor signs,
poor smooth pursuit,
vertigo,
perception of tilt

21
Q

vestibular exam findings

A

vestibular ocular

i) VOR dysfunction
ii) VOR suppression
iii) Can see + smooth pursuit, saccades

neuro cog
difficulty with visual motor speed (breakdown in smooth pursuit), reaction time

22
Q

Tx vestibular

A

vestibular rehab

meds - meclizine - common

23
Q

anxiety/mood risk factor

A

personal/family hx of anxiety, migraine, vestibular disorders

24
Q

anxiety/mood s/s

A

common in athletes

a) ruminative thoughts
b) hyper vigilant
c) fastidious
d) easily overwhelmed
e) difficulties initiating/maintaining sleep

25
Q

anxiety mood exam findings

Qs

A

a) vestibular ocular screen
i) norm
b) neurocog test
i) norm
c) Qs
i) How often do you take inventory of your s/s
ii) Difficulty turning off your thoughts
iii) Do you become symptomatic when you are thinking about your s/s

26
Q

anxiety mood Tx

A

a) Psychotherapy – unless another subtype is present
b) Treat vestibular/migraine subtype if present
c) Supervised exertion therapy
d) Cog behavior training
e) Regulated schedule
i) Sleep, exercise, diet, hydration

f) Pharm

27
Q

post trauma migrane

risk factors

A

personal or family hx of migraine, “ice-cream headache” (brain freeze), motion sensitivity, vestibular disorder, anxiety

28
Q 
migrane vs tension type HA
hrs
location
pain
other
A 
migraine 
4-72 hours
unilateral location
mod-severe pain
aggravated by PA
accompanied by n/v
photosensitivity
tension type
30mins - 7 days**
bilateral location****
mild - mod pain
not aggravated by PA****
no N/V***
photosensitivity
29
Q

what is a migraine

A

neurovascular event - failure of trigeminovascular system

genetic disposition

30
Q

post trauma s/s

A

a) variable HA
b) nausea, photo or phonophobia
c) stress, anxiety, lack of exercises
d) sleep dysregulation

31
Q

post trauma migraine exam findings

A

vestibular ocular - norm

neuro cog - verbal and visual mem

32
Q

post trauma migraine Tx

A

meds
diet
stress management
avoid migraine triggers - alcohol, caffeine, poor sleep

33
Q 
concussion GCS score
LOC
alteration of consciousness
post trauma amnesia
imaging
A

13-15

0-30 mins

breif < 24hrs

< 1 day

none

34
Q

cervical risk factor

A

prior c-spine injury, high velocity injury, strong rotational component to injury

35
Q

cervical s/s

A

a) neck pain, stiffness, soreness

b) HA radiating forward from upper C-spine
i) Starts at ears and loops back around to neck  think of ram horn
ii) Aggravated by specific neck mvmts or sustained postures

36
Q

cervical exam findings

A

a) Vestibular/ocular
i) Norm
b) Neurocog
i) Norm

c) + cervical screen

37
Q

cervical Tx

A

a) Obtaining imaging
b) Cervical stabilization exercises
c) Meds
i) Muscle relaxants, analgesics
d) Injection/nerve block
e) Massage, acupuncture

38
Q

predictive factors concussion

A

a) Initial symptoms – vestibular needs more help + time
b) Sex – F more progression
c) Age
d) Loss of. Consciousness
e) Post traumatic amnesia
f) Premorbid comorbidities

Neuro 1 (4 decks)

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