Concussion Flashcards
1
Q
- A complex pathophysiological process affecting the brain induced by traumatic biochemical forces
- Mild traumatic brain injury (mTBI)
- May not actually involve head trauma
A
Concussion
2
Q
Concussion
- ___ onset of neurologic dysfunction that resolves spontaneously
- Can result in pathological changes producing ___ rather than ____ injury
- Result is a graded set of sxs that may or may not include ___ and does NOT involve ___ abnormalities on neuroimaging.
A
- Rapid
- Functional, rather than structural injury
- LOC / structural
3
Q
- Annual incidence of ___ exceeds other neuro dx (parkinson, stroke, MS, alzheimer dz)
- Do most TBIs result in concussions or not?
A
- TBI
- 75% of TBIs each year are concussions
4
Q
3 age groups most likely to sustain TBI
A
- Children 0-4 yrs
- Adolescents 15-19 yrs (accidents / sports)
- Adults 65+ yrs (falls)
5
Q
Which age group have the HIGHEST rates of TBI-related hospitalizations/death?
A
Adults > 75 yrs
6
Q
Which gender is at highest risk of TBI/Concussion in all age groups?
A
Males
7
Q
TBI/Concussions are major source of disability for which group of people?
A
Soldiers returning from Irag/Afghanistan
8
Q
Why is it difficult to obtain estimates of yearly TBIs from sports injuries?
A
The injured not seeking care
9
Q
- 4 sports associated w/ Concussions
- Which one has internationally the highest rate?
A
- Football
- Ice Hockey
- Soccer
- Rugby (highest rates)
10
Q
What is the word for the movement of brain on:
- Initial impact?
- Secondary impact?
A
- Coup
- Contre-coup
11
Q
3 states of confusion associated w/ Concussion
A
- Dazed
- Stunned
- Answers slowly
12
Q
Types of memory loss from Concussions
A
- Retrograde amnesia
- Anterograde amnesia
13
Q
2 visual disturbances associated w/ Concussions
A
- Double vision
- Light sensitivity
14
Q
Post-Concussive Sxs last how long?
- What are they? (6)
A
Days - Months
- Chronic HA
- Short term memory difficulties
- Fatigue
- Difficulty sleeping
- Personality changes (irritable/mood swings)
- Sensitivity to light / noise
15
Q
Post-Concussive Syndrome persists for more than ___.
A
1 week
16
Q
Post-Concussive Syndrome is “clustering” of what 3 difficulties?
A
- Physical
- Somatic
- Sleep-related
Difficulties
17
Q
3 cognitive difficulties of Post-Concussive Syndrome
A
- Memory
- Problem solving
- Decreased concentration
18
Q
When should a patient w/ Concussion be evaluated clinically?
A
- At time of incident
- After incident (FU)
19
Q
What tool is used for assessing concussions in athletes?
A
Sports Concussion Assessment Tool (SCAT5)
20
Q
What imaging if any is recommended for concussions?
A
CT
21
Q
Indications for CT after Concussion
- GCS < ___ how many hours after injury?
- Suspected ________
- Sign of ___ skull fx
- ___+ episodes of vomiting
- ___ y/o or older
- Amnesia for events occuring >__ mins prior to impact
- Dangerous mechanism
- Neuro deficit
- Seizures
- Bleeding diathesis or anticoagulant use
- *****Or if return visit for reassessmen of head injury*****
A
- 15
- open/depressed skull fx
- Basilar
- 2+
- 65
- 30
22
Q
4 signs of Basilar Skull Fx
A
- Racoon eyes
- Battle sign
- Hemotympanum
- CSF rhinorrhea
23
Q
Tx of Concussion
- First thing is: ______
- Rest and ___ for HA
- Gradual increase to _____
- Can pt return to play that day?
- Return to play: not until ____
A
- # 1: removal from event / activity
- acetaminophen
- full athletic activity
- AZ law: must be evaluated before returning to sport
- all sxs are gone and no meds required
24
Q
DO NOT give which 2 medications for concussions?
A
- NSAIDS: increase risk of bleed
- Morphine: sedates/decreases level of consciousness
25
3 Intracranial (CNS) Tumors
* Astrocytoma (benign usually)
* Glioblastoma
* Meningioma
26
CNS tumors arise from cells within CNS or from ____ cancers that have \_\_\_\_\_.
systemic / metastasized to CNS
27
**CNS Tumors**
* ___ and ____ account for 2/3 of primary adult brain tumors
* ____ is most common in children
* ____ is most common in adults w/ median age of ___ y/o
* Meningiomas & Glial Tumors
* Low-grade astrocytoma
* Glioblastoma / 64 yrs
28
**CNS Tumors**
* Slight ___ predominance in malignant tumors
* Slight ___ predominance in meningiomas
* Male
* Female
29
3 CNS tumors of higher prevalence in black population
* Meningioma
* Pituitary tumors
* Craniopharyngioma
30
What classification is used for CNS tumors?
WHO
31
5 most common metastatic tumors --\> CNS
* lung
* breast
* renal
* melanoma
* colorectal
32
A mass of well differentiated, non-invading, non-metastasizing cells
benign tumor
33
* Capable to grow, invade, and spread
* Anaplasia: cells w/ poor differentiation, losing morphological characteristics of mature normal cells
Malignant
34
* Develops from epithelial cell
* Tissues that line surfaces
* Endodermal, mesodermal, & ectodermal layers
Carcinoma
35
* From mesenchymal origin
* Cancerous bone, cartilage, fat, muscle, vascular, hematopoietic cells
* (connective tissues)
Sarcoma
36
* Benign tumor of epithelial tissue w/ glandular origin
Adenoma
37
* _____ can be useful to decrease edema, thus decreasing symptomatic effects of tumors
Steroids:
Dexamethasone
38
2 main clinical manifestations of CNS tumors
#1: Focal seizures (50-80%)
#2: Headaches (50%)
39
4 Focal Signs/Sxs of CNS tumors
* Weakness
* Sensory loss
* Aphasia
* Visual spatial dysfunction
40
\*\*\*\*3 signs of Increased Intracranial Pressure (ICP) from CNS tumors\*\*\*
* Headache
* Nausea/Vomiting
* Papilledema
41
What imaging would you order for CNS tumor?
Brain MRI with contrast
42
Imaging for screening for systemic malignancy
**CT**
* chest
* abdomen
* pelvis
43
**CNS tumor eval**
* Get an LP if ____ is suspected
leptomeningeal seeding
44
What imaging for "some lesions"
(imaging is equivocal and non-neoplastic etiologies are being considered)
MR spectroscopy (type of MRI)
45
**CNS Tumor Diagnosis**
* Requires \_\_\_\_
* Type of procedure depends on what 4 things?
* ____ is used as adjunct for tumors in delicate areas (pt is awake)
* ____ performed in OR to determine preliminary biopsy results and help surgeon decide whether or not to proceed w/ extensive resection
* tissue sample for histopathologic / molecular study
* Tumor: Type, Grade, Location, Operability
* Functional MRI
* Frozen Section
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