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Flashcards in Concussion Lecture Deck (58)
1

True or false: concussions can result from blows to areas other than the head

True

2

Are concussions a functional disturbance, or a structural injury? What, then, are the usual imaging findings?

Functional disturbance (normal imaging)

3

What is the most common reason for not reporting concussions? Second most common?

1. Did not think it was serious enough
2. Did not want to leave the game

4

What is the pathophysiology of concussions?

Increased levels of K probably activate ATP-dependent Na/K pumps, creating a need for more glucose and adding to the metabolic stress (fuel need/ fuel delivery mismatch)

5

What happens to glutamate with concussions?

Increases extracellularly, and may contribute to the increase K flux

6

What is the major excitatory neurotransmitter in the CNS? Inhibitory?

Glutamate
GABA

7

What are the metabolic disruptions that occur with concussions?

Brain's need for glucose increases acutely, and cerebral blood flow and oxidative metabolism are reduced

8

What causes the regional reduction of cerebral blood flow in a concussion?

Increase in intracellular Ca

9

What is the role of APO-E?

APO-E genes encode for apolipoprotein production, which is responsible for lipid transport in the brain, maintaining neuronal structural integrity, and recovery after neurological injury

10

What is the role of APO-E epsilon 4 in the pathophysiology of concussions?

Risk factor for alzheimer's--inhibits neurite growth

11

What is the most common risk factor for concussions?

h/o previous concussions

12

What is the most common area of the head that is hit with concussions?

Temporal region

13

Where do concussions come from with soccer?

Head to head contact--not head to ball

14

What happens to head velocity with concussed athletes?

Increased velocity

15

Where is the most risky area of the head to be hit in? Why?

Top of the head--Allows max force through the head and neck

16

Is there an association between the degree of amnesia and prognosis?

No

17

When are seizures particularly bad post concussion?

Later on--immediately after generally do not carry a bad prognosis

18

What is the role of grading systems in concussions? Why?

Have fallen out of favor--not useful, and recovery is very patient-dependent

19

What is in the ddx for concussion?

-Subdural hematoma
-

20

What are the s/sx of subdural hematomas?

-Decreased LOC
-HA
-Pupil inequality
-Motor deficits

21

Pupil inequality = ?

More serious than a concussion

22

What are the s/sx of epidural hematomas?

-Decreased LOC followed b a lucid interval
-other concussive syndromes
-Late onset ipsilateral dilated pupil

23

What are the s/sx of subarachnoid hemorrhage?

-Worst ever HA
-Photophobia
-n/v
-Neck stiffness

24

What is the work up of subarachnoid hemorrhages?

head CT
Fundoscopic exam
LP

25

Which lobes are most commonly affected with intracerebral hemorrhage?

Frontal lobes

26

What is the mortality rate of intracerebral hemorrhages?

Low if pt presents conscious before intervention

27

What are the immediate problems with intracerebral hemorrhages?

-ABCs
-Evaluate for C-spine
-move if pt is conscious and without c-spine injury

28

Should the helmet be removed with head injuries?

Hockey--yes unless goalie
Football--no

29

What is the role of orientation questions (person, place, time) in checking for concussions?

Not as useful as memory questions

30

What are the cognitive assessments immediate post concussion?

-3-5 word repetition
-Serial 7's
-Months of year backward

31

What are the findings of a pronator drift test with concussive pts?

More like romberg than actual pronator drift

32

How do you prevent athletes from reentering the game?

Take away helmet

33

What is the sideline test that can be performed for concussive pts?

SCAT 3

34

What are the current recommendations with concussions?

No return to play same day, regardless of symptoms

35

What is the management for concussions?

Physical and cognitive rest

36

Why should there be physical rest post concussion?

Increased blood flow overloads area that is trying to heal, and irritation of the brain

37

What should be avoided post concussion?

No fun (no music, no screens, no videogames/tv)

38

What is the step-wise process to returning to play? (6)

1. Rest
2. Light aerobic exercise
3. Sports specific
4. Non-contact drills
5. Full contact
6. Game play

39

How much time should take place between steps of returning to play?

24 hours

40

What happens when HAs / s/sx occur along the continuum of return to play?

Drop them a level for 24 hours

41

Does taking medication still count in the stepwise return to play?

Anything that is not at baseline is not allowable

42

Concussion s/sx lasting longer than how long require further workup?

Weeks

43

Why should waking up a post concussive patient be avoided?

REM sleep is healing

44

Why are NSAIDs contraindicated with post-concussive s/sx?

Inhibit platelet function and increases bleeding risk

45

What is second impact syndrome?

Rapid brain swelling and herniation following a second head injury in an athlete still recovering

46

What is the prognosis for second impact syndrome?

-50% mortality
-If no, significant neurological symptoms

47

Who gets SIS?

Young people d/t developing brain

48

What is post concussive syndrome?

Concussion s/sx persist weeks later

49

What are the medications that may be useful in post-concussive syndrome?

Anti-depressants

50

What causes posttraumatic seizures?

Traumatic depolarizations of neurons

51

Do immediate post concussive seizures usually require anti-epileptic seizures? How about ones that occur a week later?

No

Little before or after a Week later = need long term antiepileptic seizures

52

What are the s/sx of CTE?

CNS dysfunction--parkinosnianism, ataxia, and behavioral changes

53

What is the protein that is implicated in the pathogenesis for CTE?

Apolipoprotein epsilon 4

54

Do helmet prevent concussions?

No--it is used to prevent other forms of head trauma

55

Do mouthgaurds protect against concussions?

No--reduce dental trauma

56

What is the problem with the Virginia tech study?

Based on hypothesis of some arbitrary velocity to cause concussions

57

What is the best way to prevent concussions in sports?

Change rules to reduce injuries

58

What is the role of neuropsych testing?

Tests measure a broad range of cognitive function--very expensive and not reliable