Concussions Flashcards
(25 cards)
Concussion: Glasgow score
- GCS score of 13-15
Concussion Def
- Mild traumatic brain injury (TBI)
- May or may not include LOC (sports mostly lack LOC)**
- Symptoms
- rapid onset of brief impairment (neurological fxn)
- resolves spontaneously
- Normal brain structure
- Vacant stare
- Delayed/slurred speech
- Disorientation
- Memory deficits
- Elderly = Falls**
- Young = Crashes**
- Contact sports
- high school higher rates than college
- Soldiers
- explosions, shrapnel, bullet wounds, etc
- Risk Factors
- <5 yo
- >60 yo
- Secondary Injury
- Wallerian degeneration
- release of acetylcholine, glutamate, aspartate (excitatory neurotransmitters)
- free radicals
- Axonal Rupture
- shear and tensile forces
Cerebral Edema
- Overfills cranial vault
- Flattening of gyri
- Narrowing of sulci
- Compression of ventricular cavities
- Herniation
Hallmark of concussions**
- Confusion
- Amnesia
Standardized Assessment of Concussion (SAC)
- Used for athletes
How long after a concussion should you monitor? What should you do during?
- At least 24 hours
- Bc of intracranial complication risk
- Should awake from sleep every 2 hours**
- No physical or mental strain for 24 hours
When should you hospitalize pts?
- Glasgow score of <15
- Abn CT
- bleeding
- cerebral edema
- Seizures
When should caregiver seek immediate medical help?
- Not able to awaken pt
- severe/worsening headaches
- Restlessness/unsteady/seizures
- Vision difficulties
- Vomit, Fever, Stiff neck
- Incontinence
- Weakness/numbness
Second Impact Syndrome
- Diffuse cerebral swelling, rare but fatal
- disordered cerebral autoregulation
- cerebrovascular congestion
- malignant cerebral edema
- inc. ICP
- After a 2nd concussion, while pt still symptomatic from earlier concussion
- BOXERS**
Postconcussion Syndrome
- Head and neck structure trauma
- Symptoms
- HA
- Dizzy
- Neuropsychiatric sx
- Cog impairment
- Develop first days after TBI
- Resolves w/in weeks to months
- RISK for developing ALS and Parkinson
Motor Neuron Disease
- Chronic traumatic encephalopathy
- (confirmed pathologically)
- Risk Factor
- Football
- Soccer
Post-Traumatic Headaches
- w/in 7 days after TBI
- Can be latent up to 3 months
- May be indistinguishable from nontraumatic migraines or tension HA
Cranial Nerve Injuries
- Can cause:
- anosmia/hyponosmia
- diplopia
- facial pain
- occipital neuralgia
Cumulative Neuropsychological Impairement
- A type of concussion sequelae
- Manifestations
- behavior/personality changes
- depression
- suicide
- parkinsonism
- speech/gait abnormalities
Post-Traumatic Epilepsy
- TBI pt are 2x at risk of epilepsy w/in next 5 years
- Seizures w/in 1st week isn’t epilepsy (acute symptomatic events)
- Do not tx prophylactically w/ anti-convulsants
- they don’t work to prevent seizures after TBI
Post-Traumatic Vertigo
- Direct injury to Cochlear and/or Vestibular structures
- Labyrinthine concussion may occur from blunt injury
- Contributes to disability after TBI
American Academy of Neurology: Concussion grading and management
Grade 1
- Transient confusion
- No loss of consciousness
- Concussion symptoms for less than 15 mins
Management
- Athlete may return to play if asymptomatic at 15 mins
American Academy of Neurology: Concussion grading and management
Grade 2
- Transient confusion
- No LOC
- Concussion Sx for >15 mins
Management
- Athlete can return to play if asymptomatic for one week
American Academy of Neurology: Concussion grading and management
Grade 3
- LOC of any duration
Management
- Transport to the hospital and ovserve overnight
- May return to play when asx for one week (if LOC was brief ie. seconds)
- May return to play when asx for two weeks (if LOC was prolonged)
Return to Play Protocol: Rehabilitation Stage 1
- No activity
- Complete physical and cognitive rest
- Objective: recovery
Return to Play Protocol: Rehabilitation Stage 2
- Light aerobic exercise
- Walking, swimming, or stationary cycling, keeping intensity <70% MPHR; no resistance training
- Objective: inc. HR
Return to Play Protocol: Rehabilitation Stage 3
- Sport-specific exercise
- Skating drills in ice hockey, running drills in soccer, no head impact activities
- Objective: add movement
Return to Play Protocol: Rehabilitation Stage 4
- Non-contact training drills
- Progression to more complex training drills,
- ie. passing drills in football and ice hockey
- may start progressive resistance training
- Objective:
- exercise
- coordination
- cognitive load
Return to Play Protocol: Rehabilitation Stage 5
- Full contact practice
- Following medical clearance, participate in normal training activities
- Objective
- restore confidence
- assess functional skills by coaching staff
