Seizures and Concussion Flashcards Preview

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Flashcards in Seizures and Concussion Deck (16)
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1
Q

seizures

A
  • Seizure is the result of aberrant electrical activity in the brain
  • Numerous causes include metabolic, traumatic, infections, tumors, meds/drugs, congenital defects…
  • Epilepsy is a disease characterized by the presence of recurrent seizures
  • Everybody talks at the same time (cells)
2
Q

theories behind seizures and concussion

A
  • Altered membrane permeability
  • Ion distribution – if the cells were abnormally permeable to ions, you may have unusual electrical activity
  • Changes in neuronal excitability/channel activity
  • Neurotransmitter imbalance
3
Q

types of partial seizures

A
  • Simple: no impairment of consciousness (one hemisphere)

- Complex: Consciousness impaired

4
Q

Focal (partial) seizures

A
  • the concern about partial seizures is that they can become generalized seizures
  • Most common type is temporal lobe
  • Most common form is complex partial (involving disruption of consciousness)
  • Focal seizure can “generalize” to involve entire cortex and a secondary generalized seizure (1/3)
  • Usually manifest as staring for up to 120 seconds
5
Q

seizure differential

A
  • Movement disorders, MHA, sleep disorders, syncopy, behavioral and psych issues can mimic
  • Can be acquired condition after brain injury, thorough history required
  • Work up: must include neuro consult for any concerning events/behaviors (EEG, Laboratory evaluation, Imaging)
  • Seizures can be related to masses or brain malformation
6
Q

treatment of seizures

A
  • AED – numerous trials have failed to show much benefit of one over others (Pretty universally effective!)
  • Generally started after second unprovoked seizure – you can throw a singular seizure and never have one again
  • Type of seizure and its origins are important
  • Therapy usually for period of YEARS
  • Most drugs impair cognition to some degree
  • Surgical remedies must be evaluated if epileptic focus can be established via testing/imaging
7
Q

generalized seizures

A
  • Most common in young children
  • Involve both hemispheres at outset (Absence – nonconvulsive (no twitching, etc.), Atonic – “drop”, Myoclonic – jerking, Tonic-clonic – oppositional muscle group seizure activity)
8
Q

types of seizures

A
  • Absence – nonconvulsive: very short episodes of conscious detachment, may occur 10s-100s per day (Complex or generatlized)
  • Atonic – “drop” – loss of muscle tone leading to fall
  • Myoclonic – rigidity – sustained contraction
  • Tonic-clonic – “classic” seizure
9
Q

post-ictal period

A
  • HALLMARK OF SEIZURE
  • Brain recovery
  • Variable period of suppressed consciousness and confusion
  • Severe fatigue
  • Pt may have focal defects
  • Usually awareness and energy improves gradually
10
Q

leading causes TBI - youth

A
  1. Auto Accidents
  2. Sports Injuries
    - American Academy of Neurology (2010)
    - Athletes receiving injury removed and evaluated by doctor
    - Certified athletic trainer at all sporting events (including practice)
11
Q

concussion

A
  • Physiological, not structural injury
  • Not necessarily from direct head trauma
  • Multiple injuries may lead to permanent damage
  • YOU ARE DOING A CAT SCAN TO SEE BLEED, NOT TO SEE CONCUSSION!!! You can’t see the concussion!
12
Q

post concussive syndrome

A

Characterized by continuation of 3 of: HA, dizziness, insomnia, irritability, fatigue, impaired memory, lowered tolerance to light and noise.

  • Initial neuro exam and CT usually completely normal.
  • Incidence 2-4M/yr in US; NFL 2009: 4% diagnosed, 50% reported
  • HS athletes 3x more likely to suffer second
  • M>W
  • 50% between 15-34
13
Q

PCS

A
  • HA with mixed characteristics of MHA, tension, opthalmic migraine, cluster, etc.
  • CN signs: dizziness, vertigo, tinnitus, blurred vision, diplopia, photophobia
  • Psych: anxiety, irritability, insomnia, depression, decreased libido, fatigue
  • Cognitive: memory impaired, reduced concentration/attention, reaction time, information processing
14
Q

managment of concussion

A
  • Prevention: WEAR HELMETS
  • Brain metabolism is slowed for weeks after head trauma
  • Any increase in brain metabolic activity puts strain on the organ
  • Management: Post-concussive patients should be placed on COMPLETE rest until symptom free then advance slowly back to normal activity
15
Q

Complete brain rest

A
  • Initial Treatment (No activity until asymptomatic – books on tape or soft music ok for short periods)
  • Step 1 (Short periods of reading, focusing or school attendance)
  • Step 2 (When full school day tolerated: Low impact activity – walking/stationary bike, increase intensity as tolerated)
  • Step 3 (Aerobic activity specific to sport OK)
  • Step 4 (Non-contact drills)
  • Step 5 (Full contact OK in practice setting (though full contract practices are discouraged in general))
  • Must tolerate each stage without symptoms to advance to next stage, if stage induces symptoms, fall back after rest to 24 hr symptom free
16
Q

does concussion cause ALS

A
  • Probably not: Chronic Traumatic Encephalopathy
  • Brains and spinal cords of 12 athletes (3 dx’d with ALS)
  • Abnormal buildup of tau protein in brain and spinal cord
  • 10 of 12 also had buildup of TDP-43 in brain and 3 ALS dx’d patients had TDP-43 in spinal cord
  • TDP-43 at lower brain levels in ALS