Concussions

Question 1

Why does rapid deceleration cause loss of consciousness?

Answer 1

The ascending reticular activating system happens to be particularly susceptible to deceleration trauma, and it is the main circuit responsible for wakefulness

Question 2

Acute management of concussion (in the field)

Answer 2

Remove the individual from physical activity until they are further evaluated by a medical professional (often at the ED)

A standardized concussion symptom checklist (of which many reliable tools are available online, such as the ImPACT) may be utilized. These scores taken at various time intervals help track the progression in the acute setting.

Question 3

Indications for urgent evaluation in the ER following suspected TBI

Answer 3

• New or worsening neurologic signs
• Focal deficits
• Potential spinal injury
• GCS of anything less than 15

Question 4

Managing second concussions

Answer 4

Management of concussions is generally on the conservative side, and for second concussions it should be even more conservative.

Recurrent concussions are associated with prolonged recovery time and more severe symptoms with loss of consciousness than first time concussion.

Question 5

Rate of incremental return to activities following concussion

Answer 5

Increments should be between 1 to 5 days depending upon the individual’s injury and rate of recovery.

If symptoms recur, the athlete should rest for 24 hours, then resume activity at the last stage that was tolerated.

Question 6

Second impact syndrome

Answer 6

• Rare, life-threatening syndrome of cerebral vacsular congestion and diffuse cerebral edema that occurs when an athlete sustains a second concussion while recovering from a primary concussion
• Pediatric and adolescent patients are at the highest risk for this condition

Question 7

Postconcussion syndrome

Answer 7

• Constellation of symptoms observed following a concussion. Quickly resolve in most, but may persist for weeks to years in some.
• Symptoms include:
  
  • Headache
  • Dizziness
  • Poor concentration
  • Insomnia
  • Irritability
• Considered chronic if symptoms last for > 1 year
• Higher risk with repeat concussions

Question 8

Chronic traumatic encephalopathy

Answer 8

Syndrome of progressive cognitive decline and behavior change seen years later in athletes who have sustained multiple head injuries

Includes neurocognitive impairment as well as motor symptoms (tremor, ataxia, hypertonia)

Autopsy shows diffuse brain atrophy and tau deposition.

Question 9

Who gets a CT scan in the setting of a suspected concussion?

Answer 9

• Loss of consciousness
• Altered or worsening mental status
• Anisocoria
• Seizure
• Focal defecits
• Repeated emesis
• Age older than 60