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Neurology > Concussions > Flashcards

Flashcards in Concussions Deck (27)
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1

Define Concussion

Temporary loss of brain function due to head injury

2

Mechanisms of Injury

Coup
Countercoup
Rotational
Deceleration

3

How to diagnose

History
Signs
Symptoms
Exam findings
Neurocognitive testing
Balance testing

4

Cognitive Symptoms

Feeling "dinged/foggy"
Inability to focus attention
Cognitive slowing, confusion, amnesia
Memory dysfunction
Inappropriate emotions
Fatigue

5

Physical symptoms

Double vision, seeing stars
Headaches, tinnitis
Dizziness, nausea
Balance problems
Sleep disturbances
Vacant stare
Poor coordination
Slow to follow commands/answer question
Poor concentration
Slurred or incoherent speech
Behavior/personality changes
Reckless playing behavior
Loss of consciousness

6

Initial Evaluation- Mental status testing

Orientation
Concentration (subtraction from 100)
Memory (details of contest)

7

Initial Evaluation- Gait Assessment

Have patient walk
Tandem gait
Romberg

8

Signs demanding emergency action

Increasing headache, N/V
Progressive impairment of consciousness
Gradual rise in BP
Diminution of the pulse rate
Blown pupil
Disorientation

9

Emergent Referrals

Suspicion for hematoma
C-spine injury
Worsening LOC
Focal motor weakness
Transient quadriparesis
Seizure

10

Referral

Persistant headache >7 days
Post concussion syndrome >2 weeks
Abnormal neurpsych testing
Hx of multiple concussions
Clinical judgement

11

Other disorders concussions can mimic

Substance abuse/dependency
Intermittent explosive disorder
Suicidal ideation/tendencies
Depression
Mood disorder
Impulse control

12

On field evaluations

ABC's
Loss of consciousness (cervical spine injury)
Signs of neurological deficits (ER transfer)

13

Sideline evaluations

Signs, symptoms
Mental status
Gait assessment & balance

14

Problems with sideline evaluations

Everyone wants to know consequences of concussion
Can occur on any play
Dx difficult if athlete doesn't report

15

Post game evaluation

Similar to sideline
Determine if additional testing needed
Take home instructions
Coordinate care and follow up of athlete
Discuss status of athlete with parents, coaching staff, AT

16

Indications for transfer to emergency department

Loss of consciousness
Possible cervical spine injury
Possible skull fracture
High risk for intra-cranial bleeding
Post-traumatic seizure
Acute worsening of mental status

17

Treatment of Mild Concussions

Rest, fluid, good nutrition
Physical rest
Cognitive rest (no TV, video games, texting, music)
Avoid NSAIDs
Avoid activities with risk for head injury

18

Exertion protocol

Must pass exertion tests without symptoms
Is athlete eager to return
Consider protective equiptment
Career ending

19

Rule of 3's

1 concussion- out of game/practice for several days
2 concussions- out for season
3 concussions- out of the sport

20

Return progression

Symptoms at any point, regress to previous step
Aerobic exercise
Sport specific activities without opponent
Non-contact drills
Full-contact drills
Return to game play

21

Second Impact Syndrome

Second impact to the brain while recovering from first concussion
May be minor/incidental injury
Can lead to worsening mental status

22

Prevention

Can't condition the brain
Rule changes if clear cut cause
Protective equipment
Promote fair play
Teach players to play under control, how to fall, protect self

23

Repeated Injury

Post concussive syndrome
Headaches/sleep disorders
Depression or dementia
Chronic traumatic encephalopathy

24

Post concussive syndrome

Chronic cognitive and behavioral symptoms
Headaches, fatigue, sleep difficulties, concentration issues, emotional problems, dizziness
Affect sport, academics and life
Need physical and cognitive rest
PT may be helpful
Beware of depression

25

Chronic Traumatic Encephalopathy (CTE)

A progressive degenerative disease found in individuals who have been subjected to multiple concussions and other forms of head injury

26

CTE linked to?

Memory loss
Confusion
Impaired judgement
Paranoia
Impulse control problems
Aggression
Depression
Progressive dementia

27

Defining point on autopsy

Tau bodies