Neuro 2 > Concussion > Flashcards

Concussion Flashcards

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1
Q

what level of TBI would a concussion be classified as?

A

mild TBI

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2
Q

explain the pathophysiology of a concussion

A

this is a metabolic brain injury

↑ ENERGY DEMAND + ↓ BLOOD SUPPLY → METABOLIC CRISIS

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3
Q

list the clinical subtypes of concussion

A
  1. Cognitive/Fatigue
  2. Ocular
  3. Vestibular
  4. Anxiety/Mood
  5. Cervical
  6. Post Traumatic Migraine
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4
Q

describe the symptoms of the Cognitive/Fatigue Subtype

A

most often seen EARLY ON followinc concussion

  1. Fatigue
  2. HA with cognitive and physical activity
  3. “end of day” symptoms
  4. often see sleep distrubances
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5
Q

exam findings for Cognitive/Fatigue subtype

A
  1. Vestibular/Ocular screening
    • normal
  2. Neurocognitive Test Results
    • mild, but global/widespread, deficits across all composites
    • deficits with retrieval, encoding intact
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6
Q

treatment for the cognitive/fatigue subtype

A
  1. incorporate physical/cognitive breaks throughout the day
    • NO NAPS
  2. pharmacological options available if persistent
    • neurostimulants
    • sleep aide
  3. Cog therapy → if symptoms linger more than a few months
  4. Monitored, structured exercise progression
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7
Q

risk factors for the Ocular/Visual Subtypes

A

personal/family history of ocular dysfunction

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8
Q

symptoms for the Ocular/Visual Subtypes

A
  1. Frontal HA driven by visual work
  2. Difficulties w/visually-based classes, assignments, or activities
  3. Pressure behind eyes
  4. Visual “focus” issues
  5. Blurry vision
  6. Double vision
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9
Q

exam findings for the Ocular/Visual Subtypes

A
  1. Vision/Oculomotor Exam
    • +Smooth Pursuit, Saccades
    • Convergence difficulties
      • insufficiency
      • spasms/excess
    • Accommodative insufficiency
    • Binocular visual deficits
    • Strabismus
      • Tropias
      • Phorias
  2. Neurocognitive Test Results
    • deficits in reaction time
    • deficits w/visual memory (encoding rather than retrieval)
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10
Q

what is a strabismus?

A

a misalignment of the eyes or dysconjugate gaze at rest

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11
Q

what is a topia?

A

overt deviation of the eye

tend to be present at all time

  • exo → outward (laterally)
  • eso → inward (medially)
  • hyper → upward
  • hypo → downward
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12
Q

what is phoria?

A

ocular deviation occurs when dissociation occurs

tend to show up as the eyes get tired

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13
Q

describe what occurs if strabismus is severe or subtle

A
  1. Severe
    • diplopia
    • head tilt (vertical misalignment)
    • noticeable eye turn
  2. Subtle
    • difficulty maintaining focus
    • cosmetically normal
    • ocular soreness
    • HA
    • mental dullness
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14
Q

what is the difference between convergence and divergence?

A
  1. convergence → ability of eyes to turn inward to focus on a near target
  2. divergence → ability of eyes to move outwards to focus on a further target
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15
Q

what are the general symptoms of vergence dysfunction?

A
  1. Asthenopia when reading
  2. Frontal HA
  3. Intermittent/Constant double vision
  4. Squints/closes one eye
  5. Letters appear to float/move on the page
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16
Q

list some common vergence problems

A
  1. Convergence insufficiency
  2. Convergence excess
  3. Convergence spasm
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17
Q

describe accommodative dysfunction

A

reduction in ability to focus at near, may prematurely need reading glasses or bifocals

accommodative spasm (over focusing at near)

this is a struggle to coordinate accommodation and vergence, leading to difficulty in spatial awareness

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18
Q

accommodative dysfuction will cause trouble with ________

A

spatial awareness

computers/phones/near work

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19
Q

treatment of Ocular/Visual Subtype

A
  1. Ocular Motor Training
  2. Physical Exertion → generally well tolerated
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20
Q

risk factors for vestibular subtype

A

PMHx of car sickness/motion sensitivity, migraine, anxiety

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21
Q

symptoms for Vestibular Subtype

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A
  1. Vertigo
  2. Dizziness
  3. Nausea
  4. Overwhelmed in visually-stimulating environments
  5. Balance impairments
22
Q

S/S of Vestibular Dysfunction

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A
  1. Dizziness
  2. Blurry Vision
  3. Nystagmus
  4. Tinnitus
  5. Vertigo
  6. Hearing Loss
  7. Loss of balance and possible falls
  8. Broad-based stance (to accommodate for imbalance)
  9. Sweating, nausea, and vomiting (due to ANS involvement)
23
Q

list causes of Vestibular Dysfunction in TBI

Study These Flashcards
A
  1. Labyrinthine Concussion
  2. Skull fracture
  3. Hemorrhage into Labyrinth
  4. Hemorrhage into brainstem
  5. Incrased ICP
24
Q

possible manifestation of Labyrinthine Concussion

Study These Flashcards
A

ataxia, imbalance, BPPV may be present

most common vestibular injury due to TBI

25
possible manifestations of skull fracture TBI
1. UVL or BVL (partial or complete) 2. conductive hearing loss 3. may have mixed peripheral and central lesions these are common w/blows to the occiput, temporal or parietal regions
26
possible manifestations of hemorraghes into labyrinth TBI
1. May create post traumatic hydrops (Meniere's type syndrome) 2. Damage to labyrinth, may create acute vertigo and unilteral hearing loss 3. labyrinthine damage may present with S/S similar to acute peripheral vestibular damage
27
possible manifestations of hemorrage into brainstem TBI
1. Oculomotor signs 2. poor smooth pursuit 3. vertigo 4. perception of tilt this results in damage to vestibular and oculomotor nuclei
28
possible manifestations of increased ICP TBI
1. fluctuating hearing loss 2. ataxia 3. imbalance 4. may cause perilymph fistual
29
exam findings for vestibular subtype
1. Vestibular/Ocular Screen * VOR dysfunction (vertical and/or horizontal) * VOR suppression * Can see +smooth pursuit, saccades * \*\*not sig enough to see +skew 2. Neurocognitive Test results * difficulty w/visual motor speed, reaction time
30
the vestibular subtype frequently coexisits with \_\_\_\_\_\_\_\_\_\_\_\_
Migraine and/or Anxiety Subtype
31
Treatment for vestibular subtypes
1. Vestibular Rehab Therapy (VRT) 2. Pharmacological (as needed) * Meclizine * Tricyclic antidepressants * Melatonin * SSRIs
32
risk factors for anxiety/mood subtype
personal/family hx of anxiety, migraine, vestibular disorders
33
symptoms for anxiety/mood subtype
1. ruminative thoughts 2. hyper-vigilant 3. fastidious 4. easily overwhelmed 5. difficulties initiating/maintaining sleep
34
exam findings for anxiety/mood subtype
1. Vestibular/Ocular Screen * normal 2. Neurocognitive Test Results * normal
35
anxiety/mood subtype treatment
1. treat vestibular and/or migraine subtype, if present 2. supervised exertion therapy 3. cognitive behavior training 4. regulated schedule * sleep, exercise, diet, hydration, etc 5. Psychotherapy 6. Pharmacology * antidepressants * benzos
36
risk factors for post-traumatic migraine subtype
personal or family hx of migraine, ice-cream HA, motion sensitivity, vestibular disorder, anxiety
37
symptoms for post-traumatic migraine subtype
1. variable HA * **often wakes with HA** 2. nausea, photo and/or phonophobia 3. stress, anxiety, lack of exercises 4. sleep dysregulation
38
what is a migraine?
a neurovascular event that is a failure of central modulation of trigeminovascular system * 1/3 of pts will experience preceding aura * visual, sensory, language, motor * high genetic predisposition
39
exam findings for post-traumatic migraine subtype
1. vestibular/ocular screen * normal 2. neurocognitive test results * verbal and visual memory deficits
40
treatment for post-traumatic migraine subtype
1. medications * pain, sleep regulation 2. diet 3. stress management 4. avoid migraine "triggers" * alcohol, caffeine, poor sleep 5. NO PT
41
risk factors for cervical subtype
1. prior c-spine injury 2. high-velocity injury 3. strong rotational component to injury
42
symptoms for cervical subtype
1. neck pain, stiffness, soreness 2. HA radiating forward from upper C/S * precipitated/aggravated by specific neck movements or sustained postures
43
exam findings for cervical subtypes
1. vestibular/ocular screen * normal 2. Neurocognitive test results * normal 3. + cervical screen
44
treatment for cervical subtype
1. obtain imaging 2. cervical stabilization exercises 3. medication * muscle relaxants, analgesics 4. injection/nerve block 5. massage, acupuncture
45
most commonly reported symptoms in post-concussive athletes
1. HA 2. feeling slowed down 3. difficulty concentrating 4. dizziness 5. fogginess 6. fatigue 7. visual blurring/double vision 8. light sensitivity 9. memory dysfunction 10. balance problems
46
sideline concussion assessments
1. SCAT5 2. Sideline Impact Test 3. NFL Sideline Tool 4. Standarized Assessment of Concussion (SAC) 5. King-Devick Test
47
what is the purpose of the Buffalo Concussion Treadmill Test
1. to investigate exercise tolerance in pts w/post-concussive symptoms \>3 weeks 2. to help establish appropriate levels of exercise to aid in return to play/activity 3. to aid in differentiating between possible diagnoses for concussive symptoms 4. to ID physiological variables associated with exacerbation of symptoms and pt's level of recovery
48
stopping criteria for the Buffalo Concussion Treadmill Test
1. symptom exacerbation * an increase of 3 or more pts on the VAS scale from resting VAS score 2. voluntary exhaustion * an RPE \>17 w/o sig symptom exacerbation 3. pt demo's rapid progression of complaints, pt appears faint, has stopped communicating, or continuing the test constitutes a sig health risk for the pt 4. pt reaches 90% or more of age-predicted HRmax * with or w/o any increase in symptoms and still reporting low RPE
49
BCTT Exercise prescription
1. 80% of the max HR reached w/o symptom exacerbation 2. 20 min daily w/o exceeding the time or HR constraints 3. swimming, walking or stationary cycling → do not attempt resistance training
50
describe typical recovery for concussion
1. 85-90% concussions show signs of recovery in first 10-14 days * may be more like 21-28 days for full biophysiological process 2. Recovery from sports-related concussion in children is ~4 weeks 3. early ID of impairments aids in return to activity/sport w/o prolonged sequelae
51
predictors of prolonged recovery for concussion
1. Initial symptoms 2. sex 3. age 4. loss of consciousness 5. amnesia 6. premorbid comorbidities * pysch dx, migraines, vestibular dysfunction
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