Concussion

Question 1

Imaging with concussion

Answer 1

Acute signs/symptoms largely reflect a functional disturbance instead of a structural injury and no abnormality is seen on standard neuro imaging.

Only used to rule out:
1. Intracranial/intracerebral hemorrhage
2. Skull fracture

Circumstances:
1. Prolonged confusion
2. LOC
3. Focal neurologic deficit
4. Worsening symptoms
5. Post-Traumatic Seizure
6. Post-Trarumatic Amnesia
7. GCS <15
8. Palpable skull fracture

Question 2

What testing should be used for concussion

Answer 2

SCAT5 (incorporates Maddocks’ questions).

Time, place, person are unreliable.

Question 3

Return to sport stages after concussion

Answer 3

1. Symptom limited activity: can do daily activities that don’t provoke symptoms (gradually reintroduce work/school)
2. Light aerobic exercise (walking or stationary cycling at slow/medium pace to increase heart rate <70% Max HR). No resistance training
3. Sport-specific exercise: running or skating, no head impact.
4. Non-contact training: harder training drills and progressive resistance training. Can do increased thinking.
5. Full contact practice if medically cleared. Participate in normal training.
6. Return to sport/games.

Period of rest for 1-2 days before starting (physical and cognitive rest). 24 hours needed for each step. If symptoms worsen should go back to previous step. If symptoms present more than 10-14 days or 1 month in children should be referred to expert.

Question 4

When should SCAT5 be used

Answer 4

Immediately after injury and will serial testing (athlete may have delayed symptoms). It’s utility decreases after 3-5 days.

Question 5

What to do with suspected concussion

Answer 5

1. Address 1st aid issues
2. Don’t leave player alone
3. Do serial monitoring over initial few hours
4. Use SCAT5

Question 6

How to progress back to school activities

Answer 6

Stage 1-4:

1. Daily activities at home that don’t give child symptoms. 5-15 minutes at a time and build up.
2. Homework, reading, or other cognitive activities outside classroom
3. Return to school part time with breaks during day
4. Progress school activities until full day tolerated.

Question 7

What constitutes “persistent symptoms”

Answer 7

> 10-14 days in adults and >4 weeks in children

Question 8

How long does it take to heal from concussion?

Answer 8

For most injured athletes they rapidly improve during the first 2 weeks after injury.

Question 9

Clinical recovery versus neurobiological recovery

Answer 9

Neurobiological recovery might extend beyond clinical recovery in some athletes.

Question 10

What suggests worse outcome

Answer 10

Strongest/most consistent predictor of slower recovery is severity of initial symptoms in for day or initial few days (low level of symptoms is favorable prognostic factor).

Development of subacute problems with migraine headaches or depression are risk factors for persistent symptoms lasting > 1 month.

Question 11

Worrisome symptoms that need assessment in ER?

Answer 11

1. Severe or worsening headache
2. Seizure of tonic posturing
3. Focal neurological signs
4. Looks drowsy or cannot be awakened
5. Recurrent vomiting
6. Increased confusion or irritability
7. Weakness of numbness in arms or legs
8. Severe neck pain or loss of range of motion
9. Significant irritability or agitation
10. Loss of consciousness
11. Unequal pupils

Question 12

Do helmets and mouth guards decrease concussions?

Answer 12

Date is insufficient to support or refute the superiority of one helmet over another in preventing concussions. There is no compelling evidence that mouth guards protect athletes from concussions.

Question 13

Who can return an athlete to play once a concussion is diagnosed?

Answer 13

A physician

Question 14

Recommendations for cognitive rest after a concussion?

Answer 14

Cognitive rest recommended for 2-3 days (no studying, homework, screen time, loud/bright/busy venues)