Concussion

Question 1

What is a concussion?

Answer 1

A traumatic brain injury, in which a rapid acceleration applied to the cranium results in a force which needs to be dissipated

Question 2

Describe the pathophysiology of concussion

Answer 2

1. Trauma causes axonal stretch injury due to breaking of microtubules, forming undulations
2. This causes accumulation of transport proteins
3. This causes massive Na+ and Ca2+ influx, leading to signalling disruption and depolymerisation of the cytoskeleton
4. Binding of glutamate to MNDA receptors causes further depolarisation
5. Na/K pump goes into overdrive to correct this, which uses up ATP, requiring massive amounts of glucose
6. Glucose hyper metabolism and decreased blood flow due to injury causes metabolic depression in neurones
7. Persistent Ca2+ excess also inhibits mitochondria, worsening the energy crisis

Question 3

What symptoms can arise from frontal lobe impairment?

Answer 3

Defects with:
Behaviour, emotions, initiation of movement, speech planning

Question 4

What symptoms can arise from temporal lobe impairment?

Answer 4

Defects with:
Language, memory

Question 5

What symptoms can arise from parietal lobe impairment?

Answer 5

Defects with:
Special senses, reading, writing

Question 6

What symptoms can arise from occipital lobe impairment?

Answer 6

Defects with:
Visual, perception

Question 7

What symptoms can arise from cerebellar impairment?

Answer 7

Defects with:
Balance, coordination

Question 8

What are some physical signs and symptoms of concussion in adults?

Answer 8

• Headache
• Dizziness/unsteadiness (Seeing stars)
• Buzzing in the ears
• Nausea and vomiting
• Fatigue or drowsiness
• Blurred vision
• Confusion, brain fog
• Amnesia

Question 9

What are some delated symptoms (Hours to days) following concussion?

Answer 9

• Concentration or memory complaints
• Irritability or personality changes
• Photosensitivity or photosensitivity
• Sleep disturbances
• Parosmia

Question 10

What are some symptoms of concussion in children?

Answer 10

• Dazed look
• Listlessness
• Irritability
• Unsteadiness
• Excessive crying
• Change in eating or sleeping habits
• Vomiting
• Seizures

Question 11

What are some signs of concussion?

Answer 11

• Temporary loss of consciousness
• Dysarthria
• Slow responses
• Dazed look
• Forgetfulness
• Moro and asymetric tonic neck reflex (Fencer position)

Question 12

What is the moro reflex?

Answer 12

Baby when on back will raise arms into the air above the head (Commonly seen in sports injury)

Question 13

What is the asymmetric tonic neck reflex?

Answer 13

Baby when on back with put arms in a fencer position to prevent rolling

Question 14

When do childhood reflexes usually last until?

Answer 14

They usually last for the first 2 months, but will often return in concussion

Question 15

What are some factors that affect recovery time from concussion?

Answer 15

• Degree of initial event
• Number of episodes
• Gender:
  
  • Greater degree of impairment
  • Hormonal factors
  • Greater degree of whip-lash type injury

Question 16

How long does resolution of the axonal stretch injury cascade usually take?

Answer 16

2-4 weeks

Question 17

What is 2nd impact syndrome?

Answer 17

The 2nd episode may be minor with no loss of consciousness, however there will be depressed regulatory fractures and can lead to potentially fatal cerebral oedema

Question 18

What is dementia pugilistica?

Answer 18

A chronic traumatic encephalopathy occurring commonly in boxers in which chronic trauma to the head causes neurofibrillary tangles and possible amyloid plaque formation

Question 19

What are the 6 stages of graduated return to play?

Answer 19

Question 20

What are the time frames for graduated return to play in adults and children?

Answer 20

Question 21

In what type of sporting event is a head injury assessment performed?

Answer 21

Elite games only

Question 22

What are the 3 stages of head injury assessment?

Answer 22

• Stage 1 – game day assessment using the HIA1 Form.
• Stage 2 – post-game, same day assessment using HIA2 Form.
• Stage 3 – 36-48-hour post-injury assessment using HIA3 Form