Concussion

Question 1

What is a concussion?

Answer 1

A mild traumatic brain injury (TBI) caused by a blow to the head or sudden jolt to the body, leading to rapid brain movement within the skull and temporary disruption of brain function

Question 2

Describe the pathophysiology of concussion

Answer 2

Sudden movement of the brain within the skull causes:
(1) Axonal injury
(2) Chemical imbalance
(3) Reduced blood flow

= This leads to hypermetabolism, energy crisis, calcium build-up, and risk of cell death.

Question 3

What is an Axonal injury?

Answer 3

stretching and disrupted neural communication

Question 4

What is a chemical imbalance?

Answer 4

abnormal release of neurotransmitters/ions (Na⁺, Ca²⁺)

Question 5

What is reduced blood flow?

Answer 5

temporary cerebral hypoperfusion

Question 6

Why do brain cells face an “energy crisis” after a concussion?

Answer 6

Sodium–potassium pumps work harder to restore balance, increasing glucose demand. At the same time, blood flow is reduced, leading to high energy needs but low supply

Question 7

Management for a concussion is what?

Answer 7

Managed by the GCS score, eg if someone’s score is 15, discharge with instructions for monitoring by a responsible adult

If someone has red flag symptoms, refer to the emergency department

Question 8

Explain what is second impact syndrome?

Answer 8

Younger players who experience a second event before recovery from the initial concussion

→Potentially fatal cerebral oedema

Question 9

Explain what Dementia Pugilistica is?

Answer 9

AKA chronic traumatic encephalopathy

= A type of brain damage that occurs after repeated head injuries. It’s commonly seen in boxers, football players, and others involved in contact sports

Question 10

What are the brain changes in dementia pugilistica?

Answer 10

Damage to nerve cells, accumulation of abnormal proteins (like tau), and loss of brain tissue, especially in areas related to memory and emotions

Question 11

A 22-year-old man is brought to the Emergency Department after being found confused on the street. Past medical history is difficult to obtain. His observations are: BP 150/90, HR 88, SpO2 98%. GCS 12 (E3, V3, M6) with no focal neurology. He has a small scalp haematoma but no other injuries.

What is the next best step in management?

Answer 11

ALWAYS CHECK
capillary blood glucose
FIRST

= CT should only be performed after confirming normal glucose to avoid missing this reversible cause of altered consciousness