Concussion

Question 1

• A complex pathophysiological process affecting the brain induced by traumatic biochemical forces
• Mild traumatic brain injury (mTBI)
• May not actually involve head trauma

Answer 1

Concussion

Question 2

Concussion

• ___ onset of neurologic dysfunction that resolves spontaneously
• Can result in pathological changes producing ___ rather than ____ injury
• Result is a graded set of sxs that may or may not include ___ and does NOT involve ___ abnormalities on neuroimaging.

Answer 2

• Rapid
• Functional, rather than structural injury
• LOC / structural

Question 3

• Annual incidence of ___ exceeds other neuro dx (parkinson, stroke, MS, alzheimer dz)
• Do most TBIs result in concussions or not?

Answer 3

• TBI
• 75% of TBIs each year are concussions

Question 4

3 age groups most likely to sustain TBI

Answer 4

• Children 0-4 yrs
• Adolescents 15-19 yrs (accidents / sports)
• Adults 65+ yrs (falls)

Question 5

Which age group have the HIGHEST rates of TBI-related hospitalizations/death?

Answer 5

Adults > 75 yrs

Question 6

Which gender is at highest risk of TBI/Concussion in all age groups?

Answer 6

Males

Question 7

TBI/Concussions are major source of disability for which group of people?

Answer 7

Soldiers returning from Irag/Afghanistan

Question 8

Why is it difficult to obtain estimates of yearly TBIs from sports injuries?

Answer 8

The injured not seeking care

Question 9

• 4 sports associated w/ Concussions
• Which one has internationally the highest rate?

Answer 9

• Football
• Ice Hockey
• Soccer
• Rugby (highest rates)

Question 10

What is the word for the movement of brain on:

• Initial impact?
• Secondary impact?

Answer 10

• Coup
• Contre-coup

Question 11

3 states of confusion associated w/ Concussion

Answer 11

• Dazed
• Stunned
• Answers slowly

Question 12

Types of memory loss from Concussions

Answer 12

• Retrograde amnesia
• Anterograde amnesia

Question 13

2 visual disturbances associated w/ Concussions

Answer 13

• Double vision
• Light sensitivity

Question 14

Post-Concussive Sxs last how long?

• What are they? (6)

Answer 14

Days - Months

• Chronic HA
• Short term memory difficulties
• Fatigue
• Difficulty sleeping
• Personality changes (irritable/mood swings)
• Sensitivity to light / noise

Question 15

Post-Concussive Syndrome persists for more than ___.

Answer 15

1 week

Question 16

Post-Concussive Syndrome is “clustering” of what 3 difficulties?

Answer 16

• Physical
• Somatic
• Sleep-related

Difficulties

Question 17

3 cognitive difficulties of Post-Concussive Syndrome

Answer 17

• Memory
• Problem solving
• Decreased concentration

Question 18

When should a patient w/ Concussion be evaluated clinically?

Answer 18

• At time of incident
• After incident (FU)

Question 19

What tool is used for assessing concussions in athletes?

Answer 19

Sports Concussion Assessment Tool (SCAT5)

Question 20

What imaging if any is recommended for concussions?

Answer 20

CT

Question 21

Indications for CT after Concussion

• GCS < ___ how many hours after injury?
• Suspected ________
• Sign of ___ skull fx
• ___+ episodes of vomiting
• ___ y/o or older
• Amnesia for events occuring >__ mins prior to impact
• Dangerous mechanism
• Neuro deficit
• Seizures
• Bleeding diathesis or anticoagulant use
• *****Or if return visit for reassessmen of head injury*****

Answer 21

• 15
• open/depressed skull fx
• Basilar
• 2+
• 65
• 30

Question 22

4 signs of Basilar Skull Fx

Answer 22

• Racoon eyes
• Battle sign
• Hemotympanum
• CSF rhinorrhea

Question 23

Tx of Concussion

• First thing is: ______
• Rest and ___ for HA
• Gradual increase to _____
• Can pt return to play that day?
• Return to play: not until ____

Answer 23

• # 1: removal from event / activity
• acetaminophen
• full athletic activity
• AZ law: must be evaluated before returning to sport
• all sxs are gone and no meds required

Question 24

DO NOT give which 2 medications for concussions?

Answer 24

• NSAIDS: increase risk of bleed
• Morphine: sedates/decreases level of consciousness

Question 25

3 Intracranial (CNS) Tumors

Answer 25

* Astrocytoma (benign usually) * Glioblastoma * Meningioma

Question 26

CNS tumors arise from cells within CNS or from ____ cancers that have \_\_\_\_\_.

Answer 26

systemic / metastasized to CNS

Question 27

**CNS Tumors** * ___ and ____ account for 2/3 of primary adult brain tumors * ____ is most common in children * ____ is most common in adults w/ median age of ___ y/o

Answer 27

* Meningiomas & Glial Tumors * Low-grade astrocytoma * Glioblastoma / 64 yrs

Question 28

**CNS Tumors** * Slight ___ predominance in malignant tumors * Slight ___ predominance in meningiomas

Answer 28

* Male * Female

Question 29

3 CNS tumors of higher prevalence in black population

Answer 29

* Meningioma * Pituitary tumors * Craniopharyngioma

Question 30

What classification is used for CNS tumors?

Answer 30

WHO

Question 31

5 most common metastatic tumors --\> CNS

Answer 31

* lung * breast * renal * melanoma * colorectal

Question 32

A mass of well differentiated, non-invading, non-metastasizing cells

Answer 32

benign tumor

Question 33

* Capable to grow, invade, and spread * Anaplasia: cells w/ poor differentiation, losing morphological characteristics of mature normal cells

Answer 33

Malignant

Question 34

* Develops from epithelial cell * Tissues that line surfaces * Endodermal, mesodermal, & ectodermal layers

Answer 34

Carcinoma

Question 35

* From mesenchymal origin * Cancerous bone, cartilage, fat, muscle, vascular, hematopoietic cells * (connective tissues)

Answer 35

Sarcoma

Question 36

* Benign tumor of epithelial tissue w/ glandular origin

Answer 36

Adenoma

Question 37

* _____ can be useful to decrease edema, thus decreasing symptomatic effects of tumors

Answer 37

Steroids: Dexamethasone

Question 38

2 main clinical manifestations of CNS tumors

Answer 38

#1: Focal seizures (50-80%) #2: Headaches (50%)

Question 39

4 Focal Signs/Sxs of CNS tumors

Answer 39

* Weakness * Sensory loss * Aphasia * Visual spatial dysfunction

Question 40

\*\*\*\*3 signs of Increased Intracranial Pressure (ICP) from CNS tumors\*\*\*

Answer 40

* Headache * Nausea/Vomiting * Papilledema

Question 41

What imaging would you order for CNS tumor?

Answer 41

Brain MRI with contrast

Question 42

Imaging for screening for systemic malignancy

Answer 42

**CT** * chest * abdomen * pelvis

Question 43

**CNS tumor eval** * Get an LP if ____ is suspected

Answer 43

leptomeningeal seeding

Question 44

What imaging for "some lesions" (imaging is equivocal and non-neoplastic etiologies are being considered)

Answer 44

MR spectroscopy (type of MRI)

Question 45

**CNS Tumor Diagnosis** * Requires \_\_\_\_ * Type of procedure depends on what 4 things? * ____ is used as adjunct for tumors in delicate areas (pt is awake) * ____ performed in OR to determine preliminary biopsy results and help surgeon decide whether or not to proceed w/ extensive resection

Answer 45

* tissue sample for histopathologic / molecular study * Tumor: Type, Grade, Location, Operability * Functional MRI * Frozen Section