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TBI/Concussion - Coggle Diagram
TBI/Concussion
mTBI
Definition
Traumatically induced physiological disruption of brain function as manifested by one of the following
Loss of consciousness, Loss of memory/Amnesia for events before/after incident, altered mental state at time of accident, Focal neurological deficits
New Diagnostic Criteria
Biomechanically plausible mechanism of injury (1+ criteria is met)
1 or more clinical signs
2 clinical symptoms and at least one clinical/lab finding
Neuroimaging evidence of TBI on CT/MRI
Severity Classifciation
Mild: GCS 13-15, LOC <30 min, PTA <24 hrs
Moderate: GCS 9-12, LOC <24 hrs, PTA 1day-1 week
Severe: GCS 3-8, LOC >24, PTA >1 week
Common Symptoms
Physical
Headache, nausea, vomiting, blurred/double vision, seeing stars/lights, balance issues, dizziness, sensitivty to light, tinnitus
Behavioural/Emotional
Drowsiness, fatigue/lethargy, irritability, emotional lability, depression, anxiety, more sleep, issues falling asleep
Cognitive
Feeling slowed down, in a fog, dazed, difficulty concentrating/remembering
Pathophysiology
Force on brain neuronal cell membran and axon stretching results in
Change in intracellular ion concentration, increase utilization of glucose, decrease of resting cerebral blood flow, imdisciminante release of neurotransmitters, mitochondrial dysfunction
Neuroimaging
Not standard, and only employed whenever suspicion of intracerebral hemorrhage or structural lesion is suspected
Management
Education
Educate both patient and family
Symptoms, expected outcomes, reassure recovery, normalize symptoms, manage/cope with symptoms, gradual return, access further support, manage stress
REferal
Symptoms fail to respnd to treatment, patient wtih comorbidities or persistent sympomts
Sport Related Concussion
Assessment
Medical Evaluation SCAT5, Pocket concussion, Recognition Tool
Serial Monitoring over initial few hours
No return to play on day of injury
Management
Education, Physical and Cognitive relative rest, gradual return to school/social
Return to play
Stepwise -> Next level if asymptomatic
Each step should take 24 hrs
If symptoms recur: 24 hr rest period, drop back to previous level
Before starting: Asymptomatic at rest, should not be taking any pharmacotherapy that may modify
Second Impact Syndrome
Second event -> Brain loses ability to auto-regulate cerebral and intracranial perfusion pressures
Post Traumatic Headache
Assessment
Take a focused headache history/exam to determine headache subtype
Perform neurologic/MSK exam including C-spine
Possibility of medication-overuse headache needs to be considered (>15 days/month with frequent medication use)
Management
Education and lifestyle strategy
Medications
Simple analgesics/NSAIDs for tension/unclassifiable headache
Migranous: Effervescebnd NSAID, Triptans, Narcotics only as rescue medication
Prophyulaxis: only considered if headache >8 days/month refractory
Post concussion Syndrome
Diagnostic Criteria
History of head trauama with LOC preceding symtpom onset
3 or more of following categories
headache, dizziness, malaise, fatigue, noise intolerance
Irritability, depression, anxiety, emotional lability
Subjective concentration, memory, intellectual difficulties
Insomnia
Reduced alcohol tolerance
Preoccupation with above symptoms
Treatment
Education + Pacing
Treat secondary symptoms secondarily (Balance, dizziness, cognition, fatigue, tinnitus)
Primary symptoms: Post-traumatic headache, sleep disorder, depression/anxiety/irritability