Concussion


Definition

Pathophysiology

Dx

Acute Treatment

  1. Assess and address ABCs
  2. Careful and repeated neurological exams
  3. Sports concussions
  4. Decide if CT scan necessary
  5. If CT performed and negative
  6. Recommend complete mental and physical rest while the patient is symptomatic (including NO homework or video games).
  7. Slow progression of activity from light aerobic exercise through the following stages:
  8. Physical & cognitive rest until symptoms resolve
  9. Monitor for deterioration post-injury and medical evaluation post-injury
  10. Graded program of exertion prior to medical clearance and return to play
  11. No same day RTP for athletes < 18 yo
  12. No distinction in management between elite and non-elite athletes
     
  13. Return-to-Play (RTP) Guidelines

Disposition

  1. Admit for:
  2. Discharge if:
  TYPE OF PATIENT ANATOMIC LOCATION CT FINDINGS COMMON CAUSE CLASSIC SYMPTOMS
Epidural Most common in young adults, rare in the elderly Potential space between skull and dura mater Biconvex, football-shaped hematoma Skull fracture with tear of the middle meningeal artery Immediate LOC with a "lucid" period prior to deterioration (only occurs in about 20% of patients)
Subdural More risk for the elderly & alcoholics Space between dura mater and arachnoid Crescent - or sickle-shaped hematoma Acceleration - deceleration with tearing of the bridging veins Acute: Rapid LOC-lucid period possible
Chronic: Altered MS & behavior with gradual decrease in consciousness
Subarachnoid Any age group following blunt trauma. Subarachnoid Blood in the basilar cisterns & hemispheric sulci & fissures Acceleration - Deceleration w/ tearing of the subarachnoid vessels Milt to moderate TBI w/ meningeal signs & symptoms
Contusion/
intracerebral hematoma
Any age group following blunt trauma. Usually anterior temporal or posterior frontal lobe May be normal initially with delayed bleed Severe or penetrating trauma, shaken-baby syndrome Symptoms range from normal to unconscious.