Concussion: Difference between revisions

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==Diagnosis==
==Diagnosis==
Diagnosis of MTBI is based on physical and neurological exams, duration of unconsciousness (usually less than 30&nbsp;minutes) and post-traumatic amnesia (PTA; usually less than 24&nbsp;hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15).<ref name="BorgHolm04"/> [[Neuropsychological test]]s exist to measure cognitive function.<ref name="Rees03"/>  The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient's condition.<ref name=moser>
{{
cite journal|author=Moser RS, Iverson GL, Echemendia RJ, Lovell MR, Schatz P, Webbe FM ''et al.'' |date=2007 |title=Neuropsychological evaluation in the diagnosis and management of sports-related concussion |journal=Archives of Clinical Neuropsychology |volume=22 |issue=8 |pages=909–916 |pmid=17988831
}}
</ref>  Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury.<ref name="pmid10981754">
{{
cite journal |author=Maroon JC, Lovell MR, Norwig J, Podell K, Powell JW, Hartl R |title=Cerebral concussion in athletes: Evaluation and neuropsychological testing |journal=Neurosurgery |volume=47 |issue=3 |pages=659–669; discussion 669–672 |year=2000 |pmid=10981754 |doi= |url=
}}
</ref> 


[[Image:Anizokoria.JPG|left|thumb|230px|Unequal pupil size is a sign of a brain injury more serious than concussion.]]
Health care providers examine head trauma survivors to ensure that the injury is not a more severe [[medical emergency]] such as an intracranial hemorrhage. Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting,<ref name="CookSchweer">
{{
cite journal |author=Cook RS, Schweer L, Shebesta KF, Hartjes K, Falcone RA |title=Mild traumatic brain injury in children: Just another bump on the head? |journal=Journal of Trauma Nursing |volume=13 |issue=2 |pages=58–65 |year=2006 |pmid=16884134 |doi=
}}
</ref> increasing disorientation or a deteriorating level of consciousness,<ref name="Kayteasdale">
{{
cite journal |author=Kay A, Teasdale G |title=Head injury in the United Kingdom |journal=World Journal of Surgery |volume=25 |issue=9 |pages=1210–1220 |year=2001 |pmid=11571960 |doi=10.1007/s00268-001-0084-6 |url=
}}
</ref> [[post-traumatic seizure|seizure]]s, and [[anisocoria|unequal pupil size]].<ref name="cdcfacts">
{{
cite web|publisher=Centers for Disease Control and Prevention |date=2006 |url=http://www.cdc.gov/ncipc/tbi/contents.htm |title=Facts About Concussion and Brain Injury |accessdate=2008-01-13
}}
}}
</ref>  Patients with such symptoms, or who are at higher risk for a more serious brain injury, are given [[Magnetic resonance imaging|MRI]]s or [[CT scan]]s to detect brain lesions and are observed by medical staff.   
</ref>  Patients with such symptoms, or who are at higher risk for a more serious brain injury, are given [[Magnetic resonance imaging|MRI]]s or [[CT scan]]s to detect brain lesions and are observed by medical staff.   

Revision as of 14:57, 27 February 2013

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Concussion
Deceleration can exert rotational forces in the brain, especially the midbrain and diencephalon.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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}} </ref> Patients with such symptoms, or who are at higher risk for a more serious brain injury, are given MRIs or CT scans to detect brain lesions and are observed by medical staff.

Health care providers make the decision about whether to give a CT scan using the Glasgow Coma Scale.[1] In addition, they may be more likely to perform a CT scan on people who would be difficult to observe after discharge or those who are intoxicated, at risk for bleeding, older than 60,[1] or younger than 16. Most concussions cannot be detected with MRI or CT scans.[2] However, changes have been reported to show up on MRI and SPECT imaging in concussed people with normal CT scans, and post-concussion syndrome may be associated with abnormalities visible on SPECT and PET scans.[3] Mild head injury may or may not produce abnormal EEG readings.[4]

Concussion may be under-diagnosed. The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead clinicians to miss the injury, and athletes may cover up their injuries in order to be allowed to remain in the competition.[5] A retrospective survey in 2005 found that more than 88% of concussions go unrecognized.[6]

Dementia pugilistica

Chronic encephalopathy is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition called dementia pugilistica, or "punch drunk" syndrome, which is associated with boxers, can result in cognitive and physical deficits such as parkinsonism, speech and memory problems, slowed mental processing, tremor, and inappropriate behavior.[7] It shares features with Alzheimer's disease.[8]

Second-impact syndrome

Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases. The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away.[9] No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain's arterioles lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow.[10] As the brain swells, intracranial pressure rapidly rises.[11] The brain can herniate, and the brain stem can fail within five minutes.[9] Except in boxing, all cases have occurred in athletes under age 20.[12] Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.[13]

Related Chapters


References

  1. 1.0 1.1 Ropper AH, Gorson KC (2007). "Clinical practice. Concussion". New England Journal of Medicine. 356 (2): 166–172. doi:10.1056/NEJMcp064645. PMID 17215534.
  2. Poirier MP (2003). "Concussions: Assessment, management, and recommendations for return to activity (abstract)". Clinical Pediatric Emergency Medicine. 4 (3): 179–185. doi:10.1016/S1522-8401(03)00061-2. External link in |title= (help)
  3. Binder LM (1986). "Persisting symptoms after mild head injury: A review of the postconcussive syndrome". Journal of Clinical and Experimental Neuropsychology. 8 (4): 323–346. doi:10.1080/01688638608401325. PMID 3091631.
  4. Delaney JS, Abuzeyad F, Correa JA, Foxford R (2005). "Recognition and characteristics of concussions in the emergency department population". Journal of Emergency Medicine. 29 (2): 189–197. doi:10.1016/j.jemermed.2005.01.020. PMID 16029831.
  5. Mendez MF (1995). "The neuropsychiatric aspects of boxing". International Journal of Psychiatry in Medicine. 25 (3): 249–262. PMID 8567192.
  6. Jordan BD (2000). "Chronic traumatic brain injury associated with boxing". Seminars in Neurology. 20 (2): 179–85. doi:10.1055/s-2000-9826. PMID 10946737.
  7. 9.0 9.1
  8. McCrory P (2001). "Does second impact syndrome exist?". Clinical Journal of Sport Medicine. 11 (3): 144–149. PMID 11495318.

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