Latest - (Smarty PANCE) (Latest / 1. What is a concussion?

PANCE Blueprint Neurology - All Smarty PANCE Neurology lesson sets combined (Smarty PANCE) (Latest /

• What is a concussion?

Answer: Injury to the body or head that results in a force to the brain, it can be accompanied by transient loss of consciousness; but not always.

• Concussion vs. Mild TBI

Answer: The term "concussion" is often used in the medical literature as a synonym for mild traumatic brain injury (mild TBI or mTBI). Mild TBI, or concussion has a GCS of 13 to 15

• What are the symptoms of a concussion?

Answer: Headache, dizziness (feeling off balance), confusion, retrograde/antegrade amnesia, and blurred vision. Symptoms typically resolve within 7 to 10 days postinjury.

• What are the indications for CT scan of the head in a patient with a suspected concussion?

Answer: Use validated clinical decision rules (such as the PECARN decision tool) to determine if imaging is warranted - No routine imaging of pediatric patients with mTBI.Indications for CT scan include prolonged loss of consciousness (>1 minute), persistent headache, altered mental status, repeated episodes of vomiting postinjury, history of repeated head injury/severe mechanism, or signs on physical examination of basilar skull fracture.

• What percent of CT scans in mild TBI are abnormal?

Answer: Approximately 10 per- cent of CT scans in mild TBI are abnormal, showing mild subarachnoid hemorrhage, subdural hemorrhage, or contusions. MRI is more sensitive than CT scan, showing abnormalities in approximately 30 percent of patients with normal CT scans

• What is the acute management of patients with concussion?

Answer: Rest, symptomatic treatment (for headaches and nausea), no contact sports, and decreased exposure to technology (television, cellular phones, computers, and electronic games). Athletes should be symptom free while at rest and exercise before returning to sports activities. Many states have laws requiring the patient be reevaluated and cleared before starting sports activities, and at times a stepwise progress for returning to activities is followed.

• Athletes who suffer a concussion during their activity resume their activity the same

day after normal physical exam and imaging findings?

Answer: Any child or adolescent with a suspected sport-related concussion

should be removed from further competition that day. If a concussion is diagnosed, the athlete should not return to play until a full recovery is evident.

• Patients with concussion should be admitted to the hospital if their Glasgow coma scale is less

than ?Answer: Patients with concussion should be admitted to the hospital if their Glasgow coma 1 / 4

scale is less than 15.

• What is post concussion syndrome?

Answer: Symptoms of headache, dizziness, difficulty concentrating, and fatigue that begins days to weeks after a head injury and can last weeks to several months

• What percent of patients with mild traumatic brain injury (TBI) will experience some

symptoms of PCS?Answer: 30 to 80 percent of patients with mild traumatic brain injury (TBI) will experience some symptoms of PCS

• Which patients with PCS should have an MRI?

Answer: Patient with PCS who have not had an MRI and have disabling complaints should have a brain MRI to exclude more serious pathology that would identify either a worse prognosis or an alternative cause for their symptoms.

• For patients with post concussion syndrome complaining of headache and dizziness, what

is the first-line treatment?Answer: Treatment is symptomatic treat headaches like migraines with PRN analgesics, psychotherapy

• Recovery time from post concussion syndrome?

Answer: Most patients recover quickly, within several weeks. A minority have prolonged disability

• A GCS of 13 to 15 indicates what

Answer: Mild TBI, or concussion has a GCS of 13 to 15

• A GCS of 9-12 indicates what?

Answer: Moderate TBI has a GCS of 9 to 12

• A GCS of 8 or less indicates what?

Answer: Severe TBI has a GCS of 8 or less.

• When is a brain CT indicated for TBI?

Answer: The brain CT is done for moderate and severe TBI, as well as in mild TBI where the individual has a worsening headache, persistent confusion, a focal neurological deficit, or is on anticoagulation therapy like warfarin

• Treatment of traumatic brain injury?

Answer: General measures for treating TBI include lowering the ICP by elevating the head of the bed to 30 degrees, sedation, intubation and hyperventilation in order to achieve a partial pressure of carbon dioxide or PaCO2 between 35 and 45 millimeters of mercury, osmotic diuresis with mannitol or hypertonic saline, and finally if all else fails, a decompressive 2 / 4

craniectomy. Specific lesions identified on CT scan such as epidural and subdural hematomas should be identified and evacuated

• On CT appear as a convex, "lens-shaped" hyperdense collection of blood that does not

cross the suture lines.Answer: Epidural hematomas appear as a convex, "lens-shaped" hyperdense collection of blood that does not cross the suture lines.

• On CT appear as a concave, "crescent-shaped" density that crosses the suture lines.

Answer: Subdural hematomas appear as a concave, "crescent-shaped" density that crosses the suture lines.

• On CT is seen as blood in the ventricular cisterns, interhemispheric fissures and within

the sulci.

Answer: Subarachnoid hemorrhage is seen as blood in the ventricular cisterns,

interhemispheric fissures and within the sulci.

• What two pre-hospital factors dramatically increase the mortality of patients suffering a

mild or moderate traumatic brain injury (TBI)?

Answer: Hyperventilation and poorly performed intubation

• What are the clinical indicators for performing pre-hospital or emergency department

hyperventilation, before invasive ICP monitoring, in a patient experiencing a traumatic brain injury (TBI)?Answer: Development of signs or symptoms of herniation; unilateral dilated pupil, asymmetric motor examination, or a declining GCS.

• How does cranial nerve I deficit present?

Answer: Loss of smell - CN I = Olfactory nerve

• How does cranial nerve II deficit present?

Answer: Partial or complete blindness - CN II = Optic nerve

• How does cranial nerve III deficit present?

Answer: Outward and downward deviation of the eye - Ptosis of the eyelid - Dilation of the ipsilateral pupil in complete palsy -CN III - Oculomotor nerve

• How does cranial nerve IV deficit present?

Answer: Vertical diplopia - CN IV = Trochlear nerve

• How does cranial nerve V deficit present?

Answer: Anesthesia of the forehead - Corneal drying - Decreased salivation - CN V = Trigeminal nerve 3 / 4

• How does cranial nerve VI deficit present?

Answer: Medial turning of affected eye - CN VI = Abducens nerve

• How does cranial nerve VII deficit present?

Answer: Complete or partial paralysis of the face - CN VII = Facial nerve

• How does cranial nerve VIII deficit present?

Answer: Positional vertigo - Tinnitus - Rarely hearing loss - CN VIII = Vestibulocochlear nerve

• How does cranial nerve IX deficit present?

Answer: Dysphagia and dysarthria - CN IX = Glossopharyngeal nerve

• How does cranial nerve X deficit present?

Answer: Focal: Aphonia dysphagia dysarthria - Systemic: (cardiac and GI most affected) - CN X = Vagus nerve

• How does cranial nerve XI deficit present?

Answer: Weakness with turning of head - CN XI = Spinal accessory nerve

• How does cranial nerve XII deficit present?

Answer: Weakness on the ipsilateral side and protrusion of the tongue toward the affected side

• CN XII = Hypoglossal nerve

• A group of progressive, invariably fatal, conditions that affect the brain are caused by the

accumulation of misfolded prion proteins giving the brain a "spongy" appearance?

Answer: Spongiform encephalopathy

• Diagnosis of spongiform encephalopathy?

Answer: Lumbar puncture ‘ levels of 14-3-3 protein. Definitive diagnosis with brain biopsy

• What is Creutzfeldt-Jakob disease (CJD)?

Answer: CJD is classified as a transmissible spongiform encephalopathy (TSE) along with other prion diseases that occur in humans and animals.

• How does bovine spongiform encephalopathy (mad cow disease) relate to humans?

Answer: Bovine spongiform encephalopathy (BSE), commonly known as mad cow disease, is an incurable and invariably fatal neurodegenerative disease of cattle. Symptoms include abnormal behavior, trouble walking, and weight loss. Later in the course of the disease the cow becomes unable to function normally. The time between infection and onset of symptoms is generally four to five years. Time from onset of symptoms to death is generally weeks to months. Spread to humans is believed to result in variant Creutzfeldt-Jakob disease (vCJD)

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