HEAD INJURIES

Prevention Prevalent in contact and collision sports Education and communication Protective equipment Silent epidemic

Anatomy

Amnesia RETRO-GRADE ANTERO-GRADE What did you eat for breakfast? What team are we playing? What is the score of the game? Injury ANTERO-GRADE How did you get off of the field? Repeat digits in reverse order Serial-7 Test 5-word Recall

Assessment Special Tests Neurologic exam Eye function SCAT-2 Pupils equal reactive to light (PEARL) Eye tracking Nystagmus (bumpy movement) Blurred vision

Skull Fracture Cause: Signs & Symptoms: Blunt trauma Severe headache and nausea Palpation may reveal deformity

(cerebrospinal fluid) Skull Fracture Signs & Symptoms: (con’t) Care: Immediate hospitalization Racoon Eyes Battle’s Sign Halo Sign (cerebrospinal fluid)

Concussion Mild Traumatic Brain Injury: “Immediate and transient post-traumatic impairment of neural function with no focal lesions found on neuroimaging”

Concussion Causes: Signs & Symptoms: Direct blow Acceleration/deceleration forces Shaking of the brain Signs & Symptoms: Altered consciousness Amnesia

Concussion Signs & Symptoms: (con’t) Confusion Tinnitus Dizziness Photophobia Disorientation Difficulty Concentrating Amnesia Nausea Headache Blurred vision Sleep disturbances Irritability

Concussion Care More conservative in recent years Zurich Guidelines (2009) SCAT-2 to assess symptoms and cognitive function Any symptoms: remove from participation 7-step RTP protocol

Concussion Care Must be cleared by physician Repetitive concussions: 3-6x more likely after 1st concussion Cumulative trauma

Postconcussion Syndrome Causes: Prolonged symptoms following a concussion Not determined by severity of concussion May be caused by premature RTP

Postconcussion Syndrome Signs & Symptoms: Persistent headaches Impaired memory Lack of concentration Anxiety and irritability Fatigue Depression Poor academic performance

Postconcussion Syndrome Care Brain rest after concussion: Low lights, low activity Limit “screen time” Avoid activities that tax the brain Reading from paper/book is beneficial Follow RTP protocol

Second Impact Syndrome Causes: Hit to head when concussive symptoms still present Disrupts the brain’s blood autoregulatory system Rapid swelling and herniation of brain Second impact may be minimal

Second Impact Syndrome Signs & Symptoms: Often no LOC May looked stunned Within minutes, condition degrades rapidly Dilated pupils Loss of eye movement LOC leading to coma Respiratory failure

Second Impact Syndrome Care Life-threatening injury Immediate referral Life-saving measures w/in 5 minutes Best management is prevention Allow concussions to fully heal before RTP

Epidural/Subdural Hematoma Cause of Injury Blow to head or skull fracture Tear meningeal arteries Blood pressure and hematoma occur rapidly Subdural Epidural

Epidural Hematoma Signs & Symptoms: LOC followed by period of lucidity Few signs serious head injury Gradual progression of S&S Head pains Dilation of one pupil (same side as injury) Deterioration of consciousness Depression of pulse and respiration Convulsion

Epidural/Subdural Hematoma Care Immediate medical attention CT or MRI is necessary to determine extent of injury Must relieve pressure to avoid disability or death