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Triad
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Other S&S
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Headache
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Nausea
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Vomiting
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Worse first thing in the morning
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Convulsions
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Valsalva movements make it worse
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new onset/change in HA
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Seizures
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Confusion
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Dysphagia
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Motor Weakness
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Personality Changes
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Memory Loss
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Dizziness
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Headache
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Vomiting
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S&S
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Persistant unilateral throbbing over temporal region + scalp tenderness
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Associated with PMR - look for bilateral inflammatory signs over shoulder/hip area
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>50y
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Severe burning - worse in morning & constant
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Malaise, vague aches, pains, weight loss
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ESR/CRP elevated
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Urgent referral (same day) to GP - risk of blindness
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Common in teens and young adults
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Athletes more at risk - football, boxing, hockey, soccer, MMA, military personnel, victims of domestic abuse, motor accidents
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- One type of brain injury
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- Subconcussive injury = traumatic impact to the head that does not result in immediate clinical symptoms
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- Simple concussion = progressively resolves after 7-10 days without complications
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- Complex concussion = persistent symptoms and Hx of loss of consciousness >1 minute, recurrence/exacerbation on exertion, prolonged impairment of cognitive function, seizure
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Mechanical insult - complex cascade of biochemical dysfunction - mitrochondrial dysfunction - disrupts brain's neuronal homeostasis
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- Headache
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- Confusion, light-headedness/dizziness, visual disturbances, tinnitus, lethargy, insomnia, photophobia, irritability, mood changes, cognitive difficulties
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- Impaired memory & leaning, reduced planning, inability to switch mental tasks, attention deficits, slower information processing, slowed reaction times
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- Symptoms worse with physical exertion/stress
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- GCS <15
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- Deteriorating mental status
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- Potential spinal injury
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- Progressive neurological signs/symptoms
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- Persistent vomiting
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- Suspected skull f#
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- Seizures
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- Coagulopathy
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- Prior neurosurgery
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- Multiple injuries
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What ground/field/rink are we playing at?
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What team are we playing today
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What half/quarter/period is it?
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How far into the game is it?
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Which side scored last?
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What team did we play last game?
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Did we win last game?
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Once concussed patient is out of the game, an attendant should stay with them for 24 hours post concussion
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Attendant should observe patient every 4 hours
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Should be alert for: worsening ha, irritability, persistent nausea/vomiting, difficulting speaking, swallowing, tinnitus, SOB, light headiness, numbness, confusion, memory loss, clear CSF discharge from nose/ears, unequal pupils, fever, visual disturbances, seizures, LOC, easily aroused
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Drink only clear fluids for 8-12 hours
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No alcohol
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Diet should begin light and progress to normal over 24 hours
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Sedatives, sleeping pills, aspirin and ibuprofen should be avoided
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Avoid physical and mental activity for first 24 hours - school, work, texting, video games, driving, operation of dangerous tools or heavy equipment
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Should sleep with head elevated for 24 hours
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Follow up assessment - did you hit your head? Lose conciousness? experience amnesia, loss of memory, disorientation/confusion? Dizziness or unsteadiness? Memory problems/forgetfulness? Concentration/attention problems?
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May be used to rule out Cx injury
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Canadian CT head rule - witnessed loss of conciousness,amnesia/disorietnation
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MRI for: GCS <15 at 2 hours post injury
>2 episodes of vomiting >65 or older Suspected skull f# (haemotympanum, raccoon eyes, CSF otorrhoea/rhinorrhoea, battles sign (bruising over mastoid) Pre injury amnesia >30 mins Dangerous mechanism of injury - struck by motor vehicle, MVA ejection, fall from >3 feet |
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- Recovery period = 100 days
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- Some patients have post concussion syndrome within 1-2 weeks up to 3 months
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- Delayed recovery factors = >4 symptoms
HA >60 hours Pre-injury HA Self reported fatigue/foginess prior mTBI Hx of PTSD, ADHD, learning disability advancing age no and proximity of concussions Duration of concussion (>10 days) prolonged loss of consciousness (>1 minute) amnesia convulsions co-morbidities Medication |
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- Allowed to play when:
Complete clearing of symptoms at rest - no pain meds No symptoms after provocative testing - cycling, running, cardio exercises Full return of cognitive ability, memory and concentration |
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- Can do light aerobic activity after symptoms resolve if it does not excaberate symptoms then progressive more demanding activity should be considered (70%)
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- Multiple concussed patients increased risk of Alzheimers, ALS , Suicide, Parkinsons and Dementia
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- Assess Paraspinals - suboccipitals
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- Patients who worsen/do not show improvement after 3-5 days should be referred to a specialist
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- EPA/DHA/Magnesium
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S&S
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Causes
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Management
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Sudden, abrupt Headache - Reaches peak @ 1 hour
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SAH
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REFER IMMEDIATELY TO HOSPITAL
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"Worse Headache of their life"
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Intracranial haematoma
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DON'T LET THEM DRIVE
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"Feels as though they are being hit on the back of the head"
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Cerebral venous sinus thrombosis
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Very Different type of Headache
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Cervical Artery dissection
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Ischaemic Stroke
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||
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S&S
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Severe Headache
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Neck Stiffness
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High Fever
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Altered Mental State
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Photo/Phonophobia
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Refer immediately to hospital - dial 999
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CRP, FBC, blood cultures, lx puncture
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Present in the morning
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Wakes Child at night
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No PMHx
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No Family Hx
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Associated Poor health
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Associated Neuro symptoms
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Presents unilaterally
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