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Concussions Allyson S. Howe, MD Major, USAF, MC
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Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

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Page 1: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

ConcussionsAllyson S. Howe, MD

Major, USAF, MC

Page 2: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

INTRODUCTION DEFINITION DIAGNOSIS

EVALUATION GRADING

MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT

GUIDELINES PRAGUE 2004

BOARD QUESTIONS

Page 3: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

DEFINITION OF CONCUSSION “A traumatically induced alteration of consciousness”, Robert

Cantu, 1986. A complex pathophysiological process affecting the brain,

induced by traumatic biomechanical forces. Concussion may be caused by either a direct blow to the head,

face, neck, or elsewhere on the body with an ‘impulsive’ force transmitted to the head.

It typically results in the rapid onset of short-lived impairment of neurologic function that resolves spontaneously.

It results in a graded set of symptoms that may or may not involve loss of consciousness.

Resolution of clinical/cognitive symptoms typically follows a sequential course.

Normal imaging. Prague Conference, 2004.

Page 4: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSEPIDEMIOLOGY

Mild traumatic brain injury (MTBI) accounts for 75% of all brain injuries

50,000-300,000 athletes per season “Ding” or “Bell-rung” = concussion but is not

always recognized as such by coaches or athletes

Page 5: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

PHYSIOLOGY OF CONCUSSION

Functional disturbance without gross structural injury

Immediately following concussion: Altered ionic fluxes into cells of brain INCREASED brain energy demand

(hyperglycolysis) Decreased cerebral blood flow…? Calcium

mediated As mismatch corrects, symptoms abate

Page 6: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CASE 20-year-old hockey player

in your office on Monday morning

Sustained a hit in a game on Saturday

Had dizziness and headache after the hit for 5 hours

Denies LOC Anterograde amnesia for

15 minutes Here because his coach

wants medical clearance

Page 7: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CASE #1 What else do you want to know? PRIOR CONCUSSION HISTORY Clinical history from witness (Athletic

Trainer) Mechanism of injury

Page 8: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.
Page 9: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CASEEXAM AT 36 HOURS

On exam: CN II-XII normal Normal visual acuity but

blinks often Normal attention span Normal short term

memory Doesn’t remember hit Positive Romberg FNF, RAM intact

Page 10: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSDIAGNOSIS

Generally history of head trauma Direct hit Indirect impulsive force

Neurologic compromise Improves spontaneously Non-focal (usually)

No red flags

Page 11: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSRED FLAGS

Young age Confusion lasting > 30 minutes Loss of consciousness > 5 minutes Focal neurologic deficit Deteriorating level of consciousness

Page 12: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSCOGNITIVE FEATURES

Cognitive features Unaware of period, opposition, score of game Confusion Amnesia LOC

Page 13: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSTYPICAL SYMPTOMS

Headache Balance problem Dizziness Nausea Feeling ‘foggy’ Visual problems Hearing problems Irritability, emotional changes

Page 14: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSPHYSICAL SIGNS

LOC or impaired consciousness Poor conduction or balance Convulsion Gait unsteadiness Slow to answer questions, follow directions Easily distracted Emotional disturbance Slurred speech Vomiting Vacant stare

Page 15: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

WHICH CHILD HAS A CONCUSSION?

Page 16: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSINITIAL EVALUATION

ABCs C-spine precautions Neurologic exam:

Cranial nerves Coordination testing Romberg Strength/sensation ?

Page 17: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSINITIAL EVALUATION

Memory testing Attention span: months of year backwards, repeat 5

numbers forwards and backwards Short term: 3 items at 5 minutes Assess for amnesia

Retrograde Anterograde

Consider imaging for prolonged LOC, changing LOC, focal symptoms, prolonged symptoms; clinical judgment important!

Page 18: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSNEUROPSYCH TESTING

Objective measure of cognitive status Cognitive improvement may precede or

follow clinical improvement Computer based testing can assess for

performance variability

Page 19: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSGRADING

Mild:

grade I

Moderate:

grade II

Severe:

grade III

Cantu

Colorado Consortium

American Academy of Neurology

LOC= Loss of consciousness; PTA= Post-traumatic amnesia

No LOCPTA <30min

LOC <5 minPTA >30min but <24 hrs

LOC > 5 minPTA > 24 hrs

No LOCNo amnesia+ confusion

No LOC+amnesia+confusion

Any LOC

No LOCTransient confusionSymptoms <15min

No LOCTransient confusionSymptoms >15min

Any LOC

Page 20: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CASE Cantu grading:

Grade I concussion, grade II concussion? Colorado and AAN= Grade II concussion

Balance regained after 48 hours Able to run, skate, sprint without symptoms Returned to play (NHL playoffs) at 72 hours (Scored the winning goal in his 2nd game back)

Page 21: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSAMNESIA VERSUS LOC

78 athletes with sports related concussion High school (61) and college athletes ImPACT testing pre-season and 2 days

following injury Immediate Post Concussion Assessment and Cognitive Testing

Presence of amnesia more predictive of symptom and neurocognitive deficits than loss of consciousness

Collins MW, et al. On-Field Predictors of Neuropsychological and Symptom Deficit Following Sports-related Concussion. Clinical Journal of Sport Medicine. 2003. 13:222-229.

Page 22: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSATHLETE AWARENESS

Athletes don’t realize they have or have had a concussion

328 football, 201 soccer 70.4% football, 62.7% soccer players had

experienced symptoms of concussion in previous year

23.4% football and 19.8% soccer realized they had suffered a concussion

Coaches don’t recognize injury either Players who recognized concussion were more

likely to have had one in the past

Delaney JS, Lacroix VJ, Leclerc S, Johnston KM. Concussions Among University Football and Soccer Players. Clinical Journal of Sports Medicine. 12:331-338. 2002.

Page 23: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSRETURN TO PLAY

Step-wise return to activity No activity, complete rest until asymptomatic Light aerobic exercise (walking) Sport-specific training Non-contact training drills Full contact training (after medical clearance) Game play

If athlete becomes symptomatic at any level, drops back to previous level

Page 24: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSRETURN TO PLAY

Very clear: no return to play if symptomatic

Grade I concussion most common Remove from play that

day May return once

asymptomatic and can pass exertion drills without symptom recurrence

Page 25: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSRETURN TO PLAY

Return to play for Grade I concussion most commonly by 7 days Assumes this is the first

concussion for this athlete this season

Career ending? 2 or 3 grade II or III

concussions in a career

Page 26: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSREFERRAL CRITERIA

Acute referral Subdural/epidural

hematoma C-spine injury Deteriorating LOC Focal motor weakness Transient quadriparesis Seizure

Referral Persistent headache at 7

days Post concussion syndrome

lasting > 2 weeks Abnormal neuropsych testing History of multiple high grade

concussions over season or career

Clinical discretion

Page 27: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSPRAGUE CONSENSUS 2004

IIHF, FIFA, IOC Goal: create position statement on diagnosis and

treatment of concussion Recommend abandonment of grading scales in

favor of individual and functional analysis Can only determine severity in retrospect after

symptoms have resolved completely Concept of “cognitive rest” Simple versus Complex concussion Baseline evaluation at PPE recommended

McCrory P, et al. Summary and Agreement Statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Clinical Journal of Sport Medicine. 15(2):48-55. Mar 2005.

Page 28: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSPREVENTION

Regarding sports: Helmets do not prevent concussions but

probably decrease risk Soccer headgear

May transmit force to the brain Danger to other players?

Mouth guards- controversial Proven way to prevent maxillofacial injuries

Page 29: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

As team physician for a high school football team, you are standing on the sideline during a game when you note that one player does not rise after a play. When you reach him, he is lying on his back with his eyes closed. He is not moving.

Page 30: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

The first thing to do for this patient is: A. establish that the patient has a patent

airway and is breathing B. place a roll under the patient’s neck for

support C. check the pupils D. take off the patient’s helmet and pads E. place an intravenous line

Page 31: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

After approximately 10 seconds, the patient awakens. He is disoriented and confused but can tell you his name and what he had for breakfast. He does not, however, remember anything about the game. He denies any neck pain and is allowed to sit up. With help, he walks to the sideline and sits down again for your evaluation. He says he feels perfectly fine and wants to go back into the game. Your evaluation should include:

Page 32: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

A. a complete neurologic evaluation B. immediate and long-term memory recall C. balance testing D. serial subtraction testing E. all of the above

Page 33: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

After a few moments of evaluation, the athlete begins to complain of a severe right-sided headache. He becomes lethargic and lapses again into unconsciousness. He is immediately taken to the emergency room by the ambulance on the sideline. What injury most likely accounts for his second collapse?

Page 34: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

A. subdural hematoma B. epidural hematoma C. diffuse axonal injury D. second-impact syndrome E. subarachnoid hemorrhage

Page 35: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.
Page 36: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

Warning signs for which an athlete who has sustained a concussion should seek immediate medical evaluation include:

A. difficulty in staying awake B. seizures C. urinary or bowel incontinence D. weakness or numbness of any part of

the body E. all of the above

Page 37: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

Choose the following statement that is false: A. approximately 10% of college football players will

sustain a concussion each season B. multiple concussions can result in cumulative

brain damage C. there does not have to be a loss of consciousness

for there to be a diagnosis of concussion D. athletes readily admit to symptoms of a

concussion E. close observation of the athlete is of critical

importance after a head injury

Page 38: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.
Page 39: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

A gymnast fell off the uneven bars during a competition and hit her head on the ground. She had a 2-minute loss of consciousness and had posttraumatic amnesia for 2 hours, which completely resolved. She was sent to the emergency room and had a CT scan of the head, which was negative for any intracranial bleeding. She was discharged to home. She now comes 2 days later to your office complaining of headache and the inability to concentrate in class.

Page 40: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

This patient has signs and symptoms of: A. postconcussive syndrome B. continuing symptoms of a concussion C. second-impact syndrome D. epidural hematoma E. malingering

Page 41: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

The athlete has an important competition coming up in 2 days. She should be:

A. allowed to participate because her CT scan was negative for any bleeding

B. allowed to do any event except for the uneven bars

C. restricted from any activity until she has been asymptomatic for 1 week and has no symptoms on exertion

D. restricted until her headache goes away at rest E. readmitted to the hospital for another CT scan of

the head

Page 42: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

The athlete recovers and returns to competition after one week. Two weeks later, she receives a glancing blow to the head and sustains another loss of consciousness, this time less than 30 seconds. She has no amnesia and recovers quickly with no symptoms of headache or difficulty concentration. She should:

Page 43: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

A. return to competition as soon as she is asymptomatic

B. return to competition when she has been asymptomatic for 2 week

C. be restricted for activity for at least 1 month, then only may return if she is asymptomatic for more than one week

D. return to competition but wear a helmet E. exercise on a stationary bicycle for 2

weeks

Page 44: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSTAKE HOME POINTS

No return to play if symptomatic Assume cervical spine injury in unconscious players Athletes commonly do NOT recognize they have or

have had a concussion Deteriorating LOC = bleed until proven otherwise Amnesia correlates best with cognitive deficit When in doubt, err on the side of conservative

management Individualized management is best

Page 45: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.
Page 46: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

QUESTIONS?

Page 47: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

You are covering a college football game as a team physician. A player sustains a hard hit to the head while being tackled by two other players. He stands up directly after the play, shakes his head for a moment, and then joins the huddle for the next play. He appears confused and runs to the wrong spot. After a few more plays, one of his teammates tells the trainer that he is not remembering plays.

Page 48: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

When the trainer tells you this information, you: A. allow him to continue play because he had no

loss of consciousness and the game is almost over B. have the trainer check to make sure that there is

enough air in his helmet C. watch him more carefully on the next play D. remove him immediately from play for evaluation E. remind the trainer that this particular player failed

most of his classes the previous semester

Page 49: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

When you speak to the athlete, he states that he feels fine and wants to go back to play. He denies headache or dizziness and has a normal neurologic examination. He cannot recall three objects 2 minutes after being told them. He also cannot subtract serial 7s accurately. You should now:

Page 50: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

A. allow him to return to play because he has a normal neurologic exam

B. send him directly to the hospital for a computed tomography (CT) scan of the head

C. have the athlete sit down quietly and retest him in 15 minutes

D. send him to the showers E. send him home with his parents

Page 51: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

The most important reason for not allowing an athlete with symptoms of a concussion to play is:

A. he has not been checked for a neck injury B. the athlete may experience headache and

dizziness with exertion C. if the athlete is injured, the physician is likely to

be sued D. if the patient cannot remember the plays, the

team is likely to lose the game E. the athlete is at risk for much more severe injury

if he sustains another hit

Page 52: Concussions Allyson S. Howe, MD Major, USAF, MC. INTRODUCTION DEFINITION DIAGNOSIS EVALUATION GRADING MANAGEMENT RETURN TO PLAY REFERRAL CRITERIA CURRENT.

CONCUSSIONSBOARD QUESTIONS

Which one of the following statements is not true? A. the Glasgow coma scale is a useful adjunct for

evaluating an athlete after a head injury B. despite the guidelines for return to play as compiled by

Cantu and others, the final decision should be base on the individual situation and the best clinical judgment

C. types of intracranial injuries that can be encountered in the athlete include epidural hematomas, subdural hematomas, subarachnoid hemorrhages, diffuse axonal injury and intracerebral hematomas

D. concussions can have long-lasting effects on cognitive abilities and concentration

E. Concussions can be prevented by proper helmet use


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