Mild traumatic brain injury

CONCUSSIONS

- transient aloc p trauma with neg ct

- but neg ct does not r/o diffuse axonal inj or microscopic inj

- with concussion can have abnormal neuro fnc for few days

- second impact syndrome- irrev brain damage p prior concussion after minor head inj- due to disordered autoregulation

- ct not as good as mri but good enough to find lesions requiring medical/ surgical eval

- risk of subsequent deterioration p neg initial ct is very low

- isolated skull fx and neg ct- few complications

- post traumatic sz with neg ct and neg neuro exam- low risk for subsequent sz

- theoretical risk for delayed bleeding p initial neg ct but these pts usually have abnormal neuro on presentation

- is normal neuro and neg ct, chance of delayed bleeding very rare

- minor trauma can give long term neuropsych changes- cognitive fnc, problem solving, attention, concentration- usually resolve p 1 yr

- the more concussions, the poorer the score on neuropsych testing

Return to Sports

minor- consussion, no LOC, neuro change <15 min- 1 wk no sports

Grade 2- consussion, no loc, neuro change >15 min- 1- 2 wks no sports

Grade 3- concussion w LOC- no sports for 2 wks

if second grade 3, no sport for 1 mo and ct pos- no sports for rest of season and possible for ever!