Concussions/Peds
Are children or adults at greater risk for concussions?
Children
Alcohol use in adolescents can cause difficulty in..
Visuospatial and attention deficits, verbal and nonverbal recall, language and executive function, processing speed, sustained attention
Early onset depression has greater __________ volume loss, whereas late onset depression is more associated with ____________, lower rate of family history, higher rate of _________, and increased cerebral __________
Hippocampal; executive dysfunction; dementia; ischemia
Generally, >___ minutes of anoxia during circulatory arrest results in serious brain injury and related sequalae
5
Paraneoplastic syndrome can be caused by:
Consequence of cancer, hormones/cytokines excreted by tumor cells, or by immune system response to tumor
Which tests can be given to children?
D-KEFS, WRAML-2, WISC-IV, CVLT-C, WASI-2, NEPSY-2, WISC-5
In what areas of the brain are CB1 receptors found?
Medulla, cerebellum, basal ganglia, cerebral cortex, hypothalamus, hippocampus
Bipolar disorder is associated with decreased volume in the ____________, whereas depression is associated with decreased volume in the ___________
Amygdala; hippocampus
What are the treatments for hypoxia?
Treat acute or chronic associated complications (reestablish cardiac and pulmonary function) & protect brain injury during recovery and prevent further hypoxic injury (mild therapeutic hypothermia through conventional cooling, oxygen)
What are the 4 symptoms required for a diagnosis of CJD?
Myoclonus, pyramidal/extrapyramidal findings, visual or cerebellar deficits, akinetic mutism
What are some physical, cognitive, and emotional symptoms of concussions?
Physical: nausea, vomiting, LOC, balance/clumsiness, dizziness, light/noise sensitivity, drowsiness, more/less sleep. Cognitive: dazed, confused, slowed PS, forgetfulness, amnesia. Emotional: irritability/mood symptoms, behavioral changes (acting out), personality changes.
What is the primary mechanism for alcohol within the brain?
Suppresses output from pyramidal cells by interfering with activation of NMDA receptors
During mania AND depression, there may be decreased ___________ transmission. During just mania, there may be increased ___________ and ___________ activity.
Serotonin; norepinephrine; dopamine
Neurological effects of hypoxia are:
Persistent vegetative state, cognitive impairment, extrapyramidal motor symptoms, Korsakoff syndrome, parkinsonism, cerebellar ataxia, intention myoclonus, seizures, choreoathetosis
What nucleus on MRI is associated with CJD?
“pulvinar sign” on MRI- hyperintensities in pulvinar nucleus on T2 and FLAIR
What are the components of the CDC 5-step approach to concussion management?
Baseline: back to school, step 1: light aerobic activity, step 2: moderate activity, step 3: heavy non-contact activity, step 4: practice and full contact, step 5: competition
Excessive activation of CB1 receptors in CA1 appears to interfere with _________ functioning and ____________
Hippocampal, long-term potentiation
Stress causes release of _____________, stimulating ________ to secrete cortisol
CRH (corticotropin-releasing hormone); adrenal gland
Based on Gale & Hopkins (2004), CO poisoning results in deficits in _________, _________, and _____________, while obstructive sleep apnea results in impairment of _______________
attention, memory, and executive dysfunction; executive functioning
What are the differentials for CJD?
Frontotemporal dementia, corticobasal degeneration, progressive supranuclear palsy, dementia with lewy bodies, Alzheimer’s disease
What are some of the neurochemical and neurometabolic changes of concussions
Axonal shearing may occur (microscopic and not evident on imaging), cell depolarization- release of neurotransmitters (glutamate), depletes energy storage because activation of the pump requires energy-ATP
In adults, 28 day abstinence after chronic use led to performance indistinguishable from controls, but adolescents demonstrated poorer outcomes in _______ & ______, _______, some ___________, and possibly ___
Learning & memory, processing speed, executive functions, IQ
The monoamine deficiency hypothesis of depression involves what two areas?
Raphe nuclei, locus coeruleus
Severe, persistent hypoxia is due to what?
Accumulation of catabolic products and excitatory neurotransmitters like glutamate, excess glutamate results in intracellular influx of calcium, eventually leads to diffuse cell destruction
Specific brain abnormalities on an MRI – multiple infarctions of different ages and presence of brain hemorrhage could be indication of what?
Primary CNS vasculitis