Differentiating Concussion From Intracranial Pathology in Athletes

Clinical Scenario:A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad.Focused Clinical Question:Which clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?

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Using Clinical Signs and Symptoms for Medical Management of Radiation Casualties – 2015 NATO Exercise

Radiation Research ◽

10.1667/rr14619.1 ◽

2017 ◽

Vol 187 (3) ◽

pp. 273 ◽

Cited By ~ 15

Author(s):

H. Dörr ◽

M. Abend ◽

W. F. Blakely ◽

D. L. Bolduc ◽

D. Boozer ◽

...

Keyword(s):

Medical Management ◽

Clinical Signs ◽

Signs And Symptoms ◽

Clinical Signs And Symptoms

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Relationship of depth of brain lesions to consciousness and outcome after closed head injury

Journal of Neurosurgery ◽

10.3171/jns.1988.69.6.0861 ◽

1988 ◽

Vol 69 (6) ◽

pp. 861-866 ◽

Cited By ~ 81

Author(s):

Harvey S. Levin ◽

David Williams ◽

Marsha J. Crofford ◽

Walter M. High ◽

Howard M. Eisenberg ◽

...

Keyword(s):

Head Injury ◽

Brain Lesion ◽

Closed Head Injury ◽

Secondary Effects ◽

Impaired Consciousness ◽

Content Type ◽

Closed Head ◽

Intracranial Lesions ◽

Relationship Of ◽

The Relationship

✓ Magnetic resonance (MR) imaging was performed in 94 patients who sustained closed head injury of varying severity. Results of MR studies obtained after the intensive care phase of treatment disclosed that intracranial lesions were present in about 88% of the patients. Consistent with the centripetal model of progressive brain injury proposed in 1974 by Ommaya and Gennarelli, the depth of brain lesion was positively related to the degree and duration of impaired consciousness. Further analysis indicated that the relationship between depth of brain lesion and impaired consciousness could not be attributed to secondary effects of raised intracranial pressure or to the size of intracranial lesion(s).

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The Etiologies of Isolated Fourth Cranial Nerve Palsy: A 10-Year Review of 158 Cases

10.21203/rs.3.rs-323169/v1 ◽

2021 ◽

Author(s):

Apatsa Lekskul ◽

Wadakarn Wuthisiri ◽

Phantaraporn Tangtammaruk

Keyword(s):

Nerve Palsy ◽

Demographic Data ◽

Closed Head Injury ◽

Clinical Signs ◽

Case Series ◽

Signs And Symptoms ◽

Rapid Progression ◽

Clinical Signs And Symptoms ◽

Atypical Presentations ◽

Fourth Nerve Palsy

Abstract MethodsPatients diagnosed with isolated fourth nerve palsy from January 1, 2009, through July 31, 2020 in Ramathibodi Hospital, were included in this retrospective, observational case series. The demographic data of patients, age at presentation, the etiologies of isolated fourth nerve palsy and neuroimaging results (if indicated) were recorded.ResultsWe identified 153 unilateral and 5 bilateral cases of isolated fourth nerve palsy. Mean age at presentation was 38.89 ± 25.71 years old. Most of the unilateral cases were congenital (58.17%), with vasculopathy (27.45%), intracranial neoplasm (8.5%) and other etiologies. Trauma with closed head injury was the most common etiology of bilateral cases (60%), followed by ruptured arterovenous malformation (20%) and vasculopathy (20%). Twenty-one of the 43 (48.84%) patients with vasculopathy-associated fourth nerve palsy underwent neuroimaging, with normal findings, and all patients’ symptoms resolved within 6 months of symptom onset.ConclusionsIn our series, most of the isolated fourth nerve palsy cases were congenital, followed in frequency by vasculopathy and intracranial tumor, as in many studies. In cases of vasculopathy, the clinical signs and symptoms resolved within 6 months in all cases: observation was sufficient, with no necessity for neuroimaging. However, neuroimaging should be considered in cases with atypical presentations, such as headache, periorbital pain, ataxia with positive cerebellar signs, or if there is rapid progression or no recovery.

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Software Tools for the Evaluation of Clinical Signs and Symptoms in the Medical Management of Acute Radiation Syndrome—A Five-Year Experience

Health Physics ◽

10.1097/hp.0000000000001353 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Matthias Port ◽

Julian Haupt ◽

Patrick Ostheim ◽

Matthäus Majewski ◽

Stephanie E. Combs ◽

...

Keyword(s):

Medical Management ◽

Clinical Signs ◽

Signs And Symptoms ◽

Software Tools ◽

Acute Radiation ◽

Acute Radiation Syndrome ◽

Clinical Signs And Symptoms

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Confidence and willingness among laypersons in the UK to act in a head injury situation: a qualitative focus group study

BMJ Open ◽

10.1136/bmjopen-2019-033531 ◽

2019 ◽

Vol 9 (11) ◽

pp. e033531

Author(s):

Stefan Tino Kulnik ◽

Mary Halter ◽

Ann Hilton ◽

Aidan Baron ◽

Stuart Garner ◽

...

Keyword(s):

Decision Making ◽

Head Injury ◽

Focus Group ◽

Clinical Signs ◽

Signs And Symptoms ◽

First Aid ◽

Snowball Sampling ◽

Focus Group Study ◽

Clinical Signs And Symptoms ◽

The Uk

ObjectivesTo explore factors influencing confidence and willingness among laypersons in the UK to act in a head injury situation, in order to inform first aid education offered by the British Red Cross.DesignQualitative focus group study.SettingSouth East England.ParticipantsForty-four laypersons (37 women, 7 men) were purposively recruited from the general public using snowball sampling, into one focus group each for six population groups: parents of young children (n=8), informal carers of older adults (n=7), school staff (n=7), sports coaches (n=2), young adults (n=9) and ‘other’ adults (n=11). The median (range) age group across the sample was 25–34 years (18–24, 84–95). Participants were from Asian (n=6), Black (n=6), Mixed (n=2) and White (n=30) ethnic backgrounds.ResultsThe majority of participants described being confident and willing to act in a head injury scenario if that meant calling for assistance, but did not feel sufficiently confident or knowledgeable to assist or make decisions in a more involved way. Individuals’ confidence and willingness presented as fluid and dependent on an interplay of situational and contextual considerations, which strongly impacted decision-making: prior knowledge and experience, characteristics of the injured person, un/observed head injury, and location and environment. These considerations may be framed as enablers or barriers to helping behaviour, impacting decision-making to the same extent as—or even more so than—the clinical signs and symptoms of head injury. An individual conceptual model is proposed to illustrate inter-relationships between these factors.ConclusionsOur findings show that confidence and willingness to act in a head injury scenario are dependent on several contextual and situational factors. It is important to address such factors, in addition to knowledge of clinical signs and symptoms, in first aid education and training to improve confidence and willingness to act.

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A Rare Case of an Extensive Multi-compartment Epidermoid Presenting with Pure Motor Trigeminal Neuropathy, Case Report and Review of Literature

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_277_18 ◽

2019 ◽

Vol 10 (02) ◽

pp. 364-366

Author(s):

Jaypalsinh Gohil ◽

Gopikrishnan Rajasekar ◽

Pankaj Shivhare ◽

Prakash Nair ◽

Mathew Abraham

Keyword(s):

Trigeminal Nerve ◽

Rare Case ◽

Clinical Signs ◽

Signs And Symptoms ◽

Middle Cranial Fossa ◽

Trigeminal Neuropathy ◽

Motor Component ◽

Intracranial Lesions ◽

Clinical Signs And Symptoms ◽

Pure Motor

ABSTRACTEpidermoid cysts are benign slow-growing tumors, clinical signs and symptoms at the time of presentation are related to the location and extent of the lesion. The motor fibers of the trigeminal nerve are fairly resistant to extraneous compression. Intracranial lesions in the vicinity of the trigeminal nerve usually present with sensory symptoms without affecting the motor component. We report a rare case of a middle cranial fossa epidermoid presenting with pure motor trigeminal neuropathy.

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