Concussion
MECHANISMS
■ Any blunt trauma to the head: Sporting injuries (boxing, football, soccer,
basketball, baseball) commonly lead to concussions
SYMPTOMS
■ Brief LOC/cognitive and memory dysfunction/personality change
■ Dizziness/balance disturbance
■ Headache/photophobia/tinnitus
■ Nausea/vomiting
TREATMENT
■ Supportive care and close monitoring (usually at home)
■ Patients will usually completely recover, although 30–80% have symp-
toms 3 months out, and 15% have symptoms at 1 year (postconcussion
syndrome).
■ Patients should not return to contact sports until complete resolution
of symptoms.An initial head injury may predispose patients to worse out-
comes following a second head injury.
A 71-year-old male presents with bilateral arm weakness after a ground-level
fall. He denies neck pain and moves his neck without pain. What’s the diag-
nosis and mechanism of injury?
Central cord syndrome, resulting from hyperextension injury with buckling
of the ligamentum flavum against the central cord. X-rays are often normal. MRI
is confirmative.SPINAL FRACTURESAcute spinal injuries are classified into four categories according to mecha-
nism of injury:
■ Flexion fractures (eg, wedge, flexion teardrop, clay shoveler’s)
■ Vertical compression fractures (eg, burst, Jefferson)
■ Flexion-rotation (eg, unilateral facet)
■ Extension (eg, hangman’s)
MECHANISMS
■ Motor vehicle crashes
■ Sports, falls, diving in shallow water
■ Judicial hanging with knot in front (causing hyperextension)
■ Abrupt flexion during lifting (clay shoveler’s fracture)
Cervical Spinal Fractures
SYMPTOMS/EXAM
■ Individuals with C-spine fractures typically complain of posterior midline
neck pain and pain with movement of the neck.
■ The exam varies with the fracture location and degree of associated spinal
cord injury.
TRAUMA