Solutions
Traumatic Brain Injury (TBI)
1. Also known as concussion and may or may not
involve LOC.
2. HA, dizziness and confusion are identified as the
most common c/c.
3. Currently no widely accepted classification
system.
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Patho:
,Identifiable metabolic alterations in
intra-/extracellular K+, Ca+ and glutamate
w/subsequent neuron dysfxn. Micro-tearing of
cerebral blood vessels and a relative decrease in
cerebral blood flow also occurs. An increased
requirement for glucose by the brain, coupled
w/decreased blood flow, may result in cellular
dysfxn and increased susceptibility to subsequent
brain injury.
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Risk factors:
Falls: Most common cause for pts age > 65. Up to
1/3 of all sport-related injuries may go unreported
or undiagnosed.
Contact Sports: football, basketball, hockey, soccer
(college males), skiing and snowboarding.
TBI: Clinical Presentation and Return to play
,Confusion.
Post-traumatic amnesia (PTA).
Retrograde amnesia.
LOC
Disorientation, feeling "in a fog" or zoned out.
Inability to focus (work or school).
Delayed verbal and motor responses.
Excessive drowsiness and slurred/incoherent
speech.
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HA
Fatigue
Disequilibrium and/or dizziness.
Visual disturbances.
Phonophobia (fear of loud sounds)
Nausea
Emotional lability
Irritability
Personality changes
Sleep disturbances
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Protocol takes place over 6 days.
, Migraine: Preventive Meds
AED's: Depakote 500-1000 mg/day and Topamax
25-100 mg BID.
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TCA's: Amitriptyline and nortriptyline 10-15
mg/day. SE: drowsiness, urinary retention and wt
gain.
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BBs: Propranolol 80-240 mg and Timolol 10-30
mg/day. Helps w/panic attacks.
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CCBs: Verapamil 240-320 mg/day
precaution: CV dx or hypotension.
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Feverfew: Herbal supplement. Limited clinical