concussion care

8/12/2019 Concussion Care

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August 2009 Vol. 58, No. 8: 410-414

Concussion care: Simple strategies, big payoffs

Address persistent symptoms, avoid unnecessary tests, and prevent prematurereturn to usual activities.

Amanda McConnell, DO, MPH

Department of Neurology, Ohio University College of Osteopathic Medicine, Athens Am427 !7"ohio#edu

!ay S"ubroo#, DO

Department of $amily Medicine, Ohio University College of Osteopathic Medicine,

Athens

Practice recommendations

Consider any alteration of ental status t!at follo"s a trau a to #e a$on$ussion, "!et!er or not t!ere is also a loss of $ons$iousness % A&.

'on(t order neuroi aging routinely) it is not ne$essary for diagnosing$on$ussion. Neuroi aging is i *ortant, !o"e+er, for *atients "!o e !i#it

*rolonged un$ons$iousness, fo$al neurologi$ defi$its, or "orsening sy *to s%A&.

reat *ost-$on$ussi+e !eada$!e, a $o on $o *laint, "it! a$eta ino*!en ori#u*rofen %A&.

Strengt" of recommendation $SO%&

A. ood-/uality *atient-oriented e+iden$e

'( )H'S A%)'C*+

"en can your patientreturn to play-
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. n$onsistent or li ited-/uality *atient-oriented e+iden$e

C. Consensus, usual *ra$ti$e, o*inion, disease-oriented e+iden$e, $ase series

t(s A3 and you(re ust finis!ing #rea fast "!en you get a $all fro an e ergen$yroo %67& resident telling you t!at 3a , a 14-year-old *atient of yours, !as ust #een

#roug!t in #y a #ulan$e after a $ar a$$ident. !en t!e 63 s arri+ed at t!e s$ene, t!e$ar "as totaled. !e dri+er, 3a (s older #rot!er, !ad no in uries ot!er t!an a inora#rasion on !is nose, #ut 3a "as un$ons$ious.

y t!e ti e you get to t!e !os*ital, 3a is sitting u* and tal ing. e says !is !ead a$!esand !e(s feeling di y. e(s !a+ing diffi$ulty $o *re!ending "!at !e(s doing in t!e 67,doesn(t no" !o" !e got t!ere, and !as no e ory of t!e a$$ident. e !as a s all$ontusion on !is fore!ead, #ut no ot!er a**arent in uries.

;ou /uestion 3a (s #rot!er, and !e tells you !e !ydro*laned "!ile dri+ing in t!e rain,and s idded into a tele*!one *ole. e "as !at tests "ould you *erfor > And "!at"ould you tell !is "orried *arents>

A diagnosis it" variable/and often subtle/symptoms

3a (s situation fits t!e A eri$an A$ade y of Neurology(s %AAN& definition of$on$ussion, ie, an alteration in ental status follo"ing a trau a t!at ay or ay notresult in a loss of $ons$iousness. 1 A$$ording to t!e AAN, t!is $!ange in ental status

usually lasts less t!an 24 !ours and ay #e $ou*led "it! sy *to s of +ertigo, !eada$!e,nausea, +o iting, tinnitus, *!oto*!o#ia, #lurred +ision, and anterograde or retrogradea nesia. 2-5

!e *resenting signs and sy *to s of $on$ussion are so +aria#le t!at t!e $ondition $an #e diffi$ult to diagnose. 3any *atients dis*lay not!ing ore t!an a so-$alled +a$ant stare.


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Do a mental status e3am. As t!e *atient "!at !is na e is, "!at today(s date is, and"!ere !e is no". Dee if !e $an re*eat E "ords i ediately after you say t!e and t!en 5inutes later. Can !e s*ell t!e "ord F"orldG #a$ "ards>

4et t"e story. f t!e *atient $an(t re e #er t!e in$ident or isn(t a#le to tell you a#out it,

try to get t!e details fro a "itness. f t!e *atient is a#le to tal , as if s!e or !ere e #ers "!at "as !a**ening ust #efore t!e a$$ident and after"ards. 'oes t!e *atientsee to !a+e diffi$ulty $on$entrating on your /uestions> Dee alert, or $onfused> Cant!e *atient %or a "itness& tell you !o" t!e in ury o$$urred, !o" se+ere t!e i *a$t "as,and "!et!er t!ere "as loss of $ons$iousness all i *ortant fa$tors in t!e diagnosis. 1 ast!e *atient e+er !ad a $on$ussion #efore> ere t!ere any se/uelae>

Perform a neurologic evaluation. Assess $ranial ner+es and $ere#ral, $ere#ellar, and *eri*!eral ner+e fun$tion. C!e$ *u*ils for rea$ti+ity and sy etry. Dee "!et!er t!e *atient !as full and a**ro*riate eye o+e ent in all dire$tions. Assess gri* strengt! andus$le strengt! in ar and leg fle ion and e tension. est for a#nor alities in rea$tions

to *in*ri$ , te *erature, and +i#ration in all e tre ities. As t!e *atient to $lose !is eyes,e tend t!e ar s "it! *al s u*, and !old t!e *osition for 20 to E0 se$onds. f t!e *atientfails t!is assess ent for *ronator drift, $onsider a diagnosis of us$le "ea ness or$ere#ellar disease. C!e$ gait for ata ia and s*ee$! for fluen$y and $o!eren$e.

"en a C) is re5uired

!ile ost $ases of sus*e$ted $on$ussion do not re/uire i aging, it isa**ro*riate for *atients li e t!is 52-year-old an, "!o !ad a !istory of assaultand *resented "it! di iness and +o iting. is C s$an re+ealed ild

!y*erattenuation ad a$ent to t!e $ranial s!ado" a finding suggesti+e of asu#ara$!noid !e orr!age in t!e region.

"en trauma6s an old story

atients "it! !ead in ury do not al"ays see e ergen$y $are. !ene+er an offi$e *atienttells you a#out a !ead in ury, !o"e+er inor it see s, you s!ould al"ays assess for
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$on$ussion. !e diagnosis ay #e useful in guiding treat ent and *re+ention strategies int!e future. t ay also !el* you re$ogni e *ost-$on$ussi+e sy *to s, "!i$! $an o$$ur "ee s or ont!s after t!e trau a and $ause signifi$antor#idity.

Does your patient really need imaging-

aging is usually not ne$essary for diagnosis "!en t!e ental status and neurologi$e a inations are negati+e. A#nor al i aging s$ans are rare in $ases of sus*e$ted$on$ussion, s!o"ing u* in fe"er t!an 10? of $o *uted to ogra*!y %C & s$ans and E0?of agneti$ resonan$e i ages %37 s&. 11 ;ou "ouldn(t order i aging for 3a , as !e

*assed !is neurologi$ e a "it! flying $olors. o"e+er, if !e !ad re ained un$ons$iousfor a longer *eriod, !is ental status $!anges !ad $ontinued, or !e !ad neurologi$sy *to s t!at *ersisted for ore t!an a "ee , you "ould order neuroi aging to rule outadditional *at!ology. 10,12 Neuroi aging ay also #e indi$ated in $ases of *arti$ularly

for$eful in ury a fall fro a !eig!t greater t!an E feet, for e a *le, or a *edestrian !it #y a $ar or for a *atient "it! an o*en, de*ressed, or sus*e$ted #asal s ull fra$ture.

n addition, i aging studies s!ould #e done for *atients "it! a s$ore of less t!an 15 ont!e lasgo" $o a s$ale, retrograde a nesia for ore t!an E0 inutes #efore t!ea$$ident, or ore t!an 2 e*isodes of +o iting. aging o*tions in$lude a C s$an"it!out $ontrast to e+aluate for intra$ranial #leeding or an 37 "it!out $ontrast to testfor s aller intra$ranial #leeds or a onal in ury .1E,14

C s$ans are /ui$ , generally a+aila#le, and reasona#ly ine *ensi+e, #ut ay not dete$tall rele+ant a#nor alities. 37 s are ore sensiti+e and #etter a#le to dete$t areas of

$ontusion, *ete$!ial !e orr!age, and a onal in ury, #ut are less a$$essi#le ine ergen$ies and $ost a great deal ore. 1E,14

Ne" resear$! suggests t!at *atients "it! *rolonged neurologi$ se/uelae ay #enefit frosingle *roton e ission $o *uted to ogra*!y %D 6C & or *ositron e ission to ogra*!y% 6 & in addition to $on+entional C and 37 studies. 1E,15 D 6C studies use radioa$ti+etra$ers t!at $an $ross t!e #lood-#rain #arrier to esti ate $ere#ral #lood flo") de$reased$ere#ral #lood flo" indi$ates areas of #rain da age. 11 6 s$ans are ore e *ensi+e t!anD 6C , #ut !a+e t!e ad+antage of #eing a#le to de onstrate o ygen and glu$oseeta#olis , "!i$! are ore sensiti+e indi$ators of #rain da age. !ile D 6C and 6i ages are seldo used in diagnosing $on$ussion, t!ey $an #enefit *atients "!o $ontinueto !a+e neurologi$ defi$its t!at re/uire furt!er definition of t!e areas of #rain in ury.

Ho to fine7tune concussion care

8irst, grade t"e concussion. Con$ussion s$ales are a useful guide for a ing treat entde$isions. 4,5,10 !e AAN s$ale *resented in )A9*+ 0 is t!e ost "idely used. =ee* inind, t!oug!, t!at t!is s$ale is s$!eduled for re+ision. 1

8AS) )%AC

"enever a patient tells youabout a "ead in;ury,"o ever minor, assess forconcussion.
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;ou $on$lude fro your e a ination of 3a t!at !e does !a+e a $on$ussion, and t!at !isloss of $ons$iousness indi$ates a grade E, e+en t!oug! !is sy *to s of di iness and$onfusion lasted less t!an 15 inutes.

'nitiate monitoring. !is essential as*e$t of $on$ussion anage ent $an ta e *la$e at

!o e for ost *atients, "it! !os*itali ation ne$essary for only a fe". 3a $an go !o e.;ou no" !is *arents "ell, and t!ey(re $o *etent to follo" a onitoring *roto$ol. Bort!e first 24 !ours, you tell t!e to "a e 3a u* e+ery 2 !ours, so t!at t!ey $an *i$ u*any $!ange in !is sy *to s "it!out delay. f t!ey !a+e diffi$ulty "a ing !i or !ede+elo*s signs and sy *to s su$! as +o iting or se+ere !eada$!e, you tell t!e to $allyou and #ring 3a #a$ to t!e !os*ital.

atients "!o should #e onitored in t!e !os*ital aret!ose "it! sei ures, e+iden$e of intra$ranial #leedingor $ere#ral ede a on C s$an, or a !istory of ta ingoral anti$oagulants. Do s!ould any *atients "!ose

li+ing situation is not relia#le for ade/uate !o eonitoring !o eless *atients or t!ose "it! a$!aoti$ !o e life, for instan$e.

%eturn to usual activities: "en to say


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3ost $on$ussion *atients "ill re$o+er fairly ra*idly. Knfortunately, !o"e+er, so e E8?of *atients "!o !a+e e *erien$ed a $on$ussion "it! loss of $ons$iousness $ontinue to #e

*lagued "it! "!at is $alled *ost-$on$ussi+e syndro e % CD& .1@ !e %nternationalClassification of Diseases % C'-10, 2nd ed.& defines CD as a $o #ination of signs andsy *to s t!at o$$ur "it!in 4 "ee s of !ead trau a "it! loss of $ons$iousness. !ese

in$lude !eada$!e, fatigue, de*ression, e otional la#ility, diffi$ulty $on$entrating,inso nia, and a *reo$$u*ation "it! sy *to s "it! a fear of #rain da age. !e in$iden$eof CD using $riteria in t!e Diagnostic and &tatistical Manual of Mental Disorders %'D3- V& is si ilar to t!at do$u ented "it! t!e C'-10, "!i$! suggests t!at eit!erdefinition $ould #e used to e+aluate for CD. 1

y far t!e ost $o on of t!ese *ost-$on$ussi+e sy *to s is !eada$!e, re*orted #ynearly 80? of *atients "it! CD and o$$urring ost often in t!ose "!o are !eada$!e-

*rone. 18 !at(s t!e $ase "it! 3a , "!o !as al"ays !ad a *ro#le "it! !eada$!es andreturns to your offi$e a ont! after t!e a$$ident $o *laining of *ersistent !ead *ain.

3ost *ost-$on$ussi+e !eada$!es resol+e "it! rest and o+er-t!e-$ounter edi$ations su$!as a$eta ino*!en or i#u*rofen. ;ou ay also $onsider *res$ri#ing antide*ressants, *arti$ularly t!e sele$ti+e serotonin reu*ta e in!i#itor sertraline, "!i$! !as #een s!o"n tode$rease t!e +ertigo, #lurred +ision, +isual $!anges, and !eada$!e often asso$iated "it!CD. 1@,19,20 Dtart sertraline at a dosage of 25 gLd, t!en titrate after a "ee to t!ere$o ended 50 gLd. 19 f sy *to s *ersist, slo"ly titrate to t!e a i u dose of 200gLd "!ile $arefully onitoring for *otential side effe$ts. 19

atients "it! *ost-$on$ussi+e status igrainosus, a !eada$!e lasting longer t!an E dayst!at is unres*onsi+e to $on+entional treat ent, ay #enefit fro a s!ort $ourse of$orti$osteroids. 4 Additional treat ent o*tions in$lude tri*tans, anti$on+ulsants, and M-

#lo$ ers, alt!oug! none of t!ese o*tions !as #een #a$ ed u* #y a large-s$ale, rando i ed$ontrolled trial. 1@,20

?igilance needed in cases of repeated trauma

atients "!o e *erien$e re*eated !ead trau are/uire *arti$ular attention. !ey are ore li ely to!a+e dete$ta#le signs and sy *to s and CD. 21

Also, t!ey are ore li ely to in$ur se$ond i *a$t

syndro e %D D&, a $as$ade of sy *to s t!at $ano$$ur "it!in 2 to 5 inutes of sustaining a se$ond #lo". D D *atients e *erien$e a ra*id and diffuse$ere#ral ede a, "!i$! $an lead to #rain !erniationand deat!. E D D is a *ri ary ris in s*orts li e foot#all, "!en *layers are allo"ed toreturn to t!e field too early. )A9*+ = sets out t!e s*e$ial diagnosti$ $riteria t!e AAN !asfor ulated for anaging *atients "!o e *erien$e re*eated $on$ussions.

8AS) )%AC

%epeated "ead traumaincreases t"e ris# of secondimpact syndrome, a rapid

cascade of symptoms t"atcan lead to brain "erniationand deat".
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)A9*+ =

Multiple concussions: "en can your patient return to play- 0

D;3


8/17

4. ar on = . Assess ent and anage ent of $on$ussion in s*orts. Am $am 'hysician# 1999)@0:88 P894.

5. =us!ner 'D. Con$ussion in s*orts: ini i ing t!e ris of $o *li$ations. Am $am 'hysician# 2001)@4:100 P1014.

@. Cantu 7C. ead in uries in s*ort. *r ( &ports Med# 199@)E0:289P29@.

. 'i+ision of n ury and 'isa#ility ( Nerv Ment

Dis# 2005)19E:540P550.18. 3i$ e+i$iene ', D$!rader ,


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21. !iteside Q. 3anage ent of !ead and ne$ in ury #y t!e sideline *!ysi$ian. Am $am 'hysician# 200@) 4:1E5 P1E@2.

Correspondence Amanda McConnell, DO, MPH, Grandview Hospital, Office of MedicalEducation, 405 Grand Avenue, Da ton, OH 45405! Am4"#5$#%o&io'edu

Agustus 2009 Vol. 58, No 8: 410-414

egar *era"atan: strategi seder!ana, euntungan yang #esar

3engatasi ge ala-ge ala *ersisten, !indari tes yang tida *erlu, dan en$ega! dinie #ali e egiatan #iasa.

A anda 3$Connell, '

'e*arte en =edo teran =eluarga,

'AHA3 ADAH N

T

=eti a #isa e #ali *asien Anda untu #er ain>

ra te re o endasi

T

3e *erti #ang an *eru#a!an status ental yang engi uti trau a en adi gegarota , a*a a! atau tida ada uga e!ilangan esadaran %A&. T

Qangan e esan neuroi aging se$ara rutin, tida *erlu untu endiagnosis gegarota . Neuroi aging adala! *enting, na un, untu *asien yang enun u an tidasadar an diri yang #er e*an angan, defisit neurologis fo al, atau ge ala e #uru %A&.
mailto:[email protected]:[email protected]


10/17

T

erla u an *as$a-$on$ussi+e sa it e*ala, elu!an u u , dengan a$eta ino*!enatau i#u*rofen %A&.

=e uatan 7e o endasi %D'iagnosis dengan +aria#el-dan sering !alus-ge ala

Dituasi 3a $o$o A eri$an A$ade y of %AAN& definisi Neurology tentang gegar ota ,yaitu, *eru#a!an *ada status ental setela! trau a yang ung in atau ung in tidaenga i#at an !ilangnya $ons$iousness.1 3enurut AAN, *eru#a!an status ental

#iasanya #erlangsung urang dari 24 a dan da*at dita #a! dengan ge ala +ertigo, sa ite*ala, ual, unta!, tinnitus, fotofo#ia, *engli!atan a#ur, dan anterograde atauretrograde a nesia.2-5

anda-tanda dan ge ala enya i an gegar ota sangat #er+ariasi #a!"a ondisi #isa sulit


11/17

untu endiagnosa. anya *asien ena *il an tida le#i! dari tata*an yang dise#utosong. ;ang lain !anya engala i ge ala ringan, se*erti sa it e*ala atau ual.ilangnya 3a esadaran relatif arang ter adi, ter adi !anya se itar 10? dari gegar ota$ases.@

Detida nya 1,4 uta gegar ota ter adi di A eri a Deri at setia* ta!un, enurut usatengendalian dan en$ega!an enya it %C'C& . ,8 e adian, es i*un, ung in le#i! #esar dari la*oran C'C, arena #egitu #anya asus yang #elu dia ui atau tidadila*or an . Qatu!, e$ela aan endaraan #er otor, dan $edera ola!raga adala! *enye#a#uta a, dengan se itar 250.000 #er!u#ungan dengan se*a #ola gegar ota ela*or ansetia* year.4, ,9,10

K u , ya, ta*i enantang, terlalu

iasa se*erti gegar ota , itu #isa-*ada "a tu-a an enantang untu engenali. i*s inida*at e #antu:

3ela u an *e eri saan status ental. anya an *asien a*a na anya, tanggal #era*a!ari ini adala!, dan di ana dia se arang. Hi!at a*a a! ia da*at engulangi E ata segerasetela! Anda ata an ere a dan e udian 5 enit e udian. isa a! dia enge a ataUduniaU undur>

'a*at an $erita. Qi a *asien tida da*at engingat e adian atau tida da*ate #erita!u Anda tentang !al itu, $o#ala! untu enda*at an rin$ian dari sa si. Qi a

*asien a *u #er#i$ara, #ertanya a*a a! dia atau dia ingat a*a yang ter adi se#elue$ela aan itu dan sesuda!nya. A*a a! *asien ta *a nya engala i esulitan

#er onsentrasi *ada *ertanyaan Anda> a *a "as*ada, atau #ingung> 'a*at a! *asien%atau sa si& e #erita!u Anda #agai ana $edera ter adi, se#era*a *ara! da *a nya, dana*a a! ada e!ilangan esadaran-se ua fa tor *enting dala diagnosis.1 A*a a! *asien

*erna! engala i gegar ota se#elu nya> A*a a! ada ge ala sisa a*a*un>

Ha u an e+aluasi neurologis. 3enilai saraf teng ora dan ota , fungsi saraf $ere#ellar,dan *erifer. eri sa urid untu rea ti+itas dan si etri. Hi!at a*a a! *asien e ili igera an ata *enu! dan te*at dala segala ara!. 3enilai e uatan *egangan dane uatan otot *ada lengan dan a i fle si dan e stensi. est untu elainan *ada rea si$o$o an *eniti, su!u, dan getaran di se ua e stre itas. 3intala! *asien untu enutu*atanya, e *er*an ang lengan dengan tela*a tangan e atas, dan ta!an *osisi sela a20 sa *ai E0 deti . Qi a *asien gagal ini *enilaian untu drift *ronator,e *erti #ang an diagnosis ele a!an otot atau *enya it $ere#ellar. eri sa gait untu ata sia dan *idato untu elan$aran dan o!erensi.

=eti a C di*erlu an

De entara se#agian #esar asus gegar ota diduga tida e erlu an *en$itraan, adala!te*at untu *asien se*erti ini *ria 52 ta!un, yang e ili i se ara! *enyerangan dandisa i an dengan *using dan unta!. Nya C s$an engung a* an !y*erattenuation


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ringan #erde atan dengan #ayangan-a teng ora sugestif te uan dari *erdara!ansu#ara$!noid di "ilaya! terse#ut.=eti a trau a adala! se#ua! $erita la a

asien dengan $edera e*ala tida selalu en$ari *era"atan darurat. Detia* ali *asien

antor e #erita!u Anda tentang $edera e*ala, na un e$il ta *a nya, Anda !arusselalu enilai untu gegar ota . 'iagnosis ung in #erguna dala e #i #ing *engo#atan dan strategi *en$ega!an di asa de*an. al ini uga da*at e #antu Andaengenali ge ala *as$a-$on$ussi+e, yang da*at ter adi #e#era*a inggu atau #ulansetela! trau a dan enye#a# an or#iditas yang signifi an.

Bast ra$

Detia* ali seorang *asien e #erita!u Anda tentang $edera e*ala, na un e$il,enilai untu gegar ota .

A*a a! *asien Anda #enar-#enar e #utu! an *en$itraan>en$itraan #iasanya tida di*erlu an untu diagnosis #ila status ental dan *e eri saanneurologis yang negatif. D$an *en$itraan a#nor al arang dala asus gegar ota diduga,un$ul dala "a tu urang dari 10? dari $o *uted %C & s$an to ografi dan E0? dariga #ar resonansi agneti %37 & .11 Anda tida a an e esan *en$itraan untu 3a ,saat ia ele"ati nya neurologis u ian dengan "arna ter#ang. Na un, i a ia teta* sadaruntu ang a "a tu la a, *eru#a!an ental statusnya terus #erlan ut, atau dia e ili ige ala neurologis yang #erlangsung sela a le#i! dari satu inggu, Anda a an e esanneuroi aging untu enying ir an ta #a!an *at!ology.10, 12 Neuroi aging uga da*atdiindi asi an dala asus- asus $edera yang sangat uat atu! dari etinggian le#i! dariE eter, isalnya, atau *e alan a i dita#ra o#il-atau untu *asien dengan *ata!tulang, teng ora ter#u a terte an, atau diduga #asal.

Delain itu, studi *en$itraan !arus dila u an untu *asien dengan s or urang dari 15 dilasgo" o a s ala, a nesia retrograde sela a le#i! dari E0 enit se#elu e$ela aan,atau le#i! dari 2 e*isode unta!. ili!an *en$itraan ter asu C s$an tan*a ontrasuntu enge+aluasi *erdara!an intra ranial atau 37 tan*a ontras untu engu i

*endara!an intra ranial e$il atau in ury.1E a sonal, 14

C s$an yang $e*at, u u nya tersedia, dan $u u* ura!, teta*i tida da*at endete sise ua elainan yang rele+an. 37 le#i! sensitif dan le#i! a *u endete si daera!e ar, *erdara!an *ete ie, dan $edera a sonal, teta*i urang da*at dia ses dalaeadaan darurat dan #iaya #anya ore.1E, 14

enelitian #aru enun u an #a!"a *asien dengan ge ala sisa neurologis #er e*an anganda*at enga #il anfaat dari *roton tunggal di!itung to ografi e isi %D 6C & atau

*ositron e ission to ogra*!y % 6 & selain C on+ensional dan 37 studies.1E, 15D 6C *enelitian engguna an *ela$a radioa tif yang da*at elintasi *eng!alangdara!- *eng!alang ota untu engu ur aliran dara! ota , *enurunan aliran dara! ota


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enun u an area ota da age.11 s$an 6 le#i! a!al dari*ada D 6C , teta*ie ili i eunggulan yang a *u enun u an eta#olis e o sigen dan glu osa, yangeru*a an indi ator yang le#i! sensitif dari erusa an ota . De entara D 6C dan 6ga #ar arang diguna an dala endiagnosis gegar ota , ere a da*at #er anfaat #agi

*asien yang terus engala i defisit neurologis yang e erlu an definisi le#i! lan ut

dari #idang $edera ota .

agai ana untu enye *urna an *era"atan gegar ota

erta a, elas gegar ota . D ala gegar ota adala! *anduan yang #erguna untue #uat *engo#atan de$isions.4, 5,10 D ala AAN disa i an dala a#el 1 adala! yang

*aling #anya diguna an. erlu diingat, es i*un, #a!"a s ala ini di ad"al an unture+ision.1

Anda enyi *ul an dari *e eri saan Anda dari 3a #a!"a ia e ang e ili i gegarota , dan #a!"a ia e!ilangan esadaran enun u an elas E, es i*un ge alanya

*using dan e#ingungan #erlangsung urang dari 15 enit.Ha u an *e antauan. As*e *enting dari ana e en gegar ota da*at ter adi di ru a!untu se#agian #esar *asien, dengan ra"at ina* yang di*erlu an untu !anya #e#era*a.3a #isa *ulang. =au ta!u orang tuanya dengan #ai , dan ere a o *eten untuengi uti *roto ol *e antauan. Kntu 24 a *erta a, Anda e #erita!u ere auntu #angun 3a u* setia* 2 a , se!ingga ere a da*at enga #il setia* *eru#a!andala ge ala tan*a *enundaan. Qi a ere a engala i esulitan e #angun annya atauia enge #ang an tanda-tanda dan ge ala se*erti unta! atau sa it e*ala *ara!, Andae #erita!u ere a untu eng!u#ungi Anda dan e #a"a 3a e #ali e ru a!sa it.

Bast ra$

=e#anya an *asien tida e erlu an neuroi aging. Cadangan #agi ere a denganneurologis a#nor al atau u ian status ental.

asien yang !arus di*antau di ru a! sa it adala! ere a dengan e ang, *erdara!anintra ranial #u ti atau ede a sere#ral *ada C s$an, atau ri"ayat enga #ilanti oagulan oral. Qadi !arus ada *asien yang !idu* situasi tida da*at diandal an untu

*asien ru a! yang e adai onitoring-tuna"is a atau orang-orang dengan e!idu*anru a! a$au, isalnya.

=e #ali e egiatan #iasa: =eti a engata an ;a, a*an !arus engata an 'A=Anda enyaran an orang tua 3a untu en aga dia *ulang dari se ola! dan e ili idia enga #il istira!at dari *e er aan. er onsentrasi *ada se ola! da*at e *er#uru$on$ussi+e sy *to s.12 a ti+itas fisi Dtrenuous eluar uga, dan dia tida !arussendirian sela a le#i! dari ang a *ende sa *ai se ua ge ala ereda nya.


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ota . asien dengan gegar ota elas 1 da*at e #ali e la*angan dala "a tu 15 enit,sela a u ian neurologis ere a adala! nor al dan ere a tida e ili i ge ala. 'engangegar ota elas 2, *e ain !arus tan*a ge ala sela a 1 inggu se#elu e #ali eegiatan nor al. De#ua! gegar ota elas E ensyarat an #a!"a *e ain teta* darila*angan sa *ai ia tela! asi to ati sela a 2 "ee s.4 7e o endasi ini a an #erla u

untu 3a , yang e ili i gegar ota elas E.

A 6H 1

AAN gegar ota *enilaian s$ale1 7A'6 7A'6 1 2 E 7A'6=e!ilangan esadaran ida ida ;ae ala erlangsungI15 enit HastingJ 15 enit HastingJ 15 enit

=eti a ge ala #erla a-la a

=e#anya an *asien gegar ota a an *uli! $u u* $e*at. Dayangnya, na un, #e#era*a?dari E8 *asien yang tela! engala i gegar ota dengan e!ilangan esadaran terusterganggu dengan a*a yang dise#ut *ost-$on$ussi+e sindro % CD& .1@ !e nternationalClassifi$ation of 'iseases endefinisi an % C'-10, 2nd ed.& CD se#agai o #inasi daritanda-tanda dan ge ala yang ter adi dala 4 inggu dari trau a e*ala dengane!ilangan esadaran. ni ter asu sa it e*ala, elela!an, de*resi, la#ility e osional,sulit #er onsentrasi, inso nia, dan easyi an dengan ge ala yang ta ut erusa an ota .nsiden CD engguna an riteria dala 'iagnosti dan Dtatisti 3anual of 3ental'isorders %'D3- V& iri* dengan yang dido u entasi an dengan, C'-10 yangenun u an #a!"a definisi #ai da*at diguna an untu enge+aluasi CD.1

De au! ini yang *aling u u dari *as$a-$on$ussi+e ge ala sa it e*ala, dila*or an ole!!a *ir 80? dari *asien dengan CD dan ter adi *aling sering *ada ere a yang sa ite*ala-*rone.18 tula! yang ter adi dengan 3a , yang selalu *unya asala! dengan sa ite*ala dan e #ali e antor Anda se#ulan setela! e$ela aan itu engelu! sa it e*alaterus- enerus.

=e#anya an *as$a-$on$ussi+e sa it e*ala enyelesai an dengan istira!at dan o+er-t!e-$ounter o#at se*erti a$eta ino*!en atau i#u*rofen. Anda uga da*at e *erti #ang anantide*resan rese*, !ususnya serotonin reu*ta e in!i#itor sertraline, yang tela! ter#u tienurun an +ertigo, *engli!atan a#ur, *eru#a!an +isual, dan sa it e*ala seringdi ait an dengan CD.1@ sertraline, 19,20 3ulai dengan dosis 25 g L d, e udian titrasisetela! se inggu e 50 dian ur an gLd.19 Qi a ge alanya eneta*, *erla!an titrasidengan dosis a si u 200 g L d sedang an !ati-!ati *e antauan untu sisi *otensialeffe$ts.19

asien dengan *as$a-$on$ussi+e igrainosus status, sa it e*ala #erlangsung le#i! la a


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dari E !ari yang tida res*onsif ter!ada* *engo#atan on+ensional, da*at enga #ilanfaat dari ursus sing at $orti$osteroids.4 *ili!an *engo#atan ta #a!an ter asutri*tans, anti on+ulsan, dan M-#lo$ er, es i*un tida ada *ili!an tela! didu ung ole!s ala #esar, ter ontrol, a$a trial.1@ 20

=e"as*adaan di*erlu an dala asus- asus trau a #erulang

Bast ra$

rau a e*ala #erulang ening at an risi o sindro da *a edua, ria $e*at ge alayang da*at enye#a# an !erniasi ota dan e atian.

asien yang engala i trau a e*ala #erulang e erlu an *er!atian !usus. 3ere ale#i! $enderung e ili i tanda-tanda dan ge ala terdete si dan CD.21 Quga, ere ale#i! $enderung untu di ena an sindro da *a edua %D D&, ria ge ala yang da*atter adi dala "a tu 2 sa *ai 5 enit untu e *erta!an an se#ua! *u ulan edua. D D

*asien engala i ede a ota yang $e*at dan enye#ar, yang da*at enye#a# an!erniasi ota dan deat!.E D D eru*a an risi o uta a dala ola!raga se*erti se*a #ola,eti a *e ain dii in an untu e #ali e la*angan terlalu dini. A 6H 2 eneta* anriteria diagnosti !usus AAN tela! difor ulasi an untu engelola *asien yangengala i gegar ota #erulang.

A 6H 2

e#era*a gegar ota : ila da*at e #ali *asien Anda untu #er ain 1>De+erity =6'KA 6QAHA gegar ota gegar ota =6 A%A AK H6 &Con$ussi+e ge ala

#erlangsung I15 enit =e #ali untu di*utar #ilaasi to ati sela a 1 inggu =e #ali untu di*utar #ilaasi to ati sela a 1 ingguost-trau ati$ a nesiaIE0 enit, tan*ae!ilangan =e #ali esadaran untu di*utar #ilaasi to ati sela a 2 inggu =e #ali untu di*utar #ilaasi to ati sela a 1 #ulanost-trau ati$ a nesiaJ E0 enit atau e!ilangan=e #ali esadaran untu #er ain eti aasi to ati sela a 1 #ulan 3en$ega! e #aliuntu #er ain tan*a #atas


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3e #antu en$ega! gegar ota

'ala *eran Anda se#agai *endidi , Anda da*at enginfor asi an *asien, *e a#atse ola!, dan to o! asyara at tentang *entingnya alat *elindung se*erti !el ola!raga,

sa#u *enga an, dan antong udara dala engurangi e adian $on$ussion.9, 15De#agai seorang do ter eluarga, Anda e ili i ese *atan !usus untu enga arorang tua, guru, *elati!, dan *e ain untu engenali tanda-tanda dan ge ala gegar ota ,e a!a i risi o, dan eng!enti an *e ain untu e #ali e egiatan ola!raga

*re aturely.4

Bast ra$

A ar an orang tua, guru, *elati!, dan *e ain tanda-tanda dan ge ala gegar ota dan *entingnya eng!indari e #alinya dini untu #er ain.

enying a*an'r 3$Connell la*oran tida ada *otensi onfli e*entingan yang rele+an dengan arti elini. 'r D!u#roo tela! eneri a !i#a! L #antuan *enelitian dari a eda !ar a$euti$alCo *any Htd, No+o Nordis , dan 3edtroni$. 'ia uga #ertugas di #iro s*ea er daria eda, 3er$ Co, n$, dan sanofi-a+entis.

7eferensi 1. ra te *ara eter: *engelolaan gegar ota dala ola!raga %*ernyataan ring asan&Ha*oran Du#- o ite Dtandar 3utu. Neurologi. 199 ) 48:581-585. 2. Anderson , eitger 3, 3a$leod A'. egar ota dan $edera e*ala ringan. ra$t

Neurol. 200@) @:E42-E5 . E. 'elaney QD, A#u eyad B, Correa QA, et al. enga uan dan ara teristi dari gegarota *ada *o*ulasi ga"at darurat. Q 3ed gl. 2005) 29:189-19 . 4. ar on = . enilaian dan *engelolaan gegar ota dala ola!raga. A Ba!ysi$ian. 1999) @0:88 -894. 5. =us!ner 'D. egar ota dala ola!raga: e ini al an risi o o *li asi. ABa !ysi$ian. 2001) @4:100 -1014. @. Cantu 7C. =e*ala $edera dala ola!raga. r Q D*orts 3ed. 199@) E0:289-29@. . 'i+isi asil Cedera dan Ca$at dan rogra usat Nasional untu en$ega!anCedera dan engendalian usat engendalian enya it dan en$ega!an 'e*arte en=ese!atan dan Hayanan =e anusiaan. U rau ati$ $edera ota di A eri a Deri at:un ungan ga"at darurat, ra"at ina*, dan e atian.U Qanuari 200@. ersedia di:!tt*:LL""".$d$.go+Ln$i*$L*u#-resL RinRKDR04L R 6'.!t . 'ia ses No+e #er 10,200 . 8. usat engendalian dan en$ega!an enya it Non-fatal $edera ota trau atis dariola!raga dan re reasi egiatan-A eri a Deri at, 2001-2005. 3


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10. us ie"i$ =3, ru$e DH, Cantu 7C, et al. National At!leti$ rainersAsso$iation *ernyataan si a*: ana e en ola!raga yang #er!u#ungan dengan gegarota . Q At!l =ereta. 2004) E9:280-29 . 11. 7o**er A , orson =C. egar ota . N 6ngl Q 3ed. 200 ) E5@:1@@-1 2. 12. 3$Crory , 3eeu"isse , Qo!nston =, et al. 7ing asan dan ese*a atan

*ernyataan onferensi internasional e-E *ada gegar ota dala ola!raga, No+e #er2008. r Q D*orts 3ed. 2009) 4E: @-84. 1E. a arian QQ, lyt! , Ci *ello H. en$! e sa *ing te *at tidur: #u ti $ederaota setela! gegar ota - en$ari di luar s$an $o *uted to ogra*!y. A$ad gl 3ed. 200@)1E:199-214. 14. ug!es ' , Qa$ son A, 'H 3ason, et al. =elainan *ada *en$itraan resonansiagneti dili!at a ut enyusul $edera ota ringan trau atis: orelasi dengan tesneuro*si ologi dan *e uli!an tertunda. Neuroradiology. 2004) 4@:550-558. 15. 7yan H, Di*ir '. os sindro gegar ota . nt 7e+ sy$!iatry. 200E) 15:E10-E1@. 1@. 3itten#erg , 6 Canyo$ , Condit ', et al. engo#atan *as$a-gegar ota sindroenyusul $edera e*ala ringan. Q Clin 6 * Neuro*sy$!ol. 2001) 2E:829-8E@.

1 . 3$Cauley D7, oa e C, edro a C, et al. ost-$on$ussional gangguan: adala!'D3- V riteria *er#ai an atas C'-10> Q Ner+ 3ent 'is. 2005) 19E:540-550. 18. 3i$ e+i$iene ', D$!rader,

concussion care

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