MACE Symptom Recognition & Monitoring 2 — Questions and Answers
Question 1: What are the visual symptoms of concussion?
- Blurred vision, double vision (diplopia), light sensitivity (photophobia), difficulty tracking moving objects, and visual field deficits (Correct answer)
- Concussion never affects vision
- Only color blindness occurs
- Only complete vision loss
Correct answer: Blurred vision, double vision (diplopia), light sensitivity (photophobia), difficulty tracking moving objects, and visual field deficits
Visual disturbances are common after concussion because multiple brain areas involved in visual processing are vulnerable to injury. Convergence insufficiency, accommodation dysfunction, and saccadic eye movement abnormalities are frequently observed.
Question 2: What balance and vestibular symptoms are associated with concussion?
- Dizziness, vertigo, balance problems, motion sensitivity, and difficulty with rapid head movements (Correct answer)
- Concussion does not affect balance
- Only severe TBI causes dizziness
- Balance problems only occur in elderly patients
Correct answer: Dizziness, vertigo, balance problems, motion sensitivity, and difficulty with rapid head movements
The vestibular system is commonly disrupted by concussion, causing dizziness, balance impairment, and motion sensitivity. These symptoms are assessed through balance testing (BESS) and may require vestibular rehabilitation.
Question 3: How does physical exertion affect concussion symptoms?
- Physical activity can temporarily worsen concussion symptoms (headache, dizziness, cognitive difficulties), which is why graded return-to-activity protocols are used (Correct answer)
- Exercise always helps concussion recovery
- Physical activity has no effect on symptoms
- Only extremely intense exercise affects symptoms
Correct answer: Physical activity can temporarily worsen concussion symptoms (headache, dizziness, cognitive difficulties), which is why graded return-to-activity protocols are used
Exertion increases brain metabolic demand when the brain is metabolically compromised. Symptom exacerbation during activity indicates the brain has not fully recovered. However, controlled sub-symptom threshold exercise may aid recovery.
Question 4: What emotional and behavioral changes should be monitored after concussion?
- Irritability, mood swings, anxiety, depression, decreased frustration tolerance, and personality changes (Correct answer)
- No emotional changes occur with concussion
- Only anger is an emotional symptom
- Emotional changes only occur with severe TBI
Correct answer: Irritability, mood swings, anxiety, depression, decreased frustration tolerance, and personality changes
Concussion commonly affects emotional regulation through disruption of prefrontal cortex function and limbic system connections. Irritability, anxiety, depression, and reduced emotional control are common and often distressing symptoms.
Question 5: What sleep disturbances are associated with concussion?
- Difficulty falling asleep (insomnia), excessive sleepiness, fragmented sleep, altered sleep-wake cycles, and increased or decreased total sleep time (Correct answer)
- Concussion does not affect sleep
- Only insomnia occurs
- Only excessive sleepiness occurs
Correct answer: Difficulty falling asleep (insomnia), excessive sleepiness, fragmented sleep, altered sleep-wake cycles, and increased or decreased total sleep time
Sleep disruption after concussion can manifest as both too much and too little sleep. Disrupted sleep-wake regulation, difficulty initiating sleep, frequent awakenings, and daytime drowsiness are all common and impair recovery.
Question 6: When should a concussed service member be awakened during sleep for neurological checks?
- Only when red flag symptoms were present at initial assessment or when the mechanism of injury suggests potential for more serious intracranial pathology (Correct answer)
- Every 15 minutes for 72 hours
- Never interrupt sleep after concussion
- Every hour for the first night
Correct answer: Only when red flag symptoms were present at initial assessment or when the mechanism of injury suggests potential for more serious intracranial pathology
Current evidence suggests that sleep is beneficial for concussion recovery and unnecessary interruptions are counterproductive. Neurological checks during sleep are warranted only when there is concern for intracranial bleeding or more severe injury.
MACE Symptom Recognition & Monitoring 2
What are the visual symptoms of concussion?