Concussion

- See: head injury menu

- Discussion:
    - key question is whether the patient has any degree of amnesia (either antegrade or retrograde);
    - assessment exam: 
           - sports concussion assessment Tool 2
           - ability to repeat the names of four objects 2 minutes after having been given them
           - difficulty with coordination, balance, and/or sensory or motor function;
           - MRI or CT scan is required if there are persistent headaches;
    - diff dx:
           - epidural hematoma: classic situation is loss of consciousness followed by brief recovery (before onset of coma);
           - subdural hematoma; 
    - treatment: 
           - grade 1 concussion:
                    - for a return to play, there is a requirement that the standardized assessment of concussion (SAC) be similar to baseline, and that the SAC be similar to baseline with mild to moderate sideline exertion;
                    - if there is no amnesia and the player is asymptomatic, then he may immediately return to play; 
                    - if there is amnesia, the player may not return to play for one week; 
                    - references:
                            - Grade 1 or "Ding" Concussions in High School Athletes 
                            - Return-to-play criteria after athletic concussion: a need for revision.
                            - Evaluating Mild Head Injury
                            - Standardized Assessment of Concussion: A Valuable Tool for Sideline Evaluation. Full Evaluation Needed After Brief Assessment.
                            - Sideline Assessment
                            - Implementation and use of the standardized assessment of concussion at the U.S. Naval Academy

           - grade 2 concussion: loss of consciousness;
                    - with loss of consciousness athletes need to be admitted for 24 hours for neuro checks; 
                    - 4-week period out of sports;
                    - last week prior to return, patient must be symptom-free and the athlete should not have symptoms in practice
           - safe return to play:
                    - athlete is symptom free
                    - able to perform rigorous exercises and remain free of symptoms;
                    - performs well on cognitive tests; 
                    - second impact syndrome (SIS)
                              - occurs when return to activities is allowed prior to complete resolution of the symptoms of the first head injury
                              - what can occur is a second (sometimes minor) head injury can lead to a devastating series of events that can result in sudden death;
    - references:
           - Relationship Between Postconcussion Headache and Neuropsychological Test Performance in High School Athletes.
           - Grade 1 or "Ding" Concussions in High School Athletes. 
           - Return to play guidelines after a head injury
           - Recommendations for grading of concussion in athletes
           - Second-impact syndrome.
           - Second impact in catastrophic contact-sports head trauma.
           - Simple test may help ascertain concussion in athletes
           - The role of secondary brain injury in determining outcome from severe head injury
           - The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries.
           - Research leads to paradigm shift in testing, treatment of concussion
           - Sports-Related Concussion: Assessment and Management

- Press Articles:
           - Congress Examines N.F.L. Concussions
           - N.F.L. Acknowledges Long-Term Concussion Effects 
           - League announces stricter concussion guidelines
           - N.F.L. Issues New Guidelines on Concussions




Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, January 18, 2013 3:50 pm