Brain concussion: Difference between revisions
imported>Robert Badgett |
imported>Robert Badgett No edit summary |
||
Line 93: | Line 93: | ||
====2nd International Conference on Concussion in Sport==== | ====2nd International Conference on Concussion in Sport==== | ||
The 2nd International Conference on Concussion in Sport recommends:<ref name="pmid15793085">{{cite journal |author=McCrory P, Johnston K, Meeuwisse W, ''et al'' |title=Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004 |journal=Br J Sports Med |volume=39 |issue=4 |pages=196–204 |year=2005 |month=April |pmid=15793085 |pmc=1725173 |doi=10.1136/bjsm.2005.018614 |url=http://bjsm.bmj.com/cgi/pmidlookup?view=long&pmid=15793085 |issn=}}</ref> | The 2nd International Conference on Concussion in Sport recommends:<ref name="pmid15793085">{{cite journal |author=McCrory P, Johnston K, Meeuwisse W, ''et al'' |title=Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004 |journal=Br J Sports Med |volume=39 |issue=4 |pages=196–204 |year=2005 |month=April |pmid=15793085 |pmc=1725173 |doi=10.1136/bjsm.2005.018614 |url=http://bjsm.bmj.com/cgi/pmidlookup?view=long&pmid=15793085 |issn=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=citizendium&pubmedid=15793085 Pubmed Central]</ref> | ||
'''For the acute injury:''' | '''For the acute injury:''' | ||
Line 114: | Line 114: | ||
==External links== | ==External links== | ||
* | * [http://www.olympic.org/common/asp/download_report.asp?file=en_report_1005.pdf&id=1005 Sport Concussion Assessment Tool] (SCAT card). Complete version is available at http://bjsm.bmj.com/cgi/content/full/39/4/196/F1.<ref name="pmid15793085">{{cite journal |author=McCrory P, Johnston K, Meeuwisse W, ''et al'' |title=Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004 |journal=Br J Sports Med |volume=39 |issue=4 |pages=196–204 |year=2005 |month=April |pmid=15793085 |pmc=1725173 |doi=10.1136/bjsm.2005.018614 |url=http://bjsm.bmj.com/cgi/pmidlookup?view=long&pmid=15793085 |issn=}} [http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=citizendium&pubmedid=15793085 Pubmed Central]</ref> |
Revision as of 23:58, 8 February 2009
Template:DiseaseDisorder infobox Concussion, or mild traumatic brain injury (MTBI), is the most common and least serious type of brain injury. Concussion is a "trauma-induced alteration in mental status that may or may not involve loss of consciousness". [1] A loss of consciousness is infrequent[2] although some definitions require a loss of consciousness.[3] It can be caused by acceleration or deceleration forces, or by a direct blow. Concussion is generally not associated with penetrating injuries, but instead with blunt trauma.
Classification
Grades
American Academy of Neurology clinical practice guidelines grade as follows:[4]
Grade 1:
- Transient confusion
- No loss of consciousness
- Concussion symptoms or mental status abnormalities on examination resolve in less than 15 minutes.
Grade 2:
- Transient confusion
- No loss of consciousness
- Concussion symptoms or mental status abnormalities on examination last more than 15 minutes
Grade 3:
- Any loss of consciousness, either brief (seconds) or prolonged (minutes).
Symptoms
The frequency of various symptoms has been studied using collegiate football players: the NCAA Concussion Study.[5][6]
Frequency | |
---|---|
Headache | 85% |
Dizziness/balance difficulties | 77% |
No loss of consciousness nor amnesia | 78% |
Loss of consciousness | 6% (median duration, 30 seconds) |
Anterograde amnesia Events after the injury such as exiting the field |
19% (median duration, 90 minutes) |
Retrograde amnesia Events before the injury such as inability to recall aspects of the play |
7% (median duration, 120 minutes) |
Delayed onset of symptoms | 12% (mean delay; 14+15 minutes) |
In a study of concussions in Australian Football League, 44% (102 of 234) were recorded during television broadcast.[7] Among the concussions recorded on television, 25% showed tonic posturing lasting 2 to 30 seconds with "abduction and elevation of semiflexed arms and shoulders in a 'bear-hug' posture" similar to decorticate rigidity while one-quarter of the patients with posturing also had clonic movements usually less than 10 seconds.[7] Seizures may occassionally occur.[8]
Pathophysiology
Functional magnetic resonance imaging shows hyperactivity in Brodmann's Area 6 and this is associated with time till recovery.[9]
Prognosis
A cohort study of NCAA football players found that signs and symptoms typically laste 3.5 days and resolvee by one week in 88%.[5] In the same cohort study, slow recovery from concussion is more likely among players with a history of previous concussions.[6]
Second Impact Syndrome
Second impact syndrome is a controversial syndrome in which case rapid clinical deterioration occurs after a minor injury. If this exists, it is rare.[10][11]
Treatment
Concussion in sports
Various Clinical practice guidelines address management. Additional recommendations have been based on severity of the concussion and prior concussion (see Ropper et al Table 3.[3]
American Academy of Neurology
Clinical practice guidelines from the American Academy of Neurology although not revised since 1997, provide current advice on managing concussion in sports:[4]
Grade 1:
- "Remove from contest"
- "Examine immediately and at 5 minute intervals for the development of mental status abnormalities or post-concussive symptoms at rest and with exertion."
- "May return to contest if mental status abnormalities or post-concussive symptoms clear within 15 minutes.
- "A second Grade 1 concussion in the same contest eliminates the player from competition that day, with the player returning only if asymptomatic for one week at rest and with exercise."
Grade 2:
- "Remove from contest and disallow return that day."
- "Examine on-site frequently for signs of evolving intracranial pathology."
- "A trained person should reexamine the athlete the following day."
- "A physician should perform a neurologic examination to clear the athlete for return to play after 1 full asymptomatic week at rest and with exertion."
- CT or MRI scanning is recommended in all instances where headache or other associated symptoms worsen or persist longer than one week."
- Following a second Grade 2 concussion, return to play should be deferred until the athlete has had at least two weeks symptom-free at rest and with exertion."
- Terminating the season for that player is mandated by any abnormality on CT or MRI scan consistent with brain swelling, contusion, or other intracranial pathology."
Grade 3:
- "Transport the athlete from the field to the nearest emergency department by ambulance if still unconscious or if worrisome signs are detected (with cervical spine immobilization, if indicated)."
- "A thorough neurologic evaluation should be performed emergently, including appropriate neuroimaging procedures when indicated."
- "Hospital admission is indicated if any signs of pathology are detected, or if the mental status of the athlete remains abnormal."
- "If findings are normal at the time of the initial medical evaluation, the athlete may be sent home. Explicit written instructions will help the family or responsible party observe the athlete over a period of time."
- "Neurologic status should be assessed daily thereafter until all symptoms have stabilized or resolved."
- "Prolonged unconsciousness, persistent mental status alterations, worsening postconcussion symptoms, or abnormalities on neurologic examination require urgent neurosurgical evaluation or transfer to a trauma center."
- "After a brief (seconds) Grade 3 concussion, the athlete should be withheld from play until asymptomatic for 1 week at rest and with exertion."
- "After a prolonged (minutes) Grade 3 concussion, the athlete should be withheld from play for 2 weeks at rest and with exertion."
- "Following a second Grade 3 concussion, the athlete should be withheld from play for a minimum of 1 asymptomatic month. The evaluating physician may elect to extend that period beyond 1 month, depending on clinical evaluation and other circumstances."
- "CT or MRI scanning is recommended for athletes whose headache or other associated symptoms worsen or persist longer than 1 week."
- "Any abnormality on CT or MRI consistent with brain swelling, contusion, or other intracranial pathology should result in termination of the season for that athlete and return to play in the future should be seriously discouraged in discussions with the athlete."
2nd International Conference on Concussion in Sport
The 2nd International Conference on Concussion in Sport recommends:[12]
For the acute injury:
- The player should not be allowed to return to play in the current game or practice.
- The player should not be left alone, and regular monitoring for deterioration is essential over the initial few hours after injury.
- The player should be medically evaluated after the injury.
- Return to play must follow a medically supervised stepwise process.
- A player should never return to play while symptomatic.
Return to play protocol:
- No activity, complete rest. Once asymptomatic, proceed to level 2.
- Light aerobic exercise such as walking or stationary cycling, no resistance training.
- Sport specific exercise—for example, skating in hockey, running in soccer; progressive addition of resistance training at steps 3 or 4.
- Non-contact training drills.
- Full contact training after medical clearance.
- Game play.
References
- ↑ Meehan WP, Bachur RG (January 2009). "Sport-related concussion". Pediatrics 123 (1): 114–23. DOI:10.1542/peds.2008-0309. PMID 19117869. Research Blogging.
- ↑ Cantu RC, Herring SA, Putukian M (April 2007). "Concussion". N. Engl. J. Med. 356 (17): 1787; author reply 1789. DOI:10.1056/NEJMc070289. PMID 17460239. Research Blogging.
- ↑ 3.0 3.1 Ropper AH, Gorson KC (January 2007). "Clinical practice. Concussion". N. Engl. J. Med. 356 (2): 166–72. DOI:10.1056/NEJMcp064645. PMID 17215534. Research Blogging.
- ↑ 4.0 4.1 (March 1997) "Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee". Neurology 48 (3): 581–5. PMID 9065530. [e]
- ↑ 5.0 5.1 McCrea M, Guskiewicz KM, Marshall SW, et al (November 2003). "Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study". JAMA 290 (19): 2556–63. DOI:10.1001/jama.290.19.2556. PMID 14625332. Research Blogging.
- ↑ 6.0 6.1 Guskiewicz KM, McCrea M, Marshall SW, et al (November 2003). "Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study". JAMA 290 (19): 2549–55. DOI:10.1001/jama.290.19.2549. PMID 14625331. Research Blogging.
- ↑ 7.0 7.1 McCrory PR, Berkovic SF (April 2000). "Video analysis of acute motor and convulsive manifestations in sport-related concussion". Neurology 54 (7): 1488–91. PMID 10751264. [e]
- ↑ McCrory PR, Berkovic SF (February 1998). "Concussive convulsions. Incidence in sport and treatment recommendations". Sports Med 25 (2): 131–6. PMID 9519401. [e]
- ↑ Lovell MR, Pardini JE, Welling J, et al (August 2007). "Functional brain abnormalities are related to clinical recovery and time to return-to-play in athletes". Neurosurgery 61 (2): 352–9; discussion 359–60. DOI:10.1227/01.NEU.0000279985.94168.7F. PMID 17762748. Research Blogging.
- ↑ McCrory P (July 2001). "Does second impact syndrome exist?". Clin J Sport Med 11 (3): 144–9. PMID 11495318. [e]
- ↑ McCrory PR, Berkovic SF (March 1998). "Second impact syndrome". Neurology 50 (3): 677–83. PMID 9521255. [e]
- ↑ McCrory P, Johnston K, Meeuwisse W, et al (April 2005). "Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004". Br J Sports Med 39 (4): 196–204. DOI:10.1136/bjsm.2005.018614. PMID 15793085. PMC 1725173. Research Blogging. Pubmed Central
External links
- Sport Concussion Assessment Tool (SCAT card). Complete version is available at http://bjsm.bmj.com/cgi/content/full/39/4/196/F1.[1]
- ↑ McCrory P, Johnston K, Meeuwisse W, et al (April 2005). "Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004". Br J Sports Med 39 (4): 196–204. DOI:10.1136/bjsm.2005.018614. PMID 15793085. PMC 1725173. Research Blogging. Pubmed Central