Concussion and sport
Definition
Symptoms
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SIGNS
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- Many definitions for concussion
- "minor" traumatic brain injury
- "A complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces"
- "a transiently induced alteration in mental status, (not necessarily with loss of consciousness)"
- Only pathognomic feature is post traumatic altered short term recall
- NB : Not limited to direct head impact
- Difficult to advise when to return to sport (minimise chances of catastrophic "second impact syndrome")
- Symptoms may last up to 6 months
- Standardised Assessment of Concussion (SAC) has been proposed as an objective, quantifiable assessment
Second Impact Syndrome
- Typically seen when players who remain symptomatic from a previous concussion return to play and sustain a second blow to the head.
- 2nd blow may be minor
- Later rapid, fatal brain oedema
- Thought o be due to loss autoregulation
- All reported cases : victims returned to play before symptoms related to an initial concussion had resolved. .
Repeated concussions
- After a player has suffered a first concussion, the chance of incurring a second concussion is more than 4 times greater than for the non-concussed player (Ref)
- Those who do suffer a second concussion have reduced cognitive functioning (reduced information processing ability) than those who had only been concussed once.
Concussive fitting
- Convulsive episodes start within 2 seconds of impact
- Typically brief tonic stiffening followed by myoclonic jerking
- May be asymmetrical
- Transient or last up to 3 minutes (ref)
- Not associated with structural or permanent brain injury and are non-epileptic
- All Ix (including EEG, CT and MRI) are normal
- No further treatment needed
- Can return to sport after 3 symptomatic weeks
Concussion severity and Return to play options (as per AAN guidelines (Ref))
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Definition |
Time to return to play* |
Grade 1Multiple Grade 1 |
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Grade 2Multiple Grade 2 |
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Grade 3 – briefGrade 3 – prolongedMultiple Grade 3 |
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* only if asymptomatic at rest and on exertion. † or longer depending on individual case |
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Sports related concussion in children / adolescents
- Interestingly, girls have higher concussion rates than boys do in similar sports.
- LOC is uncommon. If longer than 30 sec, it may indicate more significant intracranial injury.
- Concussion can cause symptoms that interfere with school, social & family relationships, and participation in sports.
- The signs and symptoms of a concussion typically resolve in 7 to 10 days in the majority of cases.
- Cognitive and physical rest is the mainstay of management after diagnosis.
- Imaging results are usually normal.
- Neuropsychological testing is a helpful tool in the management of concussion.
- Return to sport should be accomplished by using a progressive exercise program while evaluating for any return of signs or symptoms (rather than rigidly adhering to specific time intervals).
- Athletes with concussion should rest, both physically and cognitively, until their symptoms have resolved both at rest and with exertion. Teachers and school administrators should work with students to modify workloads to avoid exacerbation of symptoms.
- No patient (any age) should ever return to play while symptomatic at rest or with exertion.
- Athletes also should not be returned to play on the same day of the concussion, even if they become asymptomatic.
References
- Practice Parameter: The management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology 1997;48:581-585 Back
- McCrory PR, Berkovic SF. Concussive convulsions. Incidence in sport and treatment recommendations. Sports Med 1998;25(2):131-136 Back
- Cantu RC. Guidelines for return to contact sports after a cerebral concussion. Phys Sportsmed 1986;14:75-83 Back
- Halstead ME. The Council on Sports Medicine and FitnessSport-Related Concussion in Children and Adolescents. Pediatrics 126:3,597-615 (doi:10.1542/peds.2010-2005)
