Expired CME Article

Concussion in Athletes

Authors: Thomas R. Terrell, MD, MPHIL

Abstract

Annotation: Treatment of the “ding” or “bellring” complaint continues to involve tough decision-making. Combined multispecialty research-based guidelines have now evolved to permit better handling of return to contact during practice and formal competition. Dr. Terrell brings first-hand experience and current evidence-based criteria and discussion to the reader.

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References

1. Centers of Disease Control and Prevention. Sports related recurrent brain injuries-United States.MMWR 1997;46:224–227.
 
2. Kushner DS. Mild traumatic brain injury. Arch Internal Medicine 1998;158:1617–1624.
 
3. Alexander MP. Mild traumatic brain injury: pathophysiology, natural history, and clinical management. Neurology 1995;45:1253–1260.
 
4. Cantu RC. Guidelines for return to contact sports after a cerebral concussion. Physician and Sportsmedicine 1986;14:75–83.
 
5. Concussion in Sport Group: Johnston, K, Aubry, M, Cantu, R et al. Summary and agreement statement of the first international conference on concussion in sport, Vienna 2001. Physician and Sportsmedicine 2002;30.
 
6. Johnston KM, McCrory P, Mohtadi NG, et al. Evidence based review of sport-related concussion:clinical science. Clin J Sports Med 2001;11:150–159.
 
7. Sallis RE. Prevalence of headache in football players. Med Sci Sports Exerc, 2001;32(11):1820–1824.
 
8. Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain 1974;97:633–654.
 
9. Marion, DW. Traumatic Brain Injury. New York, Thieme Medical Publishers, 1999, pp 32–33.
 
10. Cantu RC. Return to play guidelines after concussion, in Neurologic Athletic Health and Spine Injuries. Philadelpia, W.B. Saunders Company, 1999: 117–122.
 
11. Hofman PAM, Kemerink GJ, Jolles J, et al. Quantitative anaylsis of magnetization transfer images of the brain-effect of closed head injury, age, and sex on white matter. Magn Reson Med 1999;42:803–806.
 
12. Hovda D, Lee S, Smith M, et al. The neurochemical and metabolic cascade following brain injury; moving form animal models to man. J Neurotrauma 1995;12:903–906.
 
13. Mitchener A, Wyper DJ, Patterson J, et al. SPECT, CT, and MRI in head injury: acute abnormalities followed up at six months. J Neurol Neurosurg Psychiatry 1997;62:6336.
 
14. Delaney SJ, Lacroix VJ, Leclerc S, et al. Concussions during the 1997 Canadian Football League season. Clin J Sports Med 2000;54:1488–1491.
 
15. Matser JT, Kessels AG, Jordan BD, et al. Chronic traumatic brain injury in professional soccer players. Neurology 1998;51:791–796.
 
16. Cartlidge, NEF and Shaw, DA. Neurologic Sequelae of Head Injury, in Head Injury. London, WB Saunders, 1981, pp 28–45.
 
17. McCrea M, Kelly JP, Kluge J, et al. Standardized assessment of concussion in football players.Neurology 1997;48:586–588.
 
18. Graham DI. Neuropathology of Head Injury, in Narayan RK, Wilberger JE Jr, Povlishock JT, (eds):Neurotrauma. NewYork, McGraw-Hill,1996, pp 46–47.
 
19. Leclerc S, Lassonde M, Delaney, JS et al. Recommendations for grading of concussions in athletes. Sports Med 2001;31:629–636.
 
20. Cantu RC. Return to play guidelines after a head injury. Clin Sport Med 1998;17:45–60.
 
21. Cantu, R. Posttraumatic retrograde and anterograde amnesia: pathophysiology and implications in grading and safe return to play. J Athl Training 2001;36:244–248.
 
22. Kelly JP, Rosenberg JH. Diagnosis and management of concussion in sports. Neurology1997;48:575–580.
 
23. Report of the Quality Standards Subcommittee. Practice parameter: the management of concussion in sports. Neurology 1997;48:581–585.
 
24. McCrory P. Does Second impact syndrome exist? Clin J Sports Med 2001;11:144–149.
 
25. Terrell T, Tucker A. Concussion in Sports (editorial) American Family Physician 1999;60:738–739.
 
26. Hinton-Bayre, A, Geffen, G. Severity of sports-related concussion and neuropsychological test performance. Neurology 2002;59:1068–1070.
 
27. Lenninger B, Gramling S, Farrell A, et al. Neuropsychological deficits in symptomatic minor head injury patients after concussion and mild concussion. J Neurol Neurosurg Psych 1990;53:293–296.
 
28. Collins M, Grindel S, Lovell M, et al. Relationship between concussion and neuropsychological performance in college football players. JAMA 1999;282:964–970.
 
29. Barth JT, Macciocchi SN, Giordani B, et al. Neuropsychological sequelae of minor head injury.Neurosurg 1983;13:529–533.
 
30. Collins M, Iverson G, Lovell M, et al. On-field predictors of neuropsychological and symptom deficit following sports-related concussion. Clin J Sports Med 2003;13:222–229.
 
31. Grindel S, Lovell M, Collins M. The assessment of sports-related concussion: the evidence behind neuropsychological testing and management. Clin J Sports Med, 2001;11:134–143.
 
32. Erlanger D, Saliba E, Barth J, et al. Monitoring resolution of postconcussion symptoms in athletes: preliminary results of a web-based neuropsychological test protocol. J Ath Training, 2001;36:280–287.
 
33. Matser J, Kessels A, Jordan B. Chronic traumatic brain injury in professional soccer players.Neurology 1998;51:791–796.
 
34. Tysavaer AT, Lochen E. Association football injuries to the brain: a preliminary report. Br J Sports Med 1981;15:163–166.
 
35. Tysvaer AT. Soccer injuries to the brain: a neuropsychologic study of former soccer players. Am J Sports Med 1991;19:56–60.
 
36. Guskiewicz K, Marshall S, Broglio S. No evidence of impaired neurocognitive performance in collegiate soccer players. Am J of Sports Med 2002;20:157–162.
 
37. Lovell M. Does brief loss of consciousness define concussion severity in athletes? Abstracts from 11th annual meeting of the American Medical Society for Sports Medicine, Orlando, Florida, April 6–7, 2002.
 
38. Peterson, C, Ferrara, M, Mrazik et al. Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports. Clin J Sports Med 2003;13:230–237.
 
39. Jordan B, Relkin N, Ravdin L. Apolipoprotein E epsilon 4 associated with chronic traumatic brain injury in boxing. JAMA 1997;278:136–140.
 
40. Kutner KC, Erlanger DM, Tsai J, Jordan B, Relkin NR. Lower cognitive performance of older football players possessing apolipoprotein E epsilon-4. Neurosurgery 2000;47(3):651–658.
 
41. Kutner KC, Erlanger DM, Tsai J, Jordan B, Relkin NR. Lower cognitive performance of older football players possessing apolipoprotein E epsilon-4. Neurosurgery 2000;47(3):651–658.