Definition
Disturbance in brain function caused by direct or indirect injury to head
- no pathology seen on standard neuorological imaging
Pathophysiology
Disruption of mitachondria
- inability to produce energy
- accounts for symptoms such as lethargy etc
Headache
- ? due to ligament injury at cranio-cervical junction
Symptoms
Confusion
Tiredness
Lethargy
Inability to concentrate
Headache
Sleep impairment
Slowed reaction times
Symptoms worsen with
- concentration
- physical exertion
80 - 90% resolve within 1 week
- some patients suffer prolonged post concussion syndrome
NHx
2 x grade 3 concussions in career
- risk of permanent damage < 10%
- amateur sportsman should cease sports after 2 x Grade 3 concussions
3 x grade 3 concussions in career
- risk of permanent damage 60%
Adolescent
- studies have shown that after a grade 3 concussion in the next year
- A grade students show little effect to their grades
- average students have significant risk of failing grades
Management
Generally accepted that concussed athlete should not return to the game
Sideline assessment
SCAT2 / Sport Concussion Assessment Tool
- assess symptoms and GCS
- also tests memory / concentration / balance / co-ordination
Canadian CT Head Rules
Stiell et al Lancet 2001
1. GCS < 15 2 hours post injury
2. 2 or more vomiting episodes
3. Age > 65
4. Signs basal skull fracture
5. Signs skull fracture
6. Dangerous mechanism - > 3 foot or > 5 stairs
7. Amnesia before event > 30 minutes
Zurich Consensus Statement SAJSM 2009
Recommends use of SCAT2 and graduated return to play
Grading American Academy Neurology 1997
Grade 1
Definition
- no loss of consciousness
- head injury with confusion < 15 minutes
- full memory of the event
Action
- first concusion: return to sport within 15 minutes
- second concussion: 1 week
Grade 2
Definition
- no loss of consciousness
- confusion > 15 minutes
Action
- first concussion: 1 week
- second concussion: 2 weeks
Grade 3
Definition
- loss of consciousness
- 3A: few seconds
- 3B: minutes
Action
3A
- first concussion: 1 month
- second concussion: 6 months
3B
- first concussion: 6 months
- second concussion: 1 year
Neuropsychological testing
i.e. IMPACT
Performed as baseline for all collision athletes
- can then compare scores if concussed
- assess when return to normal / degree impairment
Online test availabe
- word remembering
- line drawing recognition
- coloured squares
- X & O
Return to sport
Stepwise symptom-limited program, with stages of progression
- 24 hours minimum for each step
- return to step 1 if symptoms recur
1. Rest until asymptomatic (physical and mental rest)
- recovery phase
2. Light aerobic exercise (e.g. stationary cycle)
- increase HR
3. Sport-specific exercise
- add movement
4. Non-contact training drills (start light resistance training)
- co-ordination and cognition
5. Full contact training after medical clearance
- functional skills assessed by coach and trainers
6. Return to competition (game play)