Cerebral Concussion in Athletes: Evaluation and Neuropsychological Testing

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 659-672 ◽  
Author(s):  
Joseph C. Maroon ◽  
Mark R. Lovell ◽  
John Norwig ◽  
Kenneth Podell ◽  
John W. Powell ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Making ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Neuropsychological Testing ◽  
Extracellular Potassium ◽  
Loss Of Consciousness ◽  
Management Guidelines ◽  
Cerebral Concussion

ABSTRACT OBJECTIVE To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.

Assessing Mild Traumatic Brain Injury

1998 ◽  
Vol 3 (6) ◽  
pp. 1-5 ◽  
Author(s):  
Nathan D. Zasler ◽  
Michael F. Martelli
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Disease Process ◽  
The United States ◽  
Physical Symptoms ◽  
The Body ◽  
Loss Of Consciousness ◽  
Ideal System

Abstract Mild traumatic brain injury (MTBI) accounts for approximately 80% of the estimated 373000 traumatic brain injuries that occur annually in the United States. MTBI typically occurs in males 15 to 24 years of age, and postconcussional sequelae may impede physical, emotional, social, marital, vocational, and avocational functioning. Usually the severity of the initial neurologic injury is defined according to the Glasgow Coma Score, the presence and duration of amnesia (retrograde and anterograde), and the alteration of loss of consciousness and its duration. MTBI is a traumatically induced physiological disruption of cerebral function manifested by at least one of the following: loss of consciousness no longer than 20 minutes; any loss of memory; any alteration in mental status at the time of the accident; physical symptoms that potentially are related to the brain; and development of posttraumatic cognitive deficits not accounted for by emotional factors. When a patient presents with multisystem trauma, impairments may involve several parts of the body, including the nervous system. Individual impairments of other systems should be calculated separately and their whole person values combined using the Combined Values Chart in AMA Guides to the Evaluation of Permanent Impairment. At present, no ideal system can rate impairment following MTBI, and physicians must thoroughly understand both the underlying disease process and the associated injuries.

Loss of Consciousness Is Related to White Matter Injury in Mild Traumatic Brain Injury

2016 ◽  
Vol 33 (22) ◽  
pp. 2000-2010 ◽  
Author(s):  
Elisabeth A. Wilde ◽  
Xiaoqi Li ◽  
Jill V. Hunter ◽  
Ponnada A. Narayana ◽  
Khader Hasan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
White Matter ◽  
Mild Traumatic Brain Injury ◽  
White Matter Injury ◽  
Loss Of Consciousness

Loss of consciousness and altered mental state predicting depressive and post-concussive symptoms after mild traumatic brain injury

Brain Injury ◽  
2019 ◽  
Vol 33 (8) ◽  
pp. 1064-1069 ◽  
Author(s):  
Durga Roy ◽  
Matthew E. Peters ◽  
Allen Everett ◽  
Jeannie-Marie Leoutsakos ◽  
Haijuan Yan ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Mental State ◽  
Loss Of Consciousness ◽  
Altered Mental State

scholarly journals Introduction of the Abbreviated Westmead Post-Traumatic Amnesia Scale and Impact on Length of Stay

2017 ◽  
Vol 106 (4) ◽  
pp. 356-360 ◽  
Author(s):  
C. E. Watson ◽  
E. A. Clous ◽  
M. Jaeger ◽  
S. K. D’Amours
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Length Of Stay ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Hospital Admissions ◽  
Assessment Tool ◽  
Hospital Length Of Stay ◽  
Traumatic Amnesia ◽  
Post Traumatic

Background and Aims: Mild traumatic brain injury is a common presentation to Emergency Departments. Early identification of patients with cognitive deficits and provision of discharge advice are important. The Abbreviated Westmead Post-traumatic Amnesia Scale provides an early and efficient assessment of post-traumatic amnesia for patients with mild traumatic brain injuries, compared with the previously used assessment, the Modified Oxford Post-traumatic Scale. Material and Methods: This retrospective cohort study reviewed 270 patients with mild traumatic brain injury assessed for post-traumatic amnesia over a 2-year period between February 2011 and February 2013. It identified those assessed with Abbreviated Westmead Post-traumatic Amnesia Scale versus Modified Oxford Post-traumatic Scale, the outcomes of these post-traumatic amnesia assessments, the hospital length of stay for patients, and their readmission rates. Results: The Abbreviated Westmead Post-traumatic Amnesia Scale was used in 91% of patient cases (and the Modified Oxford Post-traumatic Scale in 7%), and of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 94% cleared post-traumatic amnesia testing within 4 h. Of those assessed with the Abbreviated Westmead Post-traumatic Amnesia Scale, 56% had a shorter length of stay than had they been assessed with the Modified Oxford Post-traumatic Scale, resulting in 295 bed-days saved. Verbal and written discharge advice was provided to those assessed for post-traumatic amnesia to assist their recovery. In all, 1% of patients were readmitted for monitoring of mild post-concussion symptoms. Conclusion: The Abbreviated Westmead Post-traumatic Amnesia Scale provides an effective and timely assessment of post-traumatic amnesia for patients presenting to the Emergency Department with mild traumatic brain injury compared with the previously used assessment tool. It helps identify patients with cognitive impairment and the need for admission and further investigation, resulting in appropriate access to care. It also results in a decreased length of stay and decreased hospital admissions, with subsequent cost savings to the hospital.

scholarly journals Toward Return to Duty Decision-Making After Military Mild Traumatic Brain Injury: Preliminary Validation of the Charge of Quarters Duty Test

2018 ◽  
Vol 183 (7-8) ◽  
pp. e214-e222 ◽  
Author(s):  
Mary V Radomski ◽  
Leslie F Davidson ◽  
Laurel Smith ◽  
Marsha Finkelstein ◽  
Amy Cecchini ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Decision Making ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Preliminary Validation ◽  
Return To Duty

scholarly journals A model of longitudinal hemodynamic alterations after mild traumatic brain injury in adolescents

2019 ◽  
Vol 3 ◽  
pp. 205970021983865
Author(s):  
Corey M Thibeault ◽  
Samuel Thorpe ◽  
Nicolas Canac ◽  
Michael J O’Brien ◽  
Mina Ranjbaran ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Diagnostic Tool ◽  
Brain Injuries ◽  
Transcranial Doppler Ultrasound ◽  
Traumatic Brain Injuries ◽  
Traumatic Injuries ◽  
Adolescent Population ◽  
Inverse Models

There is an unquestionable need for quantitative biomarkers of mild traumatic brain injuries. Something that is particularly true for adolescents – where the recovery from these injuries is still poorly understood. However, within this population, it is clear that the vasculature is distinctly affected by a mild traumatic brain injury. In addition, our group recently demonstrated how that effect appears to show a progression of alterations similar but in contrast to that found in severe traumatic injuries. Through measuring an adolescent population with transcranial Doppler ultrasound during a hypercapnia challenge, multiple phases of hemodynamic dysfunction were suggested. Here, we create a generalized model of the hemodynamic responses by fitting a set of inverse models to the dominant features from that work. The resulting model helps define the multiple phases of hemodynamic recovery after a mild traumatic brain injury. This can eventually be generalized, potentially providing a diagnostic tool for clinicians tracking patient’s recovery, and ultimately, resulting in more informed decisions and better outcomes.

scholarly journals Sensorimotor conflict tests in an immersive virtual environment reveal subclinical impairments in mild traumatic brain injury

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hrishikesh M. Rao ◽  
Tanya Talkar ◽  
Gregory Ciccarelli ◽  
Michael Nolan ◽  
Anne O’Brien ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Virtual Environment ◽  
Mild Traumatic Brain Injury ◽  
Brain Injuries ◽  
Clinical Tests ◽  
Immersive Virtual Environment ◽  
Average Accuracy ◽  
Patient Reported ◽  
Huge Impact

Abstract Current clinical tests lack the sensitivity needed for detecting subtle balance impairments associated with mild traumatic brain injury (mTBI). Patient-reported symptoms can be significant and have a huge impact on daily life, but impairments may remain undetected or poorly quantified using clinical measures. Our central hypothesis was that provocative sensorimotor perturbations, delivered in a highly instrumented, immersive virtual environment, would challenge sensory subsystems recruited for balance through conflicting multi-sensory evidence, and therefore reveal that not all subsystems are performing optimally. The results show that, as compared to standard clinical tests, the provocative perturbations illuminate balance impairments in subjects who have had mild traumatic brain injuries. Perturbations delivered while subjects were walking provided greater discriminability (average accuracy ≈ 0.90) than those delivered during standing (average accuracy ≈ 0.65) between mTBI subjects and healthy controls. Of the categories of features extracted to characterize balance, the lower limb accelerometry-based metrics proved to be most informative. Further, in response to perturbations, subjects with an mTBI utilized hip strategies more than ankle strategies to prevent loss of balance and also showed less variability in gait patterns. We have shown that sensorimotor conflicts illuminate otherwise-hidden balance impairments, which can be used to increase the sensitivity of current clinical procedures. This augmentation is vital in order to robustly detect the presence of balance impairments after mTBI and potentially define a phenotype of balance dysfunction that enhances risk of injury.

scholarly journals P048: Current practices of management for mild traumatic brain injuries with intracranial hemorrhage

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S80
Author(s):  
É. Fortier ◽  
V. Paquet ◽  
M. Émond ◽  
J. Chauny ◽  
S. Hegg ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Ct Scan ◽  
Mild Traumatic Brain Injury ◽  
Intracranial Hemorrhage ◽  
Management Practices ◽  
Brain Injuries ◽  
Quebec City ◽  
Historical Cohort ◽  
Public Sector Health

Introduction: The radiological and clinical follow-up of patients with a mild traumatic brain injury (mTBI) and an intracranial hemorrhage (ICH) is often heterogeneous, as there is no official guideline for CT scan control. Furthermore, public sector health expenditure has increased significantly as the number of MRI and CT scan almost doubled in Canada in the last decade. Therefore, the main objective of this study was to describe the current management practices of mTBI patients with intracranial hemorrhage at two level-1 trauma centers. Methods: Design: An historical cohort was created at the CHU de Québec – Hôpital de l'Enfant-Jésus (Québec City) and Hôpital du Sacré-Coeur (Montréal). Consecutive medical records were reviewed from the end of 2017 backwards until sample saturation using a standardized checklist. Participants: mTBI patients aged ⩾16 with an ICH were included. Measures: The main and secondary outcomes were the presence of a control CT scan and neurosurgical consultation/admission. Analyses: Univariate descriptive analyses were performed. Inter-observer measures were calculated. Results: Two hundred seventy-four patients were included, of which 51.1% (n = 140) came from a transfer. Mean age was 60.8 and 68.9% (n = 188) were men. Repeat CT scan was performed in 73.6% (n = 201) of our patients as 12.5% showed a clinical deterioration. The following factors might have influenced clinician decision to proceed to a repeat scan: anticoagulation (association of 87.1% with scanning; n = 27), antiplatelet (84.1%; 58), GCS of 13 (94.1%; 16), GCS of 14 (75%; 72) and GCS of 15 (70.2%; 111). 93.0% (n = 254) of patients had a neurosurgical consultation and only 6.7% (17) underwent a neurosurgical intervention. Conclusion: The management of mild traumatic brain injury with hemorrhage uses a lot of resources that might be disproportionate with regards to risks. Further research to identify predictive factors of deterioration is needed.

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