Notes

Outline

Sports for the Young Athlete: Concussion Joseph H Piatt, Jr, MD, FAAP Section of Neurosurgery

What is a concussion? a transient interruption of the normal functional activity of the brain caused by trauma: loss of consciousness amnesia loss of equilibrium inability to sustain attention emotional lability

Concussions are common in sporting activities. Collision, contact, and non-contact sports present widely varying risks. Athletes and coaches may not recognize. Athletes and coaches may not report.

Goals for Management of Concussion early detection of neurosurgical emergencies prevention of the postconcussion syndrome prevention of chronic posttraumatic encephalopathy (…“dementia pugilistica”) avoidance of “second impact syndrome”

Neurosurgical Conditions

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Postconcussion Syndrome: a less intense, but protracted, concussion headache dizziness, vertigo, dysequilibrium inability to sustain attention emotional lability, personality change sleep disturbance loss of stamina

Posttraumatic Encephalopathy: a permanent postconcussion syndrome Neurocognitive deficits attentional deficits executive organizational deficits disturbances of mood, personality General psychomotor slowing Motoric disabilities dysequilibrium posttraumatic parkinsonism

Second Impact Syndrome rare – perhaps 1 case per football season in the USA sudden loss of cerebrovascular autoregulation with hyperemia explosive ICP, herniation, death All victims have returned to play before resolution of symptoms of concussion.

Guidelines for Management of Concussion Robert Cantu, MD (American College of Sports Medicine), 1986 Colorado Medical Society (NCAA), 1991 American Academy of Neurology, 1997

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Grades of Concussion

Management Recommendations

Multiple Concussions (CMS)

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