Historical account

Foot ball fatalities have been tracked since 1931

Second-impact syndrome was first described by Saunders in 1984

Between 1984 and 1991, only four cases were documented

In 1994 it was discovered that a previously concussed football player was six times as likely to suffer a concussion

In 2002 A high-school football student was concussed twice within two weeks. Collapsed on the field and died six days later.

In 2010 the NFL made a new rule against leading with the head to prevent concussions

Historical Account

1966 Concussion defined as “A clinical syndrome characterized by Immediate and transient post traumatic impairment of neural function due to brainstem involvement” ( by the Committee of Head Injury Nomenclature of the Congress of Neurological Surgeons)

2001 It’s defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”

Caused by direct or indirect blow to head Rapid onset of short lived impairment of neurologic function Acute clinical symptoms-functional disturbance May or may not be a loss of consciousness Associated with grossly normal structural neuroimaging

( By the Committee on head injury nomenclature of the Congress of Neurologic Surgeons)

Grades of a Concussion

Grade 1 Transient confusion No loss of

consciousness Mental status

abnormalities resolve in 15 minutes or less

Grade 2 Similar to grade one

differing only in duration. Symptoms lasting 15 minutes or more.

Grade 3 Loss of

consciousness, brief or prolonged.

Former NFL players talk about concussions

Historical Account2004 International conference on concussion in Sport Prague 2004

Simple Concussion Complex Concussion

Resolves without complication over 7-10 days

No further intervention is required during recovery

Rest until all symptoms resolve

Testing from normal physician

Encompasses cases where athletes suffer persistent symptoms

Concussive convulsions Prolonged loss of consciousness (>

1min) Prolonged cognitive impairment

following injury Multiple concussions over time Testing from physicians with

specific expertise in the management of concussive injury (sports medicine doctor with experience in concussion, sports neurologist or neurosurgeon)

Signs and Symptoms: Short termCognitive Features Typical Symptoms

Unaware of period, opposition, score of game

Confusion Amnesia Loss of consciousness

Headache or pressure in the head

Balance problems or dizziness

Nausea Feeling “dinged”,

“foggy”, Stunned, or “dazed”

Visual problems Irritability or emotional

changes

Signs and Symptoms: Short termPhysical Signs

Loss of consciousness/impaired conscious state

Poor coordination or balance

Concussive convulsion/impact seizure

Gait unsteadiness/loss of balance

Slow to answer questions or follow directions

Easily distracted, poor concentration

Displaying inappropriate emotions (eg. Laughing or crying)

Vomiting Vacant stare/glassy eyed Slurred speech Personality changes Inappropriate playing behavior

(eg. running the wrong direction) Significantly decreased playing

ability

The Scat CardThe SCAT Card(Sport Concussion Assessment Tool)MEDICAL EVALUATION Name: _____________________ Date: __________ Sport/Team: ________________ Mouth Guard? Y N 1) SIGNSWas there loss of consciousness or unresponsiveness? Y NWas there seizure or convulsive activity? Y NWas there a balance problem/unsteadiness? Y N 2) MEMORYModified Maddocks questions (check those correct) At what venue are we? ___ Which half is it? ___ Who scored last?

___What team did we play last? ___

Did we win last game? ___ 3) SYMPTOM SCORETotal number of positive symptoms (from “SYMPTOMS” box on

other side of the card) = ______ 4) COGNITIVE ASSESSMENT(Check those correct)5 word recall Immediate Delayed

(Examples) (after concentration tasks)Word 1 _______ cat ___ ___Word 2 _______ pen ___ ___Word 3 _______ shoe ___ ___Word 4 _______ book ___ ___Word 5 _______ car ___ ___

Months in reverse order (circle those incorrect) Jun-May-Apr-Mar-Feb-Jan-Dec-Nov-Oct-Sep-Aug-Jul

ORDigits backwards (check those correct)5-2-8 3-9-1 ___6-2-9-4 4-3-7-1 ___8-3-2-7-9 1-4-9-3-6 ___7-3-9-1-4-2 5-1-8-4-6-8 ___ Ask delayed 5-word recall now 5) NEUROLOGICAL SCREENING

Pass FailSpeech ___ ___Eye Motion and Pupils ___ ___Pronator Drift ___ ___Gait Assessment ___ ___Any neurologic screening abnormality necessitates formal

neurologic or hospital assessment. 6) RETURN TO PLAY ATHLETES SHOULD NOT BE RETURNED TO PLAY THE SAME DAY

OF INJURY.When returning athletes to play, they should follow a stepwise

symptom-limited program, with stages of progression. For example:

1. rest until asymptomatic (physical and mental rest)2. light aerobic exercise (e.g. stationary cycle)3. sport-specific training4. non-contact training drills (start light resistance training)5. full contact training after medical clearance6. return to competition (game play) There should be approximately 24 hours (or longer) for each stage and

the athlete should return to stage 1 if symptoms recur. Resistance training should only be added in the later stages.

Medical clearance should be given before return to play.

Signs and Symptoms: Long term Symptoms increase with repeat concussions Chronic Headaches Chronic Dizziness Dementia Depression

Second impact syndrome death

Post concussive syndrome Continual display of symptoms such as headache, cognitive

dysfunction, irritability Chronic Traumatic Encephalopathy or CTE

TAU proteins Loss of ability to control muscles

Signs and Symptoms: Long Term EffectsChronic Traumatic Encephalopathy or CTE

• Memory Loss • Aggression • Confusion• Depression

Baby shaken syndrome

Symptoms and Signs

Small brain Inability to hold head

Damage to spinal cord and neck

Bleeding in the brain Metal retardation

Blindness Bleeding in retina

Fracture of bones

Neurological Findings

Postural Stability and Neuropsychological deficits

Design Baseline Pre-Season Follow up Post injury days

1,3,5 Control subjects

Measurements Assessed postural stability Neurocognitive functioning

was measured with: Trail-making test Wechsler Digit Span test Stroop color Word Test Hopkins Verbal Learning test

Results Subjects demonstrated

postural stability deficits significantly worse than both preseason scores and matched control subjects

Trail-Making test B and Wechsler Digit Span test resulted lowered performance

TREATMENTS•Sleep & Rest

day and night

•Medicationsacetaminophen,

ibuprofen

•Observationfirst 24 hours Treatment is directed at

symptom control for:

headaches

nausea

dizziness

insomnia

- most symptoms resolve within a week

to 10 days

Usual Outcomes

Serious head injuries can result in anything from full recovery to

death or a permanent coma.

• 300,000 sports-related concussions reported each year.

Akron Basketball

•Recovery in less than 14 days(simple concussion)

•post-concussion syndrome (complicated concussion)

•cumulative effects(complicated concussion)

•second-impact syndrome(very complicated concussion)

Brain Areas AffectedDepends on where the damage occurs

Frontal lobe, occipital lobe, temporal lobe, hippocampus, cerebellum, etc.

"You can see there are hardly any areas untouched by the damage. I would call it incredible chaos in the brain.“-Dr. Ann McKee , University of Boston

BIG BABY DAVIS

Who does it happen too?

Males- more male athletes play at-risk sports that give them a greater chance to get a concussion

Football, hockey, rugbee, lacross Age?

It occurs more severly in children, but happen more to adults do the increased aggressiveness and intensity of the sports.

THE SCIENCE!!

“A concussion is the action of the brain smacking up against the skull”- professor Pillatery

-most improperly diagnosed/ or not diagnosed at all.

-http://www.youtube.com/watch?v=8jy2f9_Gtvo&NR=1

Immediate symptoms

Disruption in neurological impulses Level 1- Level 2- Level 3-

Memory- right beforeDizziness/ disorientation- neurons trying to

refire

Swelling of the brain

Neural damage Glutamate storm Neurotransmitter spill

Blood brain barrier/autoregulation

Self-regulatory Epithelial cells Tight junction

Immune response Blood acidity Immune chemicals destroy neural tissue Destruction of neural tissue

Second impact syndrome

A second concussion tremendously increases ICP to the point that blood can no longer properly circulate through the brain resulting in extreme brain damage and death. (ischemia

ICP

ICP= tissue+blood+CSF

-Blood pooling (hematoma)- Ischemia - Hypoxia