Participation in contact or collision sports in athletes with epilepsy, genetic risk factors, structural brain lesions, or history of craniotomy

Abstract

<jats:p>✓Despite a plethora of guidelines for return to play following mild head injury, a discussion of when and if an athlete should be allowed to participate in contact or collision sports if he or she sustains a structural brain lesion or after a head injury requiring craniotomy is lacking. The structural lesions discussed include arachnoid cyst, Chiari malformation Type I, cavum septum pellucidum, and the presence of ventriculoperitoneal shunts. Issues unique to this population with respect to the possibility of increased risk of head injury are addressed. The population of athletes with epilepsy and certain genetic risk factors is also discussed. Finally, the ability of athletes to participate in contact or collision sports after undergoing craniotomies for traumatic or congenital abnormalities is evaluated. Several known instances of athletes returning to contact sports following craniotomy are also reviewed.</jats:p>

Retirement-from-sport considerations following pediatric sports-related concussion: case illustrations and institutional approach

“…Over the years, several authors have offered recommendations about when athletes should be advised to retire from contact or collision sports, but most have focused on collegiate and professional athletes. 16,18,20,21,23,43,66,76,91,93 Although some authors suggest a more conservative approach should be applied to child and adolescent athletes, 16,23 indications for retirement from sports remain controversial and there are limited reports that discuss these issues in application to pediatric SRC patients. Because decisions regarding athlete retirement are complex and must be tailored to the individuals in the absence AbbreviAtioNs CTE = chronic traumatic encephalopathy; PCS = postconcussion syndrome; RTP = return to play; SCI = spinal cord injury; SCIWORA = SCI without radiographic abnormality; SRC = sports-related concussion; TBI = traumatic brain injury.…”

“…76 Finally, several authors have suggested that patients with symptomatic or pain-causing lesions at the level of the foramen magnum, including Chiari malformations, be considered for retirement from contact and collision sports. 20,76,93 These recommendations largely stem from rare reports of sudden death among patients with Chiari malformations exposed to minor head trauma, and from speculation that medullary compression could have accounted for these outcomes. 76 A recent retrospective cohort study, however, demonstrated an exceedingly low risk of future catastrophic injury during sports participation in children with Chiari I malformation, even after foramen magnum decompression.…”

“…Some authors suggest that any athlete who has undergone a craniotomy for evacuation of any intracranial hemorrhage should be considered for retirement, 93 while others suggest that athletes with subdural and epidural hematomas may be considered for RTP if the patient has normal findings on neurological examination, brain reexpansion, and radiographic evidence of bone flap healing. 28,76 One survey-based study of the American Association of Neurological Surgeons included 32 patients who underwent craniotomy, the vast majority (approximately 80%) of whom returned to sports between 3 months and 1 year postinjury.…”

“…31,52,87,110 Bleeding associated with arachnoid cysts is thought to arise from fragile vessels within the cyst wall or bridging veins. 76 One recent retrospective study suggested that arachnoid cyst diameter of 5 cm or more was associated with a higher risk of hemorrhage/rupture in children. 26 Hydrocephalus accounts for an estimated 69,000 hospital discharges per year in the United States 11 and is most commonly treated with ventriculoperitoneal shunting or endoscopic third ventriculostomy.…”

“…16,23,76,93 Arachnoid cysts arise from CSF accumulation within layers of the arachnoid and are a common incidental finding on neuroimaging. 1 In some cases, children with arachnoid cysts have been found to present with intraarachnoid cyst hemorrhage, subdural hematoma, or hygroma following sportsrelated head injury.…”