Recognition and characteristics of concussions in the emergency department population

Delaney, J. Scott; AbuZeyad, Faras H; Correa, José A.; Foxford, Robert

doi:10.1016/j.jemermed.2005.01.020

Cited by 54 publications

(34 citation statements)

References 59 publications

(66 reference statements)

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“…Because the first episode of head trauma may not necessarily have happened on the athletic field (15,23,66), we recommend that anytime a concussive event occurs in any individual, the physician (if informed) should advise the individual to behave safely and avoid further injury for a mandatory time until the end of the vulnerability period. Regarding concussions in sports medicine, we believe the use of 1 H-MR spectroscopy to measure NAA levels in concussed athletes offers a unique opportunity to monitor the degree and recovery of the posttraumatic neurochemical damage, in consideration of the much higher risk of recurrent concussions in athletes (81).…”

Section: Resultsmentioning

confidence: 99%

Temporal Window of Metabolic Brain Vulnerability to Concussion

et al. 2008

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OBJECTIVE:In the present study, the occurrence of the temporal window of brain vulnerability was evaluated in concussed athletes by measuring N-acetylaspartate (NAA) using proton magnetic resonance ( 1 H-MR) spectroscopy. METHODS: Thirteen nonprofessional athletes who had a sport-related concussive head injury were examined for NAA determination by means of 1 H-MR spectroscopy at 3, 15, and 30 days postinjury. All athletes but three suspended their physical activity. Those who continued their training had a second concussive event and underwent further examination at 45 days from the initial injury. The single case of one professional boxer, who was studied before the match and 4, 7, 15, and 30 days after a knockout, is also presented. Before each magnetic resonance examination, patients were asked for symptoms of mild traumatic brain injury, including physical, cognitive, emotional, and sleep disturbances. Data for 1 H-MR spectroscopy recorded in five normal, age-matched, control volunteers, who were previously screened to exclude previous head injuries, were used for comparison. Semiquantitative analysis of NAA relative to creatine (Cr)-and choline (Cho)-containing compounds was performed from proton spectra obtained with a 3-T magnetic resonance system. RESULTS: Regarding the values of the NAA-to-Cr ratio (2.21 Ϯ 0.11) recorded in control patients, singly concussed athletes, at 3 days after the concussion, showed a decrease of 18.5% (1.80 Ϯ 0.04; P Ͻ 0.001). Only a modest 3% recovery was observed at 15 days (1.88 Ϯ 0.1; P Ͻ 0.001); at 30 days postinjury, the NAA-to-Cr ratio was 2.15 Ϯ 0.1, revealing full metabolic recovery with values not significantly different from those of control patients. These patients declared complete resolution of symptoms at the time of the 3-day study. The three patients who had a second concussive injury before the 15-day study showed an identical decrease of the NAA-to-Cr ratio at 3 days (1.78 Ϯ 0.08); however, at 15 days after the second injury, a further diminution of the NAA-to-Cr ratio occurred (1.72 Ϯ 0.07; P Ͻ 0.05 with respect to singly concussed athletes). At 30 days, the NAAto-Cr ratio was 1.82 Ϯ 0.1, and at 45 days postinjury, the NAA-to-Cr ratio showed complete recovery (2.07 Ϯ 0.1; not significant with respect to control patients). This group of patients declared a complete resolution of symptoms at the time of the 30-day study. CONCLUSION: Results of this pilot study carried out in a cohort of singly and doubly concussed athletes, examined by 1 H-MR spectroscopy for their NAA cerebral content at different time points after concussive events, demonstrate that also in humans, concussion opens a temporal window of brain metabolic imbalance, the closure of which does not coincide with resolution of clinical symptoms. The recovery of brain metabolism is not linearly related to time. A second concussive event prolonged the time of NAA normalization by 15 days. Although needing confirmation in a larger group of patients, these results show that NAA measurement by 1 H-MR spe...

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Section: Resultsmentioning

confidence: 99%

Temporal Window of Metabolic Brain Vulnerability to Concussion

et al. 2008

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“…In South Africa, the average rate of reported rugby-related concussions ranges from [14][15][16][17][18][19][20][21].5% at high-school [12,13] and up to 23% at university, club and provincial adult level [13]. In a series of South African studies, adolescent rugby players have revealed a significantly higher historical incidence of reported concussions per sports participant when compared with field hockey controls [7,14].…”

Section: Introductionmentioning

confidence: 99%

“…Many concussions, however, go unreported because athletes, coaches and parents often ignore the symptoms and players fear losing their place in the team [7]. Further, there is ignorance of what constitutes a concussion and symptoms may be so mild as to be clinically undetectable [15,16]. There are many reasons, therefore, why the number of concussions may not be a true reflection of the number of instances experienced.…”

Section: Introductionmentioning

confidence: 99%

Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes

et al. 2015

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“…Large-scale studies demonstrate approximately 70% of all head injury cases seen in the emergency room (ER) are in the mTBI category (Udekwu et al, 2004). However, as pointed out by the CDC and other studies (Delaney et al, 2005), a substantial number of concussions is never evaluated in the ER, making it difficult to obtain precise numbers as to the true annual incidence rate. Bazarian et al (2005) estimate that the annual mTBI incidence rate is 503.10100,000, of which PPCS rates have been conservatively estimated at 10% (Ruff et al, 1996;Wood, 2004).…”

Section: Introduction: Brief History Of Concussionmentioning

confidence: 99%

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

Bigler

2007

J Int Neuropsychol Soc

359

248

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On the mild end of the acquired brain injury spectrum, the terms concussion and mild traumatic brain injury (mTBI) have been used interchangeably, where persistent post-concussive syndrome (PPCS) has been a label given when symptoms persist for more than three months post-concussion. Whereas a brief history of concussion research is overviewed, the focus of this review is on the current status of PPCS as a clinical entity from the perspective of recent advances in the biomechanical modeling of concussion in human and animal studies, particularly directed at a better understanding of the neuropathology associated with concussion. These studies implicate common regions of injury, including the upper brainstem, base of the frontal lobe, hypothalamic-pituitary axis, medial temporal lobe, fornix, and corpus callosum. Limitations of current neuropsychological techniques for the clinical assessment of memory and executive function are explored and recommendations for improved research designs offered, that may enhance the study of long-term neuropsychological sequelae of concussion. (JINS, 2008, 14, 1-22.)

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Recognition and characteristics of concussions in the emergency department population

Cited by 54 publications

References 59 publications

Temporal Window of Metabolic Brain Vulnerability to Concussion

Temporal Window of Metabolic Brain Vulnerability to Concussion

Mild traumatic brain injuries in early adolescent rugby players: Long-term neurocognitive and academic outcomes

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

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