Sports Concussion Management: Part I

Abstract

Concussion is a popular clinical topic that has been the subject of unprecedented recent media coverage. As concerns about the potential short- and long-term implications of repetitive head injury in sports such as football continue to mount, the proper clinical management of concussion seems to increase in importance. The days of ignoring the "ding" on the sideline are definitely over. A series of updated clinical evaluation and management recommendations from international experts are highlighted in this review. The clinical presentation of an acute concussion, both the typical and more subtle variations, may be evaluated with new validated sideline evaluation tools (eg, Sports Concussion Assessment Tool 2). In addition, the role of computerized neuropsychological and balance testing in the acute and ongoing evaluation are discussed, along with how they contribute to the return-to-play decision. Same-day return to play is outdated, and the relative insensitivity of current neuroimaging modalities to demonstrate structural damage is highlighted. New therapeutic interventions such as amantadine and cognitive rest may improve recovery time. The appropriate management of concussion typically results in a normal functional and neurocognitive outcome. The recommendations in this article may guide clinicians, with varying degrees of prior experience managing concussion, to increase the likelihood of an excellent outcome.

Tintin's travel traumas: Health issues affecting the intrepid globetrotter

“…In the medical literature, concussion is defined as mild traumatic brain injury, mild brain injury or mild head injury, which are all synonymous. Many systems measure the severity, or grade, of concussion but there is little agreement over the best [6,7]. We therefore used an "Hergé'' grading system after considering the clinically evident post-traumatic signs (symbols surrounding Tintin's head after trauma): stars (grade I), whirls or candles (grade II), and LoC (grades III and IV according to duration).…”