The Pathophysiology of Concussions in Youth

Abstract

SYNOPSIS Mild traumatic brain injury, especially sport-related concussion, is particularly common among young persons. Consequences of transient pathophysiological dysfunction must be carefully considered in the context of a developing or immature brain, as must the potential for an accumulation of damage with repeated exposure over time. This review will summarize the underlying neurometabolic cascade of concussion with emphasis on the young brain in terms of acute pathophysiology, vulnerability, alterations in plasticity and activation, axonal injury, and cumulative risk from chronic, repetitive damage. The implications of these physiological changes will be discussed in the context of clinical care for the concussed youth, and areas for future investigation will be highlighted.

Involvement of the Bufodienolides in the Pathogenesis and Potential Therapy of Preeclampsia, the Acute Respiratory Distress Syndrome and Traumatic Brain Injury

“…The pathophysiology of TBI involves cellular (endothelial vascular changes), metabolic (biomarker changes) and calcium ion changes. This has also been seen in experimental concussion in an animal model accompanied by axonal injury [48,49]. During the phase of recovery, the concussed brain is at risk for greater damage with a repeat blow [50,51].…”

“…During the phase of recovery, the concussed brain is at risk for greater damage with a repeat blow [50,51]. Cases of increased dysfunction and disability after a second concussion are also seen in young children and adolescents [48,49]. This raises questions as to the utility of employing neurocognitive testing (NCT) assessments as evidence of complete recovery from an initial concussion.…”

Development of a Conservative Protocol to Return Children and Youth to Activity Following Concussive Injury

“…58,59 Therefore protocol must contain a balance of activity and rest to promote physical and emotional recovery. [60][61][62][63] Trajectories of recovery in children have been classified as those having symptoms less than 1 month, between 1 month and 3 months, and greater than 3 months. 15,20,21,30,[54][55][56]64 Management issues are different depending on the pattern of recovery and until now were not differentiated in existing protocols.…”

Effectiveness of Vestibular Rehabilitation Therapy for Treatment of Concussed Adolescents With Persistent Symptoms of Dizziness and Imbalance

“…6 In adults who experience a concussion, these pathophysiologic changes may resolve as early as 7 to 10 days; however, a younger brain may take slightly longer to heal (10-14 d or longer). 7,8 Cognitive and physical rest is most commonly prescribed in the acute phases of a concussion to remove aggravating stimulus and allow the brain's physiology and functioning to return to normal. Most children who are diagnosed early and treated properly will return to activities of daily living and participation without consequence within a reasonable time frame (30 d or less).…”