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Concussion prevention and management

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119 papers 500 to 1000 followers
By Faye Kehler Family Physician and GP Anesthetist since 1987 interested in all aspects of Medicine
Jason M Matuszak, Jennifer McVige, Jacob McPherson, Barry Willer, John Leddy
CONTEXT: With heightened awareness of concussion, there is a need to assess and manage the concussed patient in a consistent manner. Unfortunately, concussion physical examination has not been standardized or supported by evidence. Important questions remain about the physical examination. EVIDENCE ACQUISITION: Review of ClinicalKey, Cochrane, MEDLINE, and PubMed prior to July 2015 was performed using search terms, including concussion, mTBI, physical examination, mental status, cranial nerves, reflexes, cervical, vestibular, and oculomotor...
March 28, 2016: Sports Health
Tej D Azad, Amy Li, Arjun V Pendharkar, Anand Veeravagu, Gerald A Grant
BACKGROUND: Few neurologic diseases have captured the nation's attention more completely than chronic traumatic encephalopathy (CTE), which has been discovered in the autopsies of professional athletes, most notably professional football players. The tragic case of Junior Seau, a Hall of Fame, National Football League linebacker, has been the most high-profile confirmed case of CTE. Here we describe Seau's case, which concludes an autopsy conducted at the National Institutes of Health that confirmed the diagnosis...
February 2016: World Neurosurgery
Lauriane Auvergne, Andrey V Bortsov, Jacob C Ulirsch, David A Peak, Jeffrey S Jones, Robert A Swor, Robert M Domeier, David C Lee, Niels K Rathlev, Phyllis L Hendry, Samuel A McLean
OBJECTIVES: To determine the influence of epidemiologic factors and the influence of genetic variants affecting FKBP5, a protein known to modulate hypothalamic-pituitary-adrenocortical axis function, on the severity of somatic symptoms commonly termed "postconcussive" 6 and 12 months after motor vehicle collision (MVC). METHODS: European Americans 18 to 65 years of age who presented to one of eight emergency departments (EDs) after MVC were enrolled. Exclusion criteria included hospital admission...
January 2016: Psychosomatic Medicine
Christian Oldenburg, Anders Lundin, Gunnar Edman, Catharina Nygren-de Boussard, Aniko Bartfai
PRIMARY OBJECTIVE: Having three or more persisting (i.e. > 3 months) post-concussion symptoms (PCS) affects a significant number of patients after a mild traumatic brain injury (mTBI). A common complaint is cognitive deficits. However, several meta-analyses have found no evidence of long-term cognitive impairment in mTBI patients. The study sought to answer two questions: first, is there a difference in cognitive performance between PCS and recovered mTBI patients? Second, is lower cognitive reserve a risk factor for developing PCS? RESEARCH DESIGN: Prospective inception cohort study...
2016: Brain Injury: [BI]
Shweta Bharadwaj, Joshua Rocker
PURPOSE OF REVIEW: We review recommendations from recent publications on the evaluation of minor head trauma. We focus on the risks of radiation from computed tomographies (CTs), the establishment of patient risk stratifications to help guide the necessity of emergent neuroimaging, and current thoughts regarding concussions. RECENT FINDINGS: Pediatric minor head injury is a common complaint in ambulatory settings. There is a significant amount of parental and practitioner anxiety regarding prognosis and whether or not to obtain CT imaging...
February 2016: Current Opinion in Pediatrics
Adam W Kiefer, Kim Barber Foss, Amit Reches, Brooke Gadd, Michael Gordon, Ken Rushford, Ilan Laufer, Michal Weiss, Gregory D Myer
Children and adolescent athletes are at a higher risk for concussion than adults, and also experience longer recovery times and increased associated symptoms. It has also recently been demonstrated that multiple, seemingly mild concussions may result in exacerbated and prolonged neurological deficits. Objective assessments and return-to-play criteria are needed to reduce risk and morbidity associated with concussive events in these populations. Recent research has pushed to study the use of electroencephalography as an objective measure of brain injury...
2015: Frontiers in Neurology
Daniel R Westfall, John D West, Jessica N Bailey, Todd W Arnold, Patrick A Kersey, Andrew J Saykin, Brenna C McDonald
PURPOSE: The neural substrate of post-concussive symptoms following the initial injury period after mild traumatic brain injury (mTBI) in pediatric populations remains poorly elucidated. This study examined neuropsychological, behavioral, and brain functioning in adolescents post-mTBI to assess whether persistent differences were detectable up to a year post-injury. METHODS: Nineteen adolescents on average 7.5 months post-mTBI completed neuropsychological testing and an fMRI auditory-verbal N-back working memory task...
2015: Journal of Pediatric Rehabilitation Medicine
Heidi K Blume
Concussion and mild traumatic brain injury (TBI) are common pediatric injuries. Headaches are one of the most common and disabling complaints following concussion in the acute phase and are pervasive in those who have prolonged symptoms following concussion. The body of evidence regarding the epidemiology of and risk factors for pediatric concussion and post-traumatic headache is growing rapidly, but there still is a distinct lack of strong scientific evidence to support the best treatment strategies for post-traumatic headaches in either children or adults...
September 2015: Current Pain and Headache Reports
D Kimberley Molina, Vincent J M DiMaio
There has been much recent attention regarding "concussions" and the role they may play in death. As most medical professionals are aware, concussions exist on a spectrum ranging from minimal or no loss of consciousness with no residual sequelae to diffuse axonal injury and sudden death. The location on the spectrum depends not only on the nature of the impact or blow but also on the state of the individual impacted. Three previous reports have illustrated 7 deaths due to blunt force head trauma with acute ethanol intoxication (postconcussive apnea)...
December 2015: American Journal of Forensic Medicine and Pathology
Philip E Stieg
No abstract text is available yet for this article.
September 2014: Cerebrum: the Dana Forum on Brain Science
Jameson D Voss, Joseph Connolly, Karen A Schwab, Ann I Scher
Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Nonetheless, studying the epidemiology of concussion helps clarify the overall importance, risk factors, and at-risk populations for this injury. The present review will focus on recent findings related to the epidemiology of concussion including definition controversies, incidence, and patterns in the population overall and in the military and athlete populations specifically...
July 2015: Current Pain and Headache Reports
Geoffrey L Heyer, Julie A Young, Sean C Rose, Kelly A McNally, Anastasia N Fischer
OBJECTIVE: The term "post-traumatic migraine" (PTM) has been used to describe post-traumatic headaches (PTHs) that have associated migraine features, but studies of this relationship are lacking. The objective of the present study was to determine whether PTH correlates strongly with migraine symptoms among youth with concussion. METHODS: Twenty-three symptoms were analyzed from a retrospective cohort of 1953 pediatric patients with concussion. A principal component analysis (PCA) with oblique Promax rotation was conducted to explore underlying symptom relationships in the full cohort and in subcohorts stratified by the presence (n = 414) or absence (n = 1526) of premorbid headache...
April 2016: Cephalalgia: An International Journal of Headache
Lindsay D Nelson, Adam Y Pfaller, Lisa E Rein, Michael A McCrea
BACKGROUND: Preseason baseline testing using computerized neurocognitive tests (CNTs) is increasingly performed on athletes. Adequate effort is critical to establish valid estimates of ability, but many users do not evaluate performance validity, and the conditions that affect validity are not well understood across the available CNTs. PURPOSE: To examine the rates and predictors of invalid baseline performance for 3 popular CNTs: Automated Neuropsychological Assessment Metrics (ANAM), Axon Sports, and Immediate Post-Concussion and Cognitive Testing (ImPACT)...
August 2015: American Journal of Sports Medicine
Laura Purcell, Janice Harvey, Jamie A Seabrook
Time to symptom resolution, return to school, and return to play after a sport-related concussion in children and adolescents (8-17 years of age) was examined using a retrospective cohort design. A total of 198 patients aged 8 to 17 years were included, with a mean age of 13.5 years (SD = 2.2). Patients aged 8 to 12 years were symptom-free in a median of 12.0 (range 1-60) days whereas 13- to 17-year olds were symptom-free in a median of 14.0 (range 1-300) days (P = .04). Patients aged 8 to 12 years returned to learn in a median of 4...
May 2016: Clinical Pediatrics
Philip J A Dean, Joao Ricardo Sato, Gilson Vieira, Adam McNamara, Annette Sterr
PRIMARY OBJECTIVE: To investigate sustained structural changes in the long-term (>1 year) after mild traumatic brain injury (mTBI) and their relationship to ongoing post-concussion syndrome (PCS). RESEARCH DESIGN: Morphological and structural connectivity magnetic resonance imaging (MRI) data were acquired from 16 participants with mTBI and nine participants without previous head injury. MAIN OUTCOMES AND RESULTS: Participants with mTBI had less prefrontal grey matter and lower fractional anisotropy (FA) in the anterior corona radiata and internal capsule...
June 11, 2015: Brain Injury: [BI]
Tad Seifert, Victoria Shipman
During concussion, the brain is exposed to rapid acceleration, deceleration, and rotational forces, resulting in the stretching and distortion of neural structures. This produces in an injury of transient neurological dysfunction, as evidenced by the clinical symptomatology. It is now evident that recurrent head trauma is also associated with the development of some chronic neurodegenerative disorders. Despite increased awareness of concussion over the past decade, large voids remain in our understanding of its pathophysiology...
August 2015: Current Pain and Headache Reports
Lea M Alhilali, Joseph A Delic, Serter Gumus, Saeed Fakhran
PURPOSE: To determine if a central axonal injury underlies neuropsychiatric symptoms after mild traumatic brain injury (mTBI) by using tract-based spatial statistics analysis of diffusion-tensor images. MATERIALS AND METHODS: The institutional review board approved this study, with waiver of informed consent. Diffusion-tensor imaging and serial neurocognitive testing with the Immediate Post-Concussion Assessment and Cognitive Testing evaluation were performed in 45 patients with mTBI (38 with irritability, 32 with depression, and 18 with anxiety)...
December 2015: Radiology
Vanessa Fimreite, Kenneth J Ciuffreda, Naveen K Yadav
PURPOSE: To assess quantitatively the effect of luminance on VEP amplitude and latency in visually-normals (VN) and patients with mild traumatic brain injury (mTBI). METHODS: VN individuals (n = 20) and those with mTBI (n = 19) participated. Those with mTBI were assessed 1-10 years post-injury (mean = 4.97 years), with the exception of one subject. Pattern VEP testing was employed using the DIOPSYS™ NOVA-TR system, with a 74 cd m(-2) baseline luminance...
June 17, 2015: Brain Injury: [BI]
Andrew J Gardner, Grant L Iverson, Tanya N Quinn, Michael Makdissi, Christopher R Levi, Sandy R Shultz, David K Wright, Peter Stanwell
PRIMARY OBJECTIVE: To conduct the first video analysis of concussion in the Australian National Rugby League (NRL) and describe player and injury characteristics, situational factors and time to return to play. RESEARCH DESIGN: Descriptive, observational case series. METHODS AND PROCEDURES: Video analysis of 20 medically diagnosed concussions for three consenting clubs during the 2013 NRL season. MAIN OUTCOME AND RESULTS: Most concussions (83%) occurred during a high tackle, and all injured ball carriers were hit high...
June 17, 2015: Brain Injury: [BI]
Adam R Militana, Manus J Donahue, Allen K Sills, Gary S Solomon, Andrew J Gregory, Megan K Strother, Victoria L Morgan
The goal of this pilot study is to use complementary MRI strategies to quantify and relate cerebrovascular reactivity, resting cerebral blood flow and functional connectivity alterations in the first week following sports concussion in college varsity athletes. Seven college athletes (3F/4M, age = 19.7 ± 1.2 years) were imaged 3-6 days following a diagnosed sports related concussion and compared to eleven healthy controls with no history of concussion (5M/6F, 18-23 years, 7 athletes). Cerebrovascular reactivity and functional connectivity were measured using functional MRI during a hypercapnia challenge and via resting-state regional partial correlations, respectively...
June 2016: Brain Imaging and Behavior
2015-05-22 15:17:50
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