Concussion

Definition

 

Disturbance in brain function caused by direct or indirect injury to head

- no pathology seen on standard neuorological imaging

 

Pathophysiology

 

Disruption of mitachondria

- inability to produce energy

- accounts for symptoms such as lethargy etc

 

Headache

- ? due to ligament injury at cranio-cervical junction

 

Symptoms

 

Confusion

Tiredness

Lethargy

Inability to concentrate

Headache

Sleep impairment

Slowed reaction times

 

Symptoms worsen with

- concentration

- physical exertion

 

80 - 90% resolve within 1 week

- some patients suffer prolonged post concussion syndrome

 

NHx

 

2 x grade 3 concussions in career

- risk of permanent damage < 10%

- amateur sportsman should cease sports after 2 x Grade 3 concussions

 

3 x grade 3 concussions in career

- risk of permanent damage 60%

 

Adolescent

- studies have shown that after a grade 3 concussion in the next year

- A grade students show little effect to their grades

- average students have significant risk of failing grades

 

Management

 

Generally accepted that concussed athlete should not return to the game

 

Sideline assessment

 

SCAT2 / Sport Concussion Assessment Tool

- assess symptoms and GCS

- also tests memory / concentration / balance / co-ordination

 

Canadian CT Head Rules

 

Stiell et al Lancet 2001

 

1.  GCS < 15 2 hours post injury

2.  2 or more vomiting episodes

3.  Age > 65

4.  Signs basal skull fracture

5.  Signs skull fracture

6.  Dangerous mechanism - > 3 foot or > 5 stairs

7.  Amnesia before event > 30 minutes

 

Zurich Consensus Statement SAJSM 2009

 

Recommends use of SCAT2 and graduated return to play

 

Grading American Academy Neurology 1997

 

Grade 1

 

Definition

- no loss of consciousness

- head injury with confusion < 15 minutes

- full memory of the event

 

Action

- first concusion: return to sport within 15 minutes

- second concussion: 1 week

 

Grade 2

 

Definition

- no loss of consciousness

- confusion > 15 minutes

 

Action

- first concussion: 1 week

- second concussion: 2 weeks

 

Grade 3

 

Definition

- loss of consciousness

- 3A:  few seconds

- 3B:  minutes

 

Action

 

3A

- first concussion: 1 month

- second concussion: 6 months

 

3B

- first concussion: 6 months

- second concussion: 1 year

 

Neuropsychological testing

 

i.e. IMPACT

 

Performed as baseline for all collision athletes

- can then compare scores if concussed

- assess when return to normal / degree impairment

 

Online test availabe

- word remembering

- line drawing recognition

- coloured squares

- X & O

 

Return to sport

 

Stepwise symptom-limited program, with stages of progression

- 24 hours minimum for each step

- return to step 1 if symptoms recur


1. Rest until asymptomatic (physical and mental rest)

- recovery phase
2. Light aerobic exercise (e.g. stationary cycle)

- increase HR
3. Sport-specific exercise

- add movement
4. Non-contact training drills (start light resistance training)

- co-ordination and cognition
5. Full contact training after medical clearance

- functional skills assessed by coach and trainers
6. Return to competition (game play)