Concussion Management: A Complicated Task

Medical Work-Up Of The Athlete
With Concussion

By Lindsay Barton,
MomsTeam Health & Safety Editor

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Determining Extent Of Injury To Brain Is Difficult
Factors Complicating Concussion Recognition And Management
Concussion Work-Up
Importance Of Prior Concussions
Computerized Neuropsychological Assessment: Replacing Pen And Paper Tests
The Balance Error Scoring System: A Useful Test
When A CT Or MRI Is Recommended
Concussion Management And Return To Play Guidelines
Final Recommendations

Determining Extent Of Injury To Brain Is Difficult

Concussion is derived from the Latin word concussus, which means to shake violently. Initially, it was thought to produce only a temporary disturbance of brain function due to neuronal, chemical, or neuroelectrical changes without any physical changes in the brain. We now know that structural damage with the loss of brain cells does occur with some concussions. Because of advances over the last several years in the neurobiology of cerebral concussion, it has become clear that, in the minutes to days after concussive brain injury, living brain cells may exist be vulnerable, especially to minor changes in cerebral blood flow, increases in intracranial pressure, and to anoxia (insufficient oxygen to the brain).

Precisely how long this period of metabolic dysfunction lasts is not presently fully understood, and there are today no neuroanatomic or physiologic measurements that can be used to precisely determine the extent of injury in concussion, the severity of metabolic dysfunction or precisely when it has cleared.

Factors Complicating Concussion Recognition And Management

Recognition and management of concussion is also complicated by the fact that:

Concussion may be caused either by a direct blow to the head or a blow elsewhere on the body with accelerative forces indirectly transmitted to the head;
Concussion usually results in an immediate but brief short-lived impairment of neurologic function;
Though concussion occasionally results in neuropathologic changes, the acute clinical symptoms primarily reflect a functional disturbance rather than a structural injury.
Most concussions suffered by athletes do not result in a loss of consciousness.
Neuroimaging studies (MRIs) are usually normal with concussion.

Given the above facts, it is perhaps not surprising that there is currently no clear consensus on the definition or grading of concussion. All current guidelines, however, recommend that no athlete be allowed to return to collision sport practice or participation while still exhibiting symptoms from a prior concussion,, until they are asymptomatic at rest and then at exertion.

Team, physicians, athletic trainers, and other medical personnel responsible for the medical care of athletes face no more challenging problem than the recognition and management of concussion. Indeed, such injuries have captured many headlines in recent years and have spurred studies by both the National Football League and the National Hockey League.

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Article Updated: August 1, 2007

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