title: Sports-related concussions: diagnosis, complications, and current management strategies.
abstract: Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.
authors.affiliation: Department of Surgery, Section of Neurosurgery, The University of Chicago Pritzker School of Medicine, Chicago; and.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Hobbs
authors.affiliation: Department of Surgery, Section of Neurosurgery, The University of Chicago Pritzker School of Medicine, Chicago; and.
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Young
authors.affiliation: Department of Neurosurgery, NorthShore University HealthSystem, The University of Chicago Pritzker School of Medicine, Evanston, Illinois.
authors.forename: Julian E
authors.initials: JE
authors.lastname: Bailes
mesh_terms: D001265:Athletic Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D001921:Brain / Q000503:physiopathology*; D001924:Brain Concussion / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012307:Risk Factors; D013177:Sports; D016896:Treatment Outcome; D055815:Young Adult
keywords: CTE = chronic traumatic encephalopathy; DHA = docosahexaenoic acid; DTI = diffusion tensor imaging; GCS = Glasgow Coma Scale; ICH = intracranial hemorrhage; IL = interleukin; LOC = loss of consciousness; MRS = MR spectroscopy; PCS, PPCS = postconcussion syndrome, prolonged PCS; SCAT = Sport Concussion Assessment Tool; SIS = second-impact syndrome; SRC = sports-related concussion; TNFα = tumor necrosis factor–α; chronic traumatic encephalopathy; concussion; fMRI = functional MRI; mTBI = mild traumatic brain injury; mild traumatic brain injury; subconcussion