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Sports Concussions

Sports Concussions. Aaron Lear MD, CAQ Akron General Sports Medicine. Goals. Understand How Concussions Occur Understand the Short-term Effects of Concussion Understand the Proposed Long-term Effects of Concussions. Concussion Definition.

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Sports Concussions

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  1. Sports Concussions Aaron Lear MD, CAQ Akron General Sports Medicine

  2. Goals • Understand How Concussions Occur • Understand the Short-term Effects of Concussion • Understand the Proposed Long-term Effects of Concussions

  3. Concussion Definition • Sports concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces International Conference on Concussion in Sport; Zurich 2008

  4. Concussion Criteria • Blow to head, neck, or body transmitting impulsive force to head • Rapid onset of short lived symptoms • Typically resolves spontaneously in days to weeks • No structural brain or nerve injury

  5. Pathophysiology(What happens to Your Brain?) • Unclear at this time in humans • Microscopic studies at autopsy (death for reason other than concussion) suggest injury to the structure of the brain nerves (neurons) • Animal model suggests a vascular and metabolic dis-regulation • Decrease in blood flow to brain • Increase in metabolic need

  6. Pathophysiology • Some consideration for shearing injury that affects blood brain barrier • Theoretic-based on some adverse long term outcome studies

  7. Sideline Presentation • Headache • Nausea/vomiting • Confusion • Disorientation • Amnesia • Irritability • Photo/Phono-phobia • Balance impairment

  8. Sideline Testing • What month is it? • What is the date today? • What is the day of the week? • What year is it? • What time is it right now? • Balance Testing • Head and Neck Exam • Neurologic Exam

  9. What to do at the Game • Do not return to game • If athlete does not improve on sideline, or worsens may be sent to the emergency department • Do not need imaging to diagnose concussion • CT scans or MRI

  10. What do we do if there is concussion • If I am confident in a concussion-Patient goes home with instruction for monitoring • Follow up in office ASAP • Full exam, discussion with parents

  11. Care at home when they still have symptoms • Avoid physical/mental activity • Including video games, texting, computer • May recommend home from school • Until symptoms improve • May return with half days first

  12. When do they return to sports • When completely without symptoms • May get computerized testing • Stepwise return to play protocol • Running • More intense exercise • Sport specific drills • Full Go practice • Games

  13. Complications: Short-term • Repeat injury • Post concussion syndrome • Second impact syndrome • Unbelievably rare

  14. Complications: Long-term • Does concussion cause dementia? • Does concussion cause mood disorder? • How many concussions is too many? • Does being young matter?

  15. Concussion and DementiaCTE • Diffuse neuronal loss • Cerebellar scarring and nerve cell loss • Degeneration of Substantia nigra • Septum pellucidum and adjacent grey matter • Frontal and temporal lobes • Altered affect and memory • Parkinson’s syndrome • Slurred speech, loss of balance, and coordination • Loss of intellect

  16. Concussion and Dementia: CTEOmalu, B. Journal of Forensic Nursing 6 (2010) 40-46 • Proposed syndrome based on 3 autopsied NFL players with CTE

  17. Concussion and Dementia: ADGuskiewicz, K. Neurosurgery. 2005, Oct; 57 (4). 719-26

  18. Concussion and Depression Guskiewicz, K. Med. Sci. Sports Exerc., Vol. 39, No. 6, pp. 903-909, 2007 • Same NFL study • 11% of retired players with depression @ baseline • > 3 Concussions 3x more likely • 1 or 2 Concussions 1.5x more likely

  19. Troublesome Questions • When do I need to retire from sport? • How long after my symptoms are gone do I need to wait before playing again? • Do I really need to stay home from school? • Is it really as big a deal as everyone is making it? • Am I just like an NFL player?

  20. Thanks for Coming!!! • Akron General Sports Medicine • 330-344-4115 • Office at Health & Wellness Center – North in Stow • (Steels Corners Road and Rt 8)

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