Concussion Management, Over 70% of Doctors Got It Wrong – Part 2Written By: Leah Concannon, MD; Stanley Herring, MD
A Soccer Player With a Headache: Best Practices: The Problem With Concussions in Teens
The Centers for Disease Control and Prevention (CDC) estimate that at least 1.6 to 3.8 million sports-related concussions occur per year in the United States. Concussion is a form of mild traumatic brain injury and therefore has the potential for long-lasting cognitive effects. A concussion is defined as a complex pathophysiologic process affecting the brain that is induced by traumatic biomechanical forces. Any blow that transmits force to the head can result in a concussion.
Not surprisingly, the highest rates of sports-related concussions in the United States occur in US football, with boys’ ice hockey and lacrosse following closely behind. In gender-comparable sports, such as soccer and basketball, however, the concussion rate is higher in females than in males. The highest rate of concussions in female sports is found in girls’ soccer and, in some studies, ranks second behind only US football.[3,4]
Presentation. Symptoms can generally be categorized as somatic, cognitive, emotional, or sleep disturbance.Most symptoms resolve spontaneously. Headache is the most commonly reported symptom, followed by dizziness and balance difficulties.[3.6]
Imaging. An impairment in neurologic function as a result of a functional disturbance rather than a structural injury is the mechanism behind most symptoms. For this reason, traditional neuroimaging studies are generally normal, although microhemorrhages indicating axonal damage can sometimes be seen on MRI. CT and MRI are generally not helpful in diagnosing a concussion and should be used only when there is concern about more severe brain injury.
Advanced structural imaging techniques, such as diffusion tensor imaging, may more readily identify evidence of diffuse axonal injury, whereas physiologic modalities, such as functional MRI, may provide a window into functional differences between symptomatic and nonsymptomatic patients. These advanced imaging modalities are currently used primarily for research purposes.
As many as 1.6 million to 3.8 million sports related TBI’s, occur each year. This number may be low given the significant number of unreported cases. Furthermore, only 8%-19.2% of TBI in sports involve loss of consciousness (Langlois, Rutland-Brown, & Wald, 2006). Therefore, over 80% of brain injuries are lower grade without loss of consciousness. These lower grade concussions often go undetected as result of their subtle signs and the tendency of athletes to disregard their symptoms as minor or inconsequential. Please note above what a concussion is and is not and that MRI or CT DO NOT rule out concussion. David Burns, DC ND DACNB FACFN
Answer from Part One was B: “Advise Jamie and her family that athletes with attention-deficit disorder/ADHD may recover more slowly from sports concussions.”