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PubMed1993

[Indocyanine green angiography of experimental concussion necrosis in rabbit eyes].

Retinal opacity was experimentally induced by blunt trauma to pigmented rabbit eyes, and the lesions of severe traumatic retinal opacity (experimental concussion necrosis) where leakage of florescence was observed in conventional fluorescein (FLUO) fundus angiography were further examined by indocyanine green (ICG) angiography to study circulatory disturbances. Immediately after the trauma, as in our previous report on the lesion of retinal opacity where no FLUO leakage was observed, there was a delay in choroidal inflow with its peak around the point where choroidal arteries branched off from the ciliary arteries, and ICG leakage due to breakdown of the large choroidal vessels. In addition, regions showing ICG leakage were nearly coincident with those showing FLUO leakage. Observation by light microscope revealed irregular caliber of choriocapillaries (CCs) and marked dilation of the choroidal small vessels connected to the CCs. These findings were consistent with previous reports that ICG leakage occurs where there is choroidal vascular damage. Thus, the lesions are indicative of impaired barrier function of the retinal pigment epithelium and increased CCs permeability. We concluded that concussion necrosis is a combined result of direct physical damage to the outer retina and severe impairment of choroidal circulation.

Animals↗
PubMed2002

2002 Refshauge Lecture. When to retire after concussion?

The management of an athlete with recurrent concussions, whether persistently symptomatic or not, remains anecdotal. There are no evidence-based guidelines upon which a team physician can advise the athlete. All doctors involved in athlete care need to be aware of the potential for medicolegal problems if athletes are inappropriately returned to sport prematurely or in the case of professional athletes held out of sport or retired on the basis of non-scientific recommendations.

Adult↗
PubMed2002

Treatment of recurrent concussion.

The management of an athlete with recurrent concussions, whether persistently symptomatic or not, remains anecdotal. Currently, there are no evidence-based guidelines upon which a team physician can advise the athlete. All doctors involved in athlete care need to be aware of the potential for medicolegal problems if athletes are inappropriately returned to sport prematurely or, in the case of professional athletes, held out of sport or retired on the basis of nonscientific recommendations. This paper discusses such issues.

Animals↗
PubMed1992

An immediate light microscopic response of neuronal somata, dendrites and axons to non-contusing concussive head injury in the rat.

Sixteen rats were killed by transcardial perfusion fixation 1 min after a non-contusing concussive head injury, and seven rats 1 day later. In each of the "1-min" animals Golgi-like neurons and long axonal segments scattered in various proportions among unstained neurons and axons were demonstrated by a new silver method both near to and far from the impact site in a parenchymal environment unaffected by contusion. The silver-stained neurons, dendrites and axons were considered to have been damaged by the trauma because they were consistently absent from control brains. In the "1-day" brains silver-stained dendrites and axons had a beaded appearance, indicating an advanced stage of morphopathological damage. From details of these findings the following conclusions were drawn: (1) trauma can directly induce some kind of morphopathological damage in neurons which manifests itself in shrinkage of the soma and tortuosity of appendages as well as in type III argyrophilia; (2) different vulnerability of various brain areas is likely due to the inhomogeneity of the trauma-induced pressure wave propagating through the brain; and (3) the somato-dendritic and axonal domains of the neuron are selectively vulnerable to different values of the parameters of the intracranial pressure wave.

Animals↗
PubMed1988

Effects of scopolamine treatment on long-term behavioral deficits following concussive brain injury to the rat.

Scopolamine (0.1, 1.0, or 10.0 mg/kg) or saline was systemically (i.p.) administered to rats 15 min prior to concussive fluid percussion brain injury. Animals pretreated with the 1.0 mg/kg dose exhibited significantly (P less than 0.05) less motor deficits and less body weight loss and recovered to baseline performance sooner than saline-treated rats. Mortality and associated convulsions were significantly lower in rats pretreated with the 1.0 mg/kg dose of scopolamine. A 1.0 mg/kg dose of scopolamine administered (i.p.) 30 s after injury also significantly reduced behavioral deficits. No differences were observed between saline- and scopolamine-treated animals in either the incidence or duration of transient apnea following injury. A 1.0 mg/kg dose of scopolamine administered (i.p.) 15 min prior to epidural clip compression of the spinal cord had no effect on the severity of motor function deficits assessed by an inclined plane test. The data from these experiments suggest muscarinic cholinergic involvement in at least some of the long-term behavioral deficits following mild and moderate levels of brain injury. These results suggest that muscarinic cholinergic antagonists may prove beneficial in the treatment of human head injury.

Animals↗
PubMed1995

Lactate accumulation following concussive brain injury: the role of ionic fluxes induced by excitatory amino acids.

During the first few minutes following traumatic brain injury, cells are exposed to an indiscriminate release of glutamate from nerve terminals resulting in a massive ionic flux (e.g., K+ efflux) via stimulation of excitatory amino acid (EAA)-coupled ion channels. The present study was undertaken to elucidate the causal relationship between these ionic shifts and lactate accumulation in the injured brain, by examining the effects of ouabain (an inhibitor of Na+/K+-ATPase), Ba2+ (an inhibitor or non-energy-dependent glial K+ uptake) and kynurenic acid (KYN; a broad-spectrum EAA antagonist) on lactate accumulation. Two microdialysis probes were placed bilaterally in the rat parietal cortex. One was perfused with a test drug (1.0 mM ouabain, 2.0 mM Ba2+ or 10 mM KYN) and the other with Ringer's solution (control) for 30 min prior to injury. Following a 2.2-2.7 atm fluid-percussion injury, lactate levels in the dialysate increased (up to 116.6% above baseline) for the first 16 min and returned to baseline levels within 20 min after injury. This lactate accumulation was attenuated by preinjury administration of ouabain and KYN and was prolonged by Ba2+ administration. These findings indicate that lactate accumulations following concussive brain injury is a result of increased glycolysis which supports ion-pumping mechanisms, thereby, restoring the ionic balance which was disrupted by stimulation of EAA-coupled ion channels.

Animals↗
PubMed1979

Symptoms at one year following concussion from minor head injuries.

Of 131 patients with mild concussion, 19 (14.5%) still had symptoms after 1 year. Of these 19 patients, 10 had some symptoms of which they had not complained at 6 weeks. Symptoms at 1 year were more common among women and among patients who had had positive neurological findings at 24 h. Of the 19 patients who had symptoms at 1 year, 8 were involved in law suits and 6 had been suspected of malingering 6 weeks after their accident. Five of these patients were both involved in law suits and suspected of malingering.

Adolescent↗
PubMed2005

Video gaming promotes concussion knowledge acquisition in youth hockey players.

While the positive uses for video games in an educational setting have also been established, the educational aim is usually made explicit. The goal of this research was to develop a video game wherein the educational aspect was implicitly embedded in the video game, such that the gaming activity remained interesting and relevant. Following a pilot study to confirm the usability of an in-house developed game, two studies were conducted with 11-17 year old hockey players (N(1)=130, N(2)=39). Results demonstrated that participants playing the experimental version of the video game scored significantly higher on a concussion symptoms questionnaire, in a significantly faster time, than participants playing the control version of the game. Most participants indicated that they enjoyed the game and would play it again. These results suggest that educational material can be conveyed successfully and in an appealing manner via video game play.

Adolescent↗
PubMed1997

A synergistic interaction between dopamine D1 and D2 receptor subtypes in the memory impairments induced by concussive brain injury (CBI) in mice.

Profound latent learning and memory deficits with increased monoamine levels in the brain following concussive brain injury (CBI) have been documented in our previous work. The purpose of the present study was to determine the role of dopamine (DA) receptor subtypes in the memory deficits associated with CBI. Profound latent learning and memory impairments were observed in the vehicle-treated CBI mice. SCH-23390 administered 15 min post-injury had no significant effects on the impairments of latent learning and memory in the CBI mice. Sulpiride significantly improved the impairments of latent learning and memory in a dose-dependent manner, indicating that activation of dopaminergic neuronal function is involved in the CBI-induced amnesia. Interestingly, co-administration of sulpiride and SCH-23390, at doses which alone has no significant effect, significantly ameliorated the impairments of latent learning and memory. These results strongly suggested that D1 and D2 receptor subtypes are synergistically involved in the dysfunction of learning and memory associated with CBI.

Animals↗
PubMed1997

(+)-Eburnamenine-14-carboxylic acid (2-nitroxyethyl) ester (VA-045), a putative cognitive enhancer, facilitates recovery from concussive brain injury-induced learning and memory impairments in mice.

We characterized alterations in the ability of concussive brain injury (CBI) models to perform a water-finding task and examined effects of (+)-eburnamenine-14-carboxylic acid (2-nitroxyethyl) ester (VA-045), a novel apovincaminic acid derivative, on post-traumatic impairments in latent learning and memory processes. Two types of CBI-induced amnesia (retrograde and anterograde) were produced by means of post- or preacquisition head impact using a simple weight-drop device. Profound impairments of latent learning and memory processes related to retention and retrieval were observed in the CBI mice. In the CBI-induced retrograde amnesia model, VA-045 (0.5-4.0 mg/kg) significantly ameliorated impairments of latent learning and retention in both the retention test and the retest. In the CBI-induced anterograde amnesia model, the protective effects of the compound on impairments in latent learning and retention or retrieval were significant in both the retention test and the retest. These results suggested that VA-045 may be a novel cognitive enhancer for attenuating or protecting against the learning and memory dysfunction associated with CBI.

Amnesia, Retrograde↗
PubMed1990

[Post-concussion decrease in aniseikonia tolerance].

Besides loss of convergence and accommodation, head injuries can cause fusion deficiency. Part function of sensory fusion is tolerance to sphaerical and meridional aniseikonia. We will present a patient, whose aniseikonia tolerance decreased after a brain concussion.

Aniseikonia↗
PubMed1980

[Multifocal deficits following "banal" concussion (author's transl)].

This case seems worthy of attention for several reasons. To begin with, the process, which at first appeared to be concentrated in the orbital region, was triggered traumatically, with secondary glaucoma, lymphostasis and severe local pain in the left eye. Subsequently, diabetes insipidus developed, involving the hypophysis, while from the very beginning there was postchiasmatic hemianopia, later complemented by deafness and epileptiform attacks. All these complaints were most severe in the mornings, suggesting a vegetative disorder. Apart from the problem of interpreting the process the progression itself was remarkable, developing in the course of a few years from a "harmless" concussion to a complex cerebral syndrome, rendering the patient unfit for work.

Arachnoiditis↗
PubMed2002

An evaluation of the cumulative concussive effect of soccer heading in the youth population.

Soccer is the most popular team sport in the world, with 120 million individuals participating and 16 million of these individuals being based in the United States. In addition, soccer has become the fastest growing team sport in the United States over the past 10 years. Head impact injuries have been cited as comprising 15% of all injuries related to soccer. Previous studies have identified the technique of heading as being a significant factor in head impact injuries. In fact, 85% of various subgroups of participants, 19 years of age and older, have had a diminution in cognitive function abilities on a permanent basis. It was the purpose of this study to evaluate the effect of repetitive head impacts due to heading in 57 youth soccer players with a mean age of 11.5 years. The data were collected over three seasons during the first year, which correlated to approximately 60 games and/or practices. One team of 18 boys was followed for an additional year. The data collected included a cognitive function test, as well as documentation of concussive symptoms. These cognitive evaluations, conducted at both periods of time, revealed that statistically significant differences were not evident when compared to standardized norms with the exception of verbal learning. There was an inverse relationship between the number of ball impacts and verbal learning. Of note, however, is that 49% of the year-one study group did complain of headaches after heading the ball.

Adolescent↗
PubMed2000

Secondary traumatization among wives of PTSD and post-concussion casualties: distress, caregiver burden and psychological separation.

This study has two aims. First, it assesses the implication of husbands' post-traumatic stress disorder (PTSD) and post-concussion syndrome (PC) on their wives' sense of burden and emotional distress. The second aim was to examine the implication of the women's separation-individuation on their adjustment. Sixty women participated in study: 20 women married to war veterans diagnosed as suffering to PTSD, 20 women married to war veterans suffering from PC, and 20 women married to healthy controls. Data was collected using self report questionnaires assessing psychiatric symptomatology, caregiver burden and psychological separation-individuation. Results indicate that women from both research groups suffer from higher levels of burden and distress than controls. The level of separation-individuation was found to be correlated to levels of burden and distress. The complex implications of living with a traumatized spouse are discussed.

Adaptation, Psychological↗
PubMed2005

Opinion about post-concussion syndrome in health professionals.

OBJECTIVE: To compare opinion about post-concussion syndrome (PCS) in accident and emergency doctors, clinical neuropsychologists and neurosurgeons. METHOD: A UK postal survey was sent to all accident and emergency doctors, neurosurgeons and clinical neuropsychologists listed by their professional bodies. Predictions of symptom complaint were made from a vignette about minor traumatic brain injury and a questionnaire about PCS-symptoms, cause, recovery and treatment. RESULTS: All professional groups named headache, attention and memory difficulties as most common symptoms. Clinical neuropsychologists listed more symptoms at recall, more often achieved 'caseness' (Diagnostic and Statistical Manual-IV or International Classification of Diseases-10 criteria) and were more optimistic about treatment effectiveness. Neurosurgeons were more pessimistic about recovery. Organic factors were most frequently cited as the main cause of PCS, followed by emotional factors and then compensation factors. CONCLUSIONS: There was fair consistency between professional groups regarding PCS. Differences may reflect differing clinical roles between the professions, in terms of early care and late rehabilitation. The usefulness of the concept of PCS is discussed. All groups and particularly those working in acute settings may benefit from further information about minor brain injury including the effectiveness of psychological interventions.

Attitude of Health Personnel↗
PubMed2006

The rapid screen of concussion: an evaluation of the non-word repetition test for use in mTBI research.

PRIMARY OBJECTIVES: (1) To investigate the Nonword Repetition test (NWR) as an index of sub-vocal rehearsal deficits after mild traumatic brain injury (mTBI); (2) to assess the reliability, validity and sensitivity of the NWR; and (3) to compare the NWR to more sensitive tests of verbal memory. RESEARCH DESIGN: An independent groups design. METHODS AND PROCEDURES: Study 1 administered the NWR to 46 mTBI and 61 uninjured controls with the Rapid Screen of Concussion (RSC). Study 2 compared mTBI, orthopaedic and uninjured participants on the NWR and the Hopkins Verbal Learning Test (HVLT-R). MAIN OUTCOMES AND RESULTS: The NWR did not improve the diagnostic accuracy of the RSC. However, it is reliable and indexes sub-vocal rehearsal speed. These findings provide evidence that although the current form of the NWR lacks sensitivity to the impact of mTBI, the development of a more sensitive test of sub-vocal rehearsal deficits following mTBI is warranted.

Adolescent↗
PubMed1996

Post-concussive syndrome: paraclinical signs, subjective symptoms, cognitive functions and MMPI profiles.

In order to investigate the organic and psychogenic components of post-concussive syndrome (PCS), the subjective complaints, the cognitive findings and the Minnesota Multiphasic Personality Inventory (MMPI) profiles of 53 consecutive mild head injury patients (MHI) with persistent PCS were evaluated. The results seem to suggest the presence of two groups: in the first, minimal lesional signs were associated with more prolonged loss of consciousness (LC) and post-traumatic amnesia (PTA), as well as an MMPI profile not indicative of a neurotic state, whereas in the second the absence of any lesional sign was associated with shorter LC and PTA duration, as well as evidence of neurotic MMPI scores. A female prevalence was observed in the first group and a male prevalence in the other one.

Adolescent↗
PubMed1997

Tc-HMPAO SPECT in persistent post-concussion syndrome after mild head injury: comparison with MRI/CT.

The purposes of this study were: (1) to determine the prevalence of abnormal 99mTc-HMPAO SPECT scans in patients suffering from persistent post-concussive syndrome (PPCS) after mild closed head injury (CHI); (2) to compare SPECT with structural neuroimaging (MRI and CT) in patients with mild CHI; and (3) to investigate correlations between SPECT and clinical data obtained from the patient sample (neuropsychological testing, demographics, psychiatric diagnoses). Forty-three patients were included. SPECT was read as abnormal in 53% of patients and showed a total of 37 lesions while MRI was read as abnormal in 9% and CT scan in only 4.6% of patients after mild CHI. SPECT appears to be more sensitive in detecting cerebral abnormalities after mild CHI, especially in patients with PPCS symptoms, than either CT or MRI. No statistically significant relationship was found between SPECT scan abnormalities and age, past psychiatric history, history of substance abuse, or history of multiple CHI. Education level did not differ between patients with normal and abnormal SPECT. Current neuropsychiatric symptoms did not seem to have any impact on the results of SPECT scan.

Adolescent↗