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The cumulative effect of repetitive concussion in sports.

The increased popularity of contact sports worldwide exposes a large number of participants to both acute and chronic traumatic brain injury. Chronic traumatic brain injury (CTBI) represents the cumulative, long-term neurological consequences of repetitive concussive and subconcussive blows to the brain. Although this condition has been described primarily in boxing, it may be anticipated in other contact sports such as soccer, football, ice hockey, and the martial arts. Since treatment options in CTBI are relatively limited, the prevention of CTBI is of paramount importance. Minimizing the frequency and severity of acute brain injury in sport will be instrumental in accomplishing this goal. The prevention of CTBI will need to be sport specific and will undoubtedly rely on limiting the exposure of high-risk athletes, utilizing of protective equipment, enforcing strict rule adherence, training and supervising athletes, and increasing medical surveillance.

Athletic Injuries↗

Labyrinthine concussion and positional vertigo after osteotome site preparation.

An incident of positional vertigo associated with osteotome technique for installation of multiple maxillary dental implants is reported. The symptoms resolved after 2 weeks with restricted physical activity and prohibition of lifting. There is a discussion of labyrinthine concussion and treatments. Suggestions for prevention are to use small sizes of osteotomes first and then progress to larger sizes and to avoid neck extension head position during osteotome use.

Aged↗

Marked hippocampal neuronal damage without motor deficits after mild concussive-like brain injury in apolipoprotein E-deficient mice.

Of various biological factors, only allele epsilon 4 of apolipoprotein E (apoE, protein; APOE4, gene) has been thus far suggested as a major determinant of genetic risk for sporadic and late-onset familial Alzheimer's disease (AD). Environmental influences such as lack of education, traumatic brain injury, oxidative stress, environmental toxins, hormonal imbalances, and alterations in immune or inflammatory responses may also contribute to the pathogenesis of AD. Thus genetic susceptibility and environmental risk factors may have synergistic effects on the development of AD. The purpose of present report was to assess whether the gene (APOE) and the environmental risk factor (traumatic brain injury) could interact in hippocampal neuronal degeneration. We investigated the histopathological changes of hipoccampal regions after mild concussive-like brain injury without motor deficits in apoE-deficient mice using the recently described novel weight-drop device. Control mice revealed minimal neurodegenerative changes limited to CA2 and CA3, while apoE-deficient mice showed widespread neuronal degeneration throughout hippocampal subfields and part of dentate gyrus. We also observed widespread glial fibrillary acidic protein (GFAP) immunoreactivity throughout the hippocampus, which was more intense in apoE-deficient mice. The results of this study indicate that even very mild traumatic brain injury could result in widespread hippocampal damage in apoE-deficient mice. This again supports the hypothesis that apoE might play a neurotrophic or neuroprotective function in the central nervous system.

Alzheimer Disease↗

Overview of concussion consensus statements since 2000.

More refereed publications on sports-related concussion have appeared since 2000 than in all previous years combined. Three international consensus statements, documents from the National Athletic Trainers' Association (NATA) and the American College of Sports Medicine (ACSM), and entire issues of the Clinical Journal of Sport Medicine and the Journal of Athletic Training have been devoted to this subject. The object of this article is to critique the consensus statements and NATA and ACSM documents, pointing out areas of controversy.

Journal Article↗

Obliteration of pulp canal space after concussion and subluxation: endodontic considerations.

Concussion and subluxation injuries to permanent teeth lead to obliteration of the pulp canal space in 3% to 11% of cases, depending on the severity of the injury and the developmental stage of the tooth. Obliteration of the pulp canal space may make root canal treatment necessary because of the development of apical periodontitis or for cosmetic reasons. If carefully executed, root canal treatment in teeth with an obliterated pulp canal space is highly successful and may act as a basis for internal bleaching.

Adolescent↗

Aircrew helmet protection against potential cerebral concussion in low-magnitude impacts.

The response of the Gentex DH-151 (contact type) and Gentex 411 (suspension type) aircrew helmets to low-magnitude impacts, such as those sometimes encountered during cockpit buffeting, in ejection, and in parachute landings, was studied to augment the data base on helmet performance. The helmets, mounted on a Hodgson headform, were dropped on the crown and rear at impact velocities up to 4.97 m/s. Acceleration time histories were tape recorded and digitized and Gadd Severity Indices (GSI), among others, were calculated from the resultant acceleration curve. Both helmets kept the GSI below predicted concussion thresholds at 4.97 m/s and were considered to perform well on initial impacts. On second impacts, the GSI rose considerably because the shell and liner of the DH-151 cracked and the suspension of the "141" stretched during the first blow. Improvement of the multiple impact performance of both helmets appears desirable, although the suspension helmet performed slightly better than the contact helmet with respect to the criterion used.

Accidents, Aviation↗

Sudden unexpected death from cardiac concussion (commotio cordis) with unusual legal complications.

Sudden and unexpected death may result from cardiac concussion following blunt force trauma to the thorax. Undiagnosed pathologic disease must be carefully evaluated as a possible contributory element. Legal complications may arise from any autopsy. It is recommended that a photograph be taken upon completion of the autopsy. This photograph and adequate records can be used to refute any charges against the pathologist or assistants for the poor condition of a body after its release.

Adolescent↗

Are mild head injuries as mild as we think? Neurobehavioral concomitants of chronic post-concussion syndrome.

BACKGROUND: Mild traumatic brain injury (MTBI) can sometimes lead to persistent postconcussion symptoms. One well accepted hypothesis claims that chronic PCS has a neural origin, and is related to neurobehavioral deficits. But the evidence is not conclusive. In the attempt to characterise chronic MTBI consequences, the present experiment used a group comparison design, which contrasted persons (a) with MTBI and PCS, (b) MTBI without PCS, and (c) matched controls. We predicted that participants who have experienced MTBI but show no signs of PCS would perform similar to controls. At the same time, a subgroup of MTBI participants would show PCS symptoms and only these volunteers would have poorer cognitive performance. Thereby, the performance deficits should be most noticeable in participants with highest PCS severity. METHOD: 38 patients with a single MTBI that had occurred at least 12 month prior to testing, and 38 matched controls, participated in the experiment. A combination of questionnaires and neuropsychological test batteries were used to assess the extent of PCS and related deficits in neurobehavioral performance. RESULTS: 11 out of 38 MTBI participants (29%) were found to suffer from PCS. This subgroup of MTBI patients performed poorly on neuropsychological test batteries. Thereby, a correlation was found between PCS symptom severity and test performance suggesting that participants with more pronounced PCS symptoms performed worse in cognitive tasks. In contrast, MTBI patients with no PCS showed performed similar to matched control. We further found that loss of consciousness, a key criterion for PCS diagnosis, was not predictive of sustained PCS. CONCLUSION: The results support the idea that MTBI can have sustained consequences, and that the subjectively experienced symptoms and difficulties in everyday situations are related to objectively measurable parameters in neurocognitive function.

Adult↗