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PubMed1986

Alpha coma.

Six personal cases of alpha coma are reported: 3 following a cerebrovascular accident and 3 resulting from cerebral concussion. Two patients survived. On the basis of differences in pathogenesis, EEG characteristics and prognosis, the following classification is proposed: alpha coma resulting from brain stem vascular accident; cerebral concussion; diffuse cerebral hypoxia; drug intoxication. The clinical course of each of the classes of alpha coma is outlined. The alpha coma state is not restricted to cases with structural brain stem lesions c.q. lesions of the pontomesencephalic region.

Adolescent↗
PubMed2000

An extended Glasgow Coma Scale (GCS-E) with enhanced sensitivity to mild brain injury.

OBJECTIVE: The Glasgow Coma Scale-Extended (GCS-E) was developed to flag mild cases of concussion (corresponding to Grades I and II concussion as defined by the American Academy of Neurology) at the time of first contact with the health care system. SUBJECTS AND SETTING: The GCS-E was applied to 561 consecutive admissions with GCS scores of 13 to 15 at two hospitals in South Africa and two in the United Kingdom (UK). RESULTS: The amnesia scale was readily learned and reliably applied by emergency department staff without affecting the standard scoring of the GCS itself. Among patients with an admitting GCS of 15, 27% in the UK and 31% in South Africa reported amnesia of some duration. CONCLUSIONS: Wide use of the GCS-E would hold mild traumatic brain injury cases in the treatment loop, improve access to counselling, rehabilitation services, and personal injury compensation, and reduce the "cognitive dissonance" between victims of mild traumatic brain injury and treating professionals.

Adult↗
PubMed2006

[Mild brain injury: forensic sciences and indemnification].

Victims of mild trauma brain injury may develop post-concussive symptoms in an inverse proportion to the organic damages leading to difficulties in their social, occupational and family activities. Proving the link which exists between the trauma and its consequences is a difficult task and insufficient methods for evaluating post-concussive symptoms make it very difficult to demonstrate the cause and effect relationship. The judge's assessment is essential to avoid the nearly systematic but wrong diagnosis of pathological predispositions of the patient. It is particularly important to improve the nomenclature of the different kinds of injuries to reach a better indemnification for those patients who suffer from their trauma their entire life.

Adult↗
PubMed1997

Impaired cerebral autoregulation after mild brain injury.

BACKGROUND: Severe head injury may impair cerebral autoregulation, which can increase the risk of secondary neuronal injury. The likelihood of impairment in autoregulation is assumed to be low with mild head injury. We report here the absence of cerebral autoregulation in a patient who suffered a concussion from an automobile accident 6 days earlier. METHODS: The patient participated in a clinical study approved by the institutional human subjects review committee, investigating the dose-effect relationship of anesthetics on cerebral autoregulation. The patient was scheduled to undergo repair of a knee injury suffered during a motor vehicle accident, during which she had a concussion. The screening evaluation revealed no evidence of neurologic disease. The test was to be performed three times in each patient: baseline autoregulation measurements during stable fentanyl-nitrous oxide anesthesia, second and third measurements during low dose and high dose of the anesthetic to which the patient was assigned. Autoregulation was tested by increasing the mean systemic blood pressure from 80 mm Hg-100 mm Hg using a phenylephrine infusion while simultaneously recording flow velocity from a middle cerebral artery using transcranial Doppler ultrasonography. RESULTS: Static autoregulation testing during baseline testing demonstrated complete absence of this homeostatic mechanism and the study was canceled. Repeated testing in the recovery unit after the patient awoke showed identical results. CONCLUSIONS: Trivial mild head injury may result in loss of cerebral autoregulation. A clinical study of a larger series to document the incidence is warranted.

Adult↗
PubMed1994

Staining of amyloid precursor protein to study axonal damage in mild head injury.

The most common definition of cerebral concussion is that of a transient loss of neurological function without macroscopic or microscopic abnormality in the brain. However, some patients have persistent symptoms and subtle neuropsychological deficits, particularly affecting memory. We have studied five patients aged 59-89 years who sustained mild concussive head injury and died of other causes (2-99 days post-injury). Immunostaining with an antibody to amyloid precursor protein, a marker of fast axonal transport, showed multifocal axonal injury in all five. All had axonal damage in the fornices, which are important in memory function.

Aged↗
PubMed1999

Modulation of stress hormones in rainbow trout by means of anesthesia, sensory deprivation and receptor blockade.

Sympathetic activation leading to increased levels of blood catecholamines, and stimulation of the hypothalamic-pituitary inter-renal axis leading to increased cortisol, are difficult to avoid when handling animals. Yet, in research on effects of acute stress, elicitation of such responses must be minimized in the control groups. The work examines means to achieve a minimally disturbed state in rainbow trout (Oncorhynchus mykiss). Level of arousal was determined by adrenaline and cortisol concentrations in plasma, and by the spleen:somatic index. Fish were prepared for bleeding by rapid capture and concussion, by infusion of anesthetic into the undisturbed home tank, by confinement in black boxes, or by being fed alpha- and beta-receptor antagonists. Even when done quickly, netting and concussion yielded fish with ca. 200-pmol adrenaline/ml plasma. Cortisol was elevated (to > 10 ng/ml) within 30 s of stress initiation. Surreptitious infusion of anesthetic (2-phenoxyethanol, PE) into tanks yielded fish with lower adrenaline levels (means 19.34 and 19.58 pmols/ml in home tank and black boxes, respectively). Among fish given phentolamine and propranolol, spleen:somatic indices and plasma adrenaline were higher than in diet controls, whether undisturbed or stressed, indicative of successful receptor blockade. Since careful infusion of 2-PE yielded the lowest adrenaline levels, and requires no special apparatus, it is the method of choice for obtaining minimally stressed fish.

Adaptation, Physiological↗
PubMed1998

Traumatic brain injury in children in Denmark: a national 15-year study.

Demographic trends are reported concerning three types of traumatic brain injury (concussions, cranial fractures, and intracranial contusions/haemorrhages) among children in Denmark of ages up to and including 14 years, for a fifteen year period from 1979 through 1993. The data were derived from a national computer-based hospitalization register and include 49,594 children, of whom 60% were boys and 89% had suffered a concussion. Virtually all injuries were the result of accidents. A major finding was that there has been a general decline in the incidence of traumatic brain injuries, especially for boys from 5 to 14 years old, suggesting a degree of success in preventive measures, particularly regarding road safety. The incidence of fatal cases of intracranial contusions/haemorrhages approximately halved over the 15 year period. However, as a proportion of all diagnosed cases, mortality from intracranial contusions/haemorrhages remained fairly constant at about 22%, perhaps because there have been no markedly successful innovations in acute care. Among children surviving a intracranial contusions/haemorrhages, rather considerable numbers were found to have been awarded disability pension at ages under 30.

Accidents↗
PubMed2003

The neuropsychology of heading and head trauma in Association Football (soccer): a review.

Association Football (soccer) is the most popular and widespread sport in the world. A significant proportion of the injuries suffered in football are head injuries involving trauma to the brain. In normal play, head trauma frequently arises from collisions, but some researchers have claimed that it also may arise as a consequence of heading the ball. Although assessments based on biomechanical analyses are equivocal on the potential for brain injury due to football heading, a growing literature seems to support the claim that neuropsychological impairment results from general football play and football heading in particular. However, this review suggests a distinction is required between the neuropsychological effects of concussive and subconcussive head trauma and that all of the neuropsychological studies conducted so far suffer from methodological problems. At best, a few of these studies may be regarded as exploratory. The review concludes that presently, although there is exploratory evidence of subclinical neuropsychological impairment as a consequence of football-related concussions, there is no reliable and certainly no definitive evidence that such impairment occurs as a result of general football play or normal football heading. The neuropsychological consequences of football-related subconcussive effects await confirmatory investigation.

Alcoholism↗
PubMed1994

Cervical musculoskeletal dysfunction in post-concussional headache.

Persistent headache is a common symptom following a minor head injury or concussion, possibly related to simultaneous injury of structures of the cervical spine. This study measured aspects of cervical musculoskeletal function in a group of patients (12) with post-concussional headache (PCH) and in a normal control group. The PCH group was distinguished from the control group by the presence of painful upper cervical segmental joint dysfunction, less endurance in the neck flexor muscles and a higher incidence of moderately tight neck musculature. Active range of cervical motion and postural attitude were not significantly different between groups. As upper cervical joint dysfunction is a feature of cervicogenic causes of headache, the results of this study support the inclusion of a precise physical examination of the cervical region in differential diagnosis of patients suffering persistent headache following concussion.

Adolescent↗
PubMed2001

Anandamide, but not 2-arachidonoylglycerol, accumulates during in vivo neurodegeneration.

Endogenous cannabinoid receptor ligands (endocannabinoids) may rescue neurons from glutamate excitotoxicity. As these substances also accumulate in cultured immature neurons following neuronal damage, elevated endocannabinoid concentrations may be interpreted as a putative neuroprotective response. However, it is not known how glutamatergic insults affect in vivo endocannabinoid homeostasis, i.e. N-arachidonoylethanolamine (anandamide) and 2-arachidonoylglycerol (2-AG), as well as other constituents of their lipid families, N-acylethanolamines (NAEs) and 2-monoacylglycerols (2-MAGs), respectively. Here we employed three in vivo neonatal rat models characterized by widespread neurodegeneration as a consequence of altered glutamatergic neurotransmission and assessed changes in endocannabinoid homeostasis. A 46-fold increase of cortical NAE concentrations (anandamide, 13-fold) was noted 24 h after intracerebral NMDA injection, while less severe insults triggered by mild concussive head trauma or NMDA receptor blockade produced a less pronounced NAE accumulation. By contrast, levels of 2-AG and other 2-MAGs were virtually unaffected by the insults employed, rendering it likely that key enzymes in biosynthetic pathways of the two different endocannabinoid structures are not equally associated to intracellular events that cause neuronal damage in vivo. Analysis of cannabinoid CB(1) receptor mRNA expression and binding capacity revealed that cortical subfields exhibited an up-regulation of these parameters following mild concussive head trauma and exposure to NMDA receptor blockade. This may suggest that mild to moderate brain injury may trigger elevated endocannabinoid activity via concomitant increase of anandamide levels, but not 2-AG, and CB(1) receptor density.

Animals↗
PubMed1999

[Craniocerebral trauma in sports. With recommendations for prevention].

Traumatic brain injury (TBI) is found in many sports. A mild head injury (concussion of brain) is found in more than 80%, mainly in sports with contact to others. Especially affected by death are air sports, horse riding and cycling, whereby brain damage often is the leading injury. With the example of a cycling accident the possible processing dynamics of a mild head injury with secondary brain damage through an intracranial hematoma is demonstrated in the following. For the assessment of sports ability, there is often made the division with symptoms as confusion, amnesia and unconsciousness after a mild head injury (scale 1-3). According to the gravitational scale of cerebral concussion, an adequate sports break should be kept. Postcommotional symptoms prove sports inability. A chronic brain damage is not rarely found in some combative sports. In this case the injury may result in a traumatic encephalopathia with the evaluation of dementia and in some cases also Parkinson's disease is observed. To prevent a TBI there should be worn an adequate protective headgear especially by children in training and in sports contests concerning risk sports. Further recommendations for prevention are presented and with them there will also be responded to sports ability in neurosurgical diseases.

Accidents, Traffic↗
PubMed2003

Injuries from motorcycle- and moped crashes in Sweden from 1987 to 1999.

The objective of this paper is to study injuries from motorcycle and moped crashes in Sweden from 1987 to 1999. Databases at the National Board for Health and Welfare and codes from both ICD9 and ICD10 systems were used, including patterns of age, gender, E-code and type of injury. Length of hospital stay, type of injuries and trends over time was evaluated. To get a more detailed picture of the age distribution, type of vehicle used and number of killed, data from the Swedish National Road Administration were also used. In Sweden, 27,122 individuals received in-patient care due to motorcycle and moped injuries between 1987 and 1999. The motorcycle and moped injury rate was reduced in the second half of the studied period and so were the total days of treatment per year. Males had eight times the incidence of injuries compared to females. Riders under the age of 26 and in particular those at an age of 15 had the highest incidence rate. Head injuries were the most frequent diagnosis, followed by fractures to the lower limbs. Concussion was the most frequent head injury. Focal and diffuse brain injuries combined showed the same frequency as concussion. It is concluded that more preventative strategies must be presented before the injury rate can be reduced.

Accidents, Traffic↗
PubMed2003

How safe are childcare products, toys and playground equipment? A Swedish analysis of mild brain injuries at home and during leisure time 1998-1999.

The aim was to highlight the role of childcare products as causes for mild brain injury (concussion) in small children (0-4 years of age) and to determine the most dangerous products. By childcare products this report means the following items: child and baby furniture, nursing tables, baby walkers, toys, baby carriages, sport equipment for children, playground equipment and security equipment for children. The data were derived from the EHLASS (European Home and Leisure Accident Surveillance System) for 1998 and 1999 and covered a restricted population of Sweden (approximately 5 per cent). According to this register 182 mild brain injuries (concussions) were recorded following a fall, an accident or a blow to the head among children (0-4 years of age) during 1998 and 158 for 1999. Of those injuries, childcare products were the cause of the accident in 84 (46 per cent) and 76 (48 per cent) cases respectively for 1998 and 1999. The number of children admitted for hospital care was 68 (57/84) and 74 (56/76) per cent respectively. The home was the most common place of the accident and play and leisure activity were the most common activities. More than 50 per cent of these accidents took place during daytime. The product type that caused most accidents was nursery furniture and, in this category, the baby walker was the most dangerous. The product type that caused the second most frequent accidents was playground equipment.

Accidental Falls↗
PubMed2006

Serum S-100B and cleaved-tau are poor predictors of long-term outcome after mild traumatic brain injury.

PRIMARY OBJECTIVE: To determine the relationship of serum S-100B and C-tau levels to long-term outcome after mild traumatic brain injury (mild TBI). RESEARCH DESIGN: A prospective study of 35 mild TBI subjects presenting to the emergency department. METHODS AND PROCEDURES: Six hour serum S-100B and C-tau levels compared to 3-month Rivermead Post Concussion Questionnaire (RPCQ) scores and post-concussive syndrome (PCS). MAIN OUTCOMES AND RESULTS: The linear correlation between marker levels and RPCQ scores was weak (S-100B: r = 0.071, C-tau: r = -0.21). There was no statistically significant correlation between marker levels and 3-month PCS (S-100B: AUC = 0.589, 95%CI. 038, 0.80; C-tau: AUC = 0.634, 95%CI 0.43, 0.84). The sensitivity of these markers ranged from 43.8-56.3% and the specificity from 35.7-71.4%. CONCLUSIONS: Initial serum S-100B and C-tau levels appear to be poor predictors of 3-month outcome after mild TBI.

Adolescent↗
PubMed1995

Coupling of a finite element human head model with a lumped parameter Hybrid III dummy model: preliminary results.

A skull-brain finite element model of the human head has been coupled with a multilink rigid body model of the Hybrid III dummy. The experimental coupled model is intended to represent anatomically a 50th percentile human to the extent the dummy and the skull-brain model represent a human. It has been verified by simulating several human cadaver head impact tests as well as dummy head 'impacts" during barrier crashes in an automotive environment. Skull-isostress and brain-isostrain response curves were established based on model calibration of experimental human cadaver tolerance data. The skull-isostress response curve agrees with the JARI Human Head Impact Tolerance Curve for skull fracture. The brain-isostrain response curve predicts a higher G level for concussion than does the JARI concussion curve and the Wayne State Tolerance Curve at the longer time duration range. Barrier crash simulations consist of belted dummies impacting an airbag, a hard and soft steering wheel hub, and no head contact with vehicle interior components. Head impact force, intracranial pressures and strains, skull stress, and head center-of-gravity acceleration were investigated as injury parameters. Head injury criterion (HIC) was also calculated along with these parameters. Preliminary results of the model simulations in those impact conditions are discussed.

Accidents, Traffic↗
PubMed2002

Does the use of artificial turf contribute to head injuries?

BACKGROUND: A number of high-profile professional football players have suffered career-ending concussions. The purpose of this article is to test the surfaces used by a professional team to determine their impact-attenuating properties. METHODS: An accelerometer was dropped from a height of 48 inches onto three different playing fields in the St. Louis area: an indoor artificial turf practice field, a grass outdoor practice field, and the artificial turf field at a domed stadium. The accelerometer was dropped 20 times from a height of 48 inches onto each surface. RESULTS: Statistical analysis of the peak Gs for impacts onto each surface indicate all three are statistically different. The artificial surface of the domed stadium was the hardest surface, with an average peak acceleration of 261 Gs compared with 183 Gs for the indoor artificial turf practice field and 246 Gs for the outdoor grass field. CONCLUSION: The surface used to play league games has the least impact attenuation of any field tested and may contribute to the high incidence of concussion in football players.

Acceleration↗
PubMed1999

Youth ice hockey tournament injuries: rates and patterns compared to season play.

OBJECTIVE: To prospectively document the incidence of game injury rates in youth ice hockey tournaments to compare with season-long game injury rates and to analyze the injuries occurring at tournaments by mechanism, type, body location, severity, player position, and period of play. DESIGN: A prospective injury report form completed for injured players by the tournament athletic trainer. SETTING: Four boys' tournaments and one girls' tournament during the 1993-94 season. PARTICIPANTS: 807 boys and girls, ages 9-19. MEASUREMENTS/MAIN RESULTS: 60 injuries occurred in boys and 4 occurred in girls. There were 26 boys with significant injuries and no girls with significant injuries. The significant game injury rates per 1000 player hours were 50.9 for boys combined, 57.9 for boys' Peewee A, 42.7 for boys' Bantam A, 64.8 for boys' varsity high school, 44.8 for boys' Junior Gold, and 0 for girls' Peewee A and B. Cerebral concussion comprised 15% of boys' injuries. CONCLUSIONS: The significant injury rate for boys' tournament game play was 4-6 times higher than the season game injury rates in two previous season-long studies. In boys' games, 65% of "all" injuries and 77% of "significant" injuries were related to collisions. The girls' rules of play do not allow body checking, and there were no significant injuries in girls' games. The boys had high rates of cerebral concussion injury at all age levels. Minimizing the frequency and intensity of collisions in the boys' game may decrease the injury rates, especially in the tournament setting.

Adolescent↗
PubMed2003

CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations.

OBJECTIVE: To determine the repeatability of a computerized cognitive test designed to monitor recovery from concussion and assist team physicians make return to play decisions (CogSport). To determine the correlation between CogSport and two conventional neuropsychological tests. DESIGN: Prospective, serial investigation of cognitive function. SETTING: Professional and semi-professional Australian Football clubs and a university affiliated research institute in Melbourne, Australia. PARTICIPANTS: Three-hundred healthy young adults, including 240 elite athletes. MAIN OUTCOME MEASURES: Intra-class correlation (ICC) coefficients for CogSport performance measures administered serially. ICC between CogSport performance measures and conventional neuropsychological tests. Normative data for CogSport performance measures. RESULTS: Measures of psychomotor function, decision making, working memory and learning were highly reliable. Some measures also displayed high correlations with conventional neuropsychological tests of information processing and attention. Preliminary normative data is described. CONCLUSIONS: CogSport is a highly reliable cognitive function test when administered to healthy young adults and elite athletes. CogSport measures similar cognitive functions as conventional tests used commonly in concussion research.

Adolescent↗