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PubMed2006

[Comparison of retrograde amnesia changes within different injury levels of cerebral concussion in rats].

OBJECTIVE: To investigate the retrograde amnesia changes within different injury levels of cerebral concussion in rats. METHODS: A metallic pendulum striker device of brain injury was deployed to duplicate CC models of different injury levels within Sprague-Dawley (S-D) rats. The investigated animals were divided into two groups according to classification standard, that is, Pure Cerebral Concussion (PCC) group and Complicated Cerebral Concussion (CCC) group. One control group was used, and each group included 8 animals. The retrograde amnesia of each group was assessed by Morris Water Maze (MWM) Test from 3 days preinjury to 7 days postconcussion. RESULTS: Compared with the control group, the retrograde amnesia was detected within 3 days in PCC group, and 5 days in CCC group after injury. At the same time, the two groups both manifested space recognition deficit. CONCLUSION: The retrograde amnesia existed in both pure cerebral concussion group and complicated cerebral concussion. Furthermore, the lasting time of retrograde amnesia in animals correlates to the injury level of brain concussion.

Amnesia, Retrograde↗
PubMed1977

[Surgery of concussion foci in the cerebral hemispheres].

On the basis of observations in 144 patients operated on because of severe cerebral concussions, the importance of primary and secondary removal of the concussion focus is stressed. The diagnosis is made by means of EEG, angiography, and echo encephalography. Examinations of the concussion region with clearance etc. showed that the immediate vicinity of the cerebral lesion exhibits a considerably reduced blood flow which, due to the stimulus of the concussion, will further decrease within the following days. After six days, the blood supply stabilises in the zone of the oscillating reaction. The enlargement of the zone of necrosis intensifies the intracranial increase in pressure and can only be avoided by the removal of the concussion. Resection is carried out subpial in order to isolate the cerebral tissue from the dura mater. Lethality: With solitary concussion foci 22%, in case of combination with intracranial haematoma 60%, with multiple foci 67%, total 46%.

Action Potentials↗
PubMed2003

Evaluation of neuropsychological domain scores and postural stability following cerebral concussion in sports.

CONTEXT: With increasing knowledge and research about concussion, there have been few objective studies that have used neuropsychological domain scores and postural stability to assess concussion. OBJECTIVE: To evaluate the recovery curve of athletes who incur sport-related concussion from repeated serial testing of neuropsychological and posturography testing. DESIGN: A prospective epidemiological model was used for the course of the study. SETTING: Division I intercollegiate athletics. PARTICIPANTS: Athletes participating in football, soccer, basketball, softball, and cheerleading. MAIN OUTCOME MEASURES: Neuropsychological scores and posturography measures were obtained preseason and serially at day 1, day 2, day 3, and day 10 postconcussion. Control participants were tested at the same intervals. Neuropsychological scores were converted to standards score and then into domains of attention, learning, speed of information processing, concentration, memory, and verbal fluency. Analysis of covariance with the baseline test as the covariate was used to analyze the data with univariate post hoc tests performed. RESULTS: Significant group differences were found for self reported symptoms (P = 0.001), speed of information processing (P = 0.005), mean stability (P = 0.002), and vestibular function (P = 0.003) between injured and control participants. A group, by day, planned comparison found that speed of information processing and composite balance measures demonstrated significant differences through day 10 postinjury, while symptoms and the vestibular ratio remained significant only through day 3. CONCLUSIONS: The concussion recovery curve demonstrated short-term neuropsychological and posturography deficits following injury. A comprehensive approach to concussion management should be used to assess the injury and make return-to-play decisions.

Adult↗
PubMed1984

The prognosis of patients with concussion and increased creatine kinase BB in the cerebrospinal fluid.

In a series of 93 emergency patients, 58 were classified as concussions on a clinical basis. Thirteen of the patients with concussion had increased levels of creatine kinase isoenzyme BB (CK-BB) in their cerebrospinal fluid (CSF). We performed a prospective, follow-up investigation comparing 10 patients with a CK-BB increase and 10 patients without a CK-BB increase after concussion. Within 24 hours, at 6 months and 3 years after concussion, each patient was subject to a special interview to obtain pre-concussional baseline data and post-concussional follow-up data concerning their complaints and capacity for daily activities. We found a definite change towards increasing disability in 8 of the 10 patients with a raised CK-BB, and in only 1 of the 10 patients with normal levels of CK-BB. A careful neuropsychological examination confirmed inferior performance in tests especially sensitive to brain injury in patients with a CK-BB increase. Our results suggest that increased levels of CK-BB after concussion signify a more severe injury which is not found in the clinical examination during the first days after the accident, and that these patients are a high-risk group for the development of post-concussional problems and symptoms.

Adolescent↗
PubMed1998

Quantification of post-concussion symptoms 3 months after minor head injury in 100 consecutive patients.

Post-concussion symptoms (PCS) (such as headaches, irritability, anxiety, dizziness, fatigue and impaired concentration) are frequently experienced by patients who have sustained a minor head injury (MHI). The post-concussion syndrome has been defined as a clinical state where 3 or more symptoms persist for more than 3 months. This report focuses on the quantification of PCS according to the Rivermead Postconcussion Symptoms Questionnaire (RPQ). We studied 100 consecutive patients with MHI and normal computed tomography of the brain. At 3 months after injury, 62% reported the presence of one or more symptoms, and 40% fulfilled the diagnostic criteria for post-concussion syndrome. Patients with post-concussion syndrome had significantly (P < 0.001) higher RPQ scores (mean 19.1, SD 11.9) than those without (mean 1.2, SD 1.8). Patients on sick leave owing to the injury reported significantly (P = 0.05) higher RPQ scores (mean 10.3, SD 13.2) than those not on sick leave (mean 5.5, SD 8.6). We observed no association between age, gender, cause of injury, severity of injury, duration of amnesia and RPQ score. RPQ score provides useful information about the severity of PCS regardless of whether the diagnostic criteria for the post-concussion syndrome are met or not.

Adolescent↗
PubMed1981

Cerebral concussion in rats rapidly induces hypothalamic-specific effects on opiate and cholinergic receptors.

Conscious male adult rats were concussed by a blow to the occiput with a blunt dart, shot from a spring-loaded pistol. Animals were decapitated within 2 sec, brains quickly removed, several brain regions homogenized in cold buffer and radioreceptor assays carried out. There was a 20% increase in binding of [3H]naloxone and [3H]QNB in the hypothalamus but not in the amygdala, striatum, hippocampus, cortex, midbrain and hindbrain. For animals killed 5-10 sec after concussion, when normal conscious behavior had returned, there were no changes in binding between control and concussed rats. Binding of [3H]spiroperidol and [3H]ouabain was unaffected by concussion. To rule out changes due to non-specific stress, one series of rats received a blow to the lower body. There was no change from control in [3H]QNB binding to hypothalamic tissues by a body blow as compared with the blow to the head. The findings suggests decreased binding of endogenous endorphins and acetylcholine to their respective receptors as a result of concussion. The transient deficit in endogenous transmitter binding may temporarily interrupt hypothalamic circuits concerned with the state of consciousness.

Animals↗
PubMed1998

Involvement of nicotinergic mechanisms in thyrotropin-releasing hormone-induced neurologic recovery after concussive head injury in the mouse.

A behavioral study was performed in an attempt to understand the neuronal mechanisms involved in the thyrotropin-releasing hormone (TRH)-induced improvement of consciousness after concussive head injury in the mouse. Intravenous administration of TRH dose dependently shortened the duration of unconsciousness after concussion in the mouse (ED50 = 3.2 mg/kg). The improvement of recovery evoked by TRH (3 mg/kg i.v.) after concussion was not affected by i.p. pretreatment with N-(2-chloroethyl)-N-ethyl-2-bromobenzylamine, alpha-methyl-para-tyrosine, p-chlorophenylalanine, scopolamine or methylscopolamine. However, mecamylamine or hexamethonium i.p. pretreatment completely inhibited the TRH-induced improvement of outcome in traumatic brain injury. The results imply that TRH-induced improvement of recovery after concussion is not associated with increased activity of monoaminergic neurons in the brain. These results suggest that the inhibitory effect of TRH upon unconsciousness after concussion in mice is mainly produced by activation of central cholinergic systems via nicotinic receptors whereas muscarinic receptors seem to be not implicated.

Animals↗
PubMed2004

Relation between subjective fogginess and neuropsychological testing following concussion.

The purpose of this study was to examine the relation between the subjective report of feeling foggy at one-week post concussion and acute neuropsychological outcome. The outcome variables were derived from a computerized neuropsychological screening battery, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Participants were 110 high school students who sustained a sports-related concussion and were evaluated 5-10 days post injury (M = 6.8 days). Athletes were divided into two groups on the basis of self-reported fogginess. The first group reported no fogginess (n = 91), whereas the second group reported experiencing some degree of fogginess (n = 19) on a 6-point scale. The athletes with persistent fogginess experienced a large number of other post-concussion symptoms, compared to the athletes with no reported fogginess. In addition, the athletes with persistent fogginess had significantly slower reaction times, reduced memory performance, and slower processing speed. Thus, athletes with any degree of self-reported fogginess at one-week post injury are likely to have adverse effects from their concussions in multiple domains.

Adolescent↗
PubMed2005

Standard regression-based methods for measuring recovery after sport-related concussion.

Clinical decision making about an athlete's return to competition after concussion is hampered by a lack of systematic methods to measure recovery. We applied standard regression-based methods to statistically measure individual rates of impairment at several time points after concussion in college football players. Postconcussive symptoms, cognitive functioning, and balance were assessed in 94 players with concussion (based on American Academy of Neurology Criteria) and 56 noninjured controls during preseason baseline testing, and immediately, 3 hr, and 1, 2, 3, 5, and 7 days postinjury. Ninety-five percent of injured players exhibited acute concussion symptoms and impairment on cognitive or balance testing immediately after injury, which diminished to 4% who reported elevated symptoms on postinjury day 7. In addition, a small but clinically significant percentage of players who reported being symptom free by day 2 continued to be classified as impaired on the basis of objective balance and cognitive testing. These data suggest that neuropsychological testing may be of incremental utility to subjective symptom checklists in identifying the residual effects of sport-related concussion. The implementation of neuropsychological testing to detect subtle cognitive impairment is most useful once postconcussive symptoms have resolved. This management model is also supported by practical and other methodological considerations.

Acute Disease↗
PubMed2003

Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden.

OBJECTIVES: To study quality of life and subjective post-concussion symptoms in adults (16-60 years) with a mild traumatic brain injury (MTBI) 3 months and 1 year after injury. METHODS: Of a total of 489 patients 173 responded to questionnaires at 3 months and at 1 year, including the SF-36 health-related quality of life survey, which is a standardized measure validated for Swedish conditions. Post-concussion symptoms were rated as either existing or non-existing in a 21-item checklist [a modified version of Comprehensive Psychopathological Rating Scale (CPRS)]. RESULTS: SF-36 showed impaired scores in all dimensions. Existing post-concussion symptoms were reported by 1545%. Significantly, more symptoms were present at 3 months than at 3 weeks after injury. Furthermore, a significant correlation between higher rates of post-concussion symptoms and lower SF-36 scores was found. CONCLUSIONS: The SF-36 results were significantly impaired compared with an age- and gender-matched normative control group and the rate of post-concussion symptoms was significantly higher at 3 months than at 3 weeks after injury. As a significant correlation between higher rates of symptoms and low SF-36 scores was also found we assume SF-36 to be a sensitive enough measure of MTBI-related effects.

Adolescent↗
PubMed2002

A controlled historical cohort study on the post-concussion syndrome.

In Lithuania, expectation of chronic symptoms after minor head injury is less than in western countries and possibilities for monetary compensation are minimal. Therefore, an opportunity exists to study the post-concussion syndrome (PCS) without several confounding factors present in western societies. We sent questionnaires about symptoms attributed to PCS to 200 subjects who had a concussion with loss of consciousness between 35 and 22 months before the study. For each study subject, a sex- and age-matched control person with minor non-head injury was identified. These controls received similar questionnaires. All the responding post-concussion patients stated that they had had acute headache after the trauma but this headache had disappeared in 96% of cases within 1 month. Headache and dizziness at the time of the questioning were not significantly more prevalent in the patients with concussion than in the controls, and there was no significant difference concerning subjective cognitive dysfunction. Scores of visual analogue scales of symptoms attributed to PCS showed no significant differences except for depression, alcohol intolerance and worry about brain injury, which were more frequent in the concussion group. No specific effect of the head injury was detected when various definitions and different constellations of core symptoms of PCS were used. These findings question the validity of the PCS as a useful clinical entity.

Adult↗
PubMed2004

Effect of an acute bout of soccer heading on postural control and self-reported concussion symptoms.

Our purpose was to determine if an acute bout of heading soccer balls adversely affected postural control and self-reported symptoms of cerebral concussion. Thirty-one college-aged soccer players were randomly placed into either a kicking group or a heading group. Subjects either kicked or headed 18 soccer balls over the course of 40 minutes. Subjects had their postural control assessed while standing on a force plate and completed a concussion symptoms checklist on three separate occasions: prior to, immediately following, and 24 hours after kicking or heading. There were no significant differences between the heading and kicking groups on the postural control measures prior to, immediately following, and 24 hours after kicking/heading. The heading group did, however, report significantly more concussion symptoms than the kicking group immediately after heading, but not 24 hours after heading. The number of previous concussions sustained by subjects did not influence the effects of heading. An acute bout of soccer heading appears to cause an increase in self-reported symptoms of cerebral concussion lasting less than 24 hours but no quantifiable deficits in postural control. Further research is needed to investigate the cumulative effects of soccer heading on postural control and other objective measures of brain function.

Adult↗
PubMed2000

Electrophysiological indices of persistent post-concussion symptoms.

UNLABELLED: Mild head injuries (MHI) including concussion were once considered transient alterations of function that resulted in no long-term structural or functional effects. This opinion has changed somewhat in recent years, based on the scientific evidence and popular cases in the media that suggest MHI can result in damage that can, in some cases, lead to long-term cognitive sequelae. PURPOSE AND METHODS: An EP/ERP assessment battery is presented as a method for detecting changes in brain function that form the organic basis of persistent post-concussion symptoms (PCS). The primary focus of the paper was directed towards using this battery to determine whether or not brain function in individuals with persistent PCS was different than responses of individuals that comprised a nomative database. RESULTS: Visual and auditory ERPs and visual EPs were beyond a 2.5 standard deviation normal limit in young and older groups of individuals with persistent post-concussion symptoms. CONCLUSIONS: Evidence of changes in brain function in individuals with persistent post-concussion symptoms is consistent with the position that the post-concussion syndrome has a substantial biological, as opposed to a psychological, basis.

Adult↗
PubMed2004

Video analysis of head blows leading to concussion in competition Taekwondo.

PRIMARY OBJECTIVES: To analyse the situational and contextual factors surrounding concussions and head blows in Taekwondo. METHODS AND PROCEDURES: Prospective design. Direct observation, subject interview and videotape recording used. A total of 2328 competitors participated in the 2001 tournament, South Korea. All matches were recorded on videotape. All recipients of head blows were interviewed by athletic therapists and the researcher immediately after the match. The videotapes of concussions and head blows were analysed. RESULTS: A total of 1009 head blows including concussions were analysed. Head blows and concussions were most evident when the attacker was situated in a closed stance and received a single roundhouse kick. The most frequent anatomical site of the head impact was the temporal region. CONCLUSIONS: The frequency of head blows and concussions is high in Taekwondo. Development of blocking skills, safety education, rigorous enforcement of the competition rules and improvement of head-gear are recommended.

Adolescent↗
PubMed2005

Attentional deficits in concussion.

PRIMARY OBJECTIVE: The purpose of the present study was to examine deficits in the alerting, orienting and executive components of attention in individuals who have recently suffered a concussion. RESEARCH DESIGN: A group design was used in which the performance by individuals with concussion was compared to control subjects matched for age, height, weight and activity level. METHODS AND PROCEDURES: Participants completed the Attentional Network Test (ANT) that breaks down attention into alerting, orienting and executive components. Reaction time and response accuracy were the dependent variables. MAIN OUTCOMES AND RESULTS: It was found that only the orienting and executive components of attention were affected by concussion, whereas the alerting component was normal. Furthermore, participants with concussion required a significantly longer time than controls to initiate correct responses. CONCLUSIONS: These results suggest that the orienting and executive components of attention are most susceptible to the effects of concussion.

Adolescent↗
PubMed1998

Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete.

OBJECTIVE: This study investigated the clinical utility of the Standardized Assessment of Concussion (SAC) in detecting concussion in athletes. METHOD: Athletic trainers administered the SAC to 568 nonconcussed high school and college football players prior to the 1995 and 1996 football seasons. Thirty-three of these players experienced concussion and were tested immediately following injury; 28 of the 33 underwent additional follow-up testing 48 hours after the injury. RESULTS: Concussed players scored significantly below nonconcussed controls on all SAC measures and significantly below their own pre-injury baseline performance. Follow-up testing documented return to preinjury baseline. CONCLUSION: These findings support the SAC's effectiveness in detecting concussion and tracking recovery in order to determine a player's fitness to return to play.

Adolescent↗
PubMed1997

Were you knocked out? A team physician's approach to initial concussion management.

To present an evidence-based approach reviewing the acute management of concussive brain injury in sport. All published articles on the acute management of sport-related brain injury were extracted using searches of computerised databases (Medline, Embase, Sport Discus) as well as detailed literature reviews based upon the published bibliographies in this area. The review details the aspects where prospective scientific data is available upon which to base clinical management strategies. The first few minutes after an athlete receives a concussive injury provides a window of opportunity during which time the initial medical management forms a crucial and potentially lifesaving treatment. All clinicians involved in care of the concussed athlete need to have an understanding of the early management of the concussed athlete and a strategy by which they may manage such problems. An efficient and appropriate response to the immediate concussion management will help minimise the potential sequelae which may impact upon the athletes ability to return to sport.

Athletic Injuries↗
PubMed2000

Sports-related concussions.

Concussion is the most common head injury occurring in sports participation. Concussions range from a brief period of neural dysfunction to a prolonged period of unconsciousness with retrograde amnesia. It is imperative that the pediatric emergency medicine specialist be familiar with the proper initial assessment of the child or adolescent athlete who has sustained a sports-related concussion, the latest grading scales of concussions, and the current recommendations for returning the athlete to competition. A systematic approach to the athlete who has suffered a concussion will minimize the risk of further injury or mortality.

Adolescent↗