Participation in Contact or Collision Sports in Athletes With Epilepsy, Genetic Risk Factors, Structural Brain Lesions, or History of Craniotomy

Vincent J. Miele, M.D.; Julian E. Bailes, M.D.; Neil A. Martin, M.D.


Neurosurg Focus. 2006;21(4) 

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Structural Brain Lesions

Arachnoid cysts result from developmental splitting of the arachnoid membrane[73] and are often incidentally diagnosed in childhood. Found more commonly in male patients younger than 20 years of age, they are present in 1% of the general population. Although they are considered to be benign developmental anomalies, and asymptomatic athletes who harbor them have ordinarily been allowed to continue to participate in contact sports, arachnoid cysts have been associated with a triad of complications, including midline shift, SDH, and intracystic hemorrhage.[25,73] The rare but well-known propensity for arachnoid cysts to hemorrhage, either spontaneously or as a result of trauma, is thought to occur in approximately 0.1% of people with this entity.

The relationship between arachnoid cysts and SDHs was first noted in 1971.[66] Since that time, an association between the presence of an arachnoid cyst and the later development of an SDH has been identified in several contact and collision sports, including soccer (caused by "heading" the ball),[41,62,78] football,[81] and basketball.[42] This complication has also been seen in noncontact sports such as race walking.[15]

Several theories exist to explain why arachnoid cysts are linked to a higher risk of hemorrhage. Bleeding is thought to originate from fragile vessels within the cyst wall or leptomeninges, or from bridging veins.[58] Because the cysts are less compliant than normal brain tissue, a reduction in buffering of adjacent tissue results in an increased likelihood of tearing of associated bridging vessels. It is also possible that the different composition of arachnoid cyst fluid compared with normal CSF results in magnification and a greater transfer of pressure generated by head impacts, increasing the likelihood of rupture of the bridging veins or of the vessels within the cyst wall.[25]

An arachnoid cyst may present an increased risk, and although it is not an absolute contraindication to participation in contact sports, patients and their family members should be carefully counseled that the risk of a traumatically induced hemorrhage is present but uncertain.


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