Sports-related Concussions: Diagnosis, Complications, and Current Management Strategies

Jonathan G. Hobbs, MD; Jacob S. Young, BS; Julian E. Bailes, MD

Disclosures

Neurosurg Focus. 2016;40(4):e5 

In This Article

Abstract and Introduction

Abstract

Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7–10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.

Introduction

According to the Centers for Disease Control and Prevention, sports-related concussions (SRCs) affect 1.6–3.8 million people each year in the US[65] and account for 5%–9% of all sports-related injuries.[40,120] Alarmingly, nearly 30% of these concussions occur in individuals between 5 and 19 years of age, and most result in a visit to the emergency room. These events occur in both helmeted and nonhelmeted sports alike, with concussive traumas being noted in both competition and practice settings.[50,70] Among organized sports, football, wrestling, girls' soccer, boys' soccer, and girls' basketball consistently account for the majority of concussions in the US.[4,40,70,120,129]

Although almost 90% of SRCs will have a spontaneous resolution of symptoms in 7–10 days following the initial injury,[35,79,82,90,101] a small percentage of athletes will experience persistent symptoms that require protracted, multidisciplinary treatment modalities. Unfortunately, it is hard to predict which athletes will suffer from extended difficulties, because symptom resolution does not indicate complete recovery from the traumatic event. To properly treat these patients, many of whom are student athletes, we must remember that there are scholastic, financial, and social implications in addition to the health concerns that make it of paramount importance that we provide optimal medical therapy. As the publicity around concussions continues to increase, it is likely that the number of patients neurosurgeons see in their practice will increase as well. This article aims to discuss the most current understanding of SRC and therapeutic strategies for neurosurgeons as well as a multidisciplinary health care team that is required to successfully ensure a safe return to play for these patients.

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