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Functional MRI

Because concussion is believed to represent a functional neural perturbance rather than a structural one, use of structural neuroimaging modalities, such as MRI and CT, is normal in cases of concussion. Functional MRI examines the metabolic/physiological state of the brain and, thus, has been proposed as an empirical means to assess and monitor concussion.

Functional […]

Neuropsychological Testing

Neuropsychological tests are functional cognitive instruments that are used to assess changes in attention, concentration, memory, information-processing speed, and motor speed or coordination. These tests provide a validated means to quantify cognitive weakness, and it is increasingly clear that neuropsychological assessment is a useful tool for measuring both the initial and recovery stages of athletes […]

Standardized Assessment of Concussion

Standardized concussion assessment forms have been developed for initial evaluation of the concussed athlete. While standardized assessment is not a substitute for a physician evaluation or a formal neurologic or neuropsychological examination, it does help to detect and quantify initial cognitive deficits, and it provides an objective and standardized mental status examination directed toward the […]

Current Grading Systems

More than 15 grading systems and return-to-play parameters have been published to guide the team physician, trainer, and coach in the evaluation and management of concussion. However, because of a lack of scientific foundation, these recommendations and grading systems are relatively arbitrary guides.

For example, most concussion grading systems determine return-to-play decisions based on the […]

Management of Concussion

The management of concussion has three crucial considerations. First, immediate neurologic emergencies must be identified. Second, the devastating scenario of second-impact syndrome must be prevented, and the risk of recurrent concussive episodes should be minimized.

Finally, the cumulative effects of repeated concussion, which may lead to CTBI, must be avoided. The identification of neurologic emergencies […]

Chronic Traumatic Brain Injury

The long-term sequelae of multiple concussive events remain unclear. In boxers, dementia puglistica or punch drunk syndrome, which includes a pattern of ataxia, pyramidal tract dysfunction, tremor, impaired memory, dysarthria, and behavioral changes, has long been recognized as a result of the cumulative effects of concussions.

More recently, the term chronic traumatic brain injury (CTBI) […]

Second-Impact Syndrome

An extremely rare but life-threatening consequence of premature return-to-play is the second-impact syndrome. This occurs when an athlete who has not completely recovered from an initial concussive event sustains a second head trauma.

The second event may be relatively minor, but a catastrophic increase in intracranial pressure can occur because of dysregulation of cerebral blood […]

Postconcussion Syndrome

It has been estimated that 20% of patients will suffer postconcussive symptoms after concussion. Characteristics of postconcussion syndrome include impaired memory and concentration, persistent headache, fatigue, mood and sleep disturbances, and dizziness. Many of these symptoms are short-lived, and they usually resolve spontaneously. Treatment includes nonnarcotic analgesics and rest.

Recent neurocognitive testing protocols have begun […]

Diagnosis of Concussion

The signs and symptoms of concussion vary, but any change in an athlete’s behavior should be recognized as an indication of altered neurologic functioning. Typical features of concussion are headache, disorientation, blank stare, slurred speech, delayed verbal responses to questions, slow and uncoordinated motor function, dizziness, emotional lability, and short-term memory deficits; any head trauma […]

Mechanism of Injury

A committee of representatives from the NFL Team Physicians Society and the NFL Athletic Trainers Society, NFL equipment managers, and scientific experts in the area of traumatic brain injury recently investigated the location and direction of helmet impacts in the NFL using sophisticated acquisition of high-speed video impact data and biomechanical reconstruction to determine impact […]