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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 […]

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 […]

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 […]


Overall, it is estimated that approximately 300,000 sports-related concussive events occur in the United States annually. It has been estimated that 3.9% to 7.7% of high school and college athletes sustain a concussion each year.

Contact sports in particular place athletes at risk for head trauma. Football is recognized as having the highest risk; however, […]

Concussion-Cerebral Pathophysiology of Concussion

Concussion injuries are thought to result from diffuse axonal injuries caused by rapid acceleration/deceleration of the head, which results in stretching of nerve fibers. During the past decade, significant insight has been gained regarding the pathophysiology of concussion. The postconcussive defects clearly do not occur with significant anatomic perturbation and do appear to resolve over […]

Spectrum of Head Injuries

Intracranial hemorrhage can be divided into three types: epidural, subdural, and subarachnoid. Each type of intracranial hemorrhage is potentially devastating, so prompt, accurate assessment and appropriate treatment must be instituted. The initial presentation ranges from headache to neurologic deficits to loss of consciousness. Blood is an irritant to brain tissue and may precipitate a seizure.


Clinical Evaluation of Head Injuries-On-the-Bench Evaluation

Athletes should be questioned for specific symptoms when they are taken off the field. In particular, athletes should be questioned about dizziness, visual changes (e.g., photophobia, double vision, or blurriness), headache, nausea, vertigo, and tinnitus. Many of these symptoms may not be present immediately but may occur in a delayed fashion. Vomiting may be indicative […]

Clinical Evaluation of Head Injuries-On-the-Field Evaluation

The initial on-the-field evaluation is directed toward assessing the levels of consciousness and of associated injuries, particularly cervical spine trauma. The medical personnel must first assess the patient’s airway, breathing, and circulation (i.e., ABCs).

If the patient is unconscious, the initial respondent must assume that an associated cervical spine injury has occurred, and the neck […]

Pathophysiology of Head Injuries

Athletic head injuries usually result from direct impact and/or deceleration-rotational events. Classic principles of brain contusions include the concept of coup injury, in which a forceful blow to a stationary head imparts maximal brain injury directly beneath the point of impact.

On the other hand, contrecoup injuries occur when the energy of impact is transferred […]