Recovery Disability Disability

Effects of pegorgotein on neurologic outcome of patients with severe head injury. JAMA 1996;276:539-543.

Study

Tirilazad (n=557) PEG-SOD (n= 162) Data from Young B, Runge JW, Waxman KJ, et al:

well documented that fatal brain swelling may occur in the setting of one minor HI followed in short order by a second minor HI in athletes who are still symptomatic from the first injury.^ The cumulative effects of multiple minor HIs is recognized in boxing as the punch drunk syndrome (see later); however, the occurrence of this syndrome in association with other sports is controversial.

For sports-related minor HI, the American Academy of Neurology has defined three grades of concussion and recommended guidelines for return to play. y For Grades 1 and 2, there is transient confusion and no loss of consciousness. Resolution of concussion symptoms or mental status abnormalities occurs in less than 15 minutes in Grade 1 and more than 15 minutes in Grade 2. Grade 3 concussion is any loss of consciousness. Players with Grade 1 concussion may return to play the same day if they have a normal sideline neurological assessment including a detailed mental status examination. Players with Grade 2 and 3 concussions should not return to play the same day. Guidelines for return to play after removal from the contest (, Tablei51:2i ) are necessary because of concern over the cumulative effects of even mild head injury and the rare occurrence of second impact syndrome.y

Dementia, long recognized as a sequela of multiple head injuries in boxing, was termed punch drunk by Martland in 1928 and dementia pugilistica by Millspauch in 1937. Neuropathological study of brains of boxers with dementia pugilistica demonstrate beta-amyloid protein-containing diffuse plaques and neurofibrillary tangles, which are pathological features of Alzheimer's disease. Increased expression of beta-amyloid precursor protein is part of an acute-phase response to neuronal injury, which can lead to deposition of beta-amyloid protein. y

Patients with moderate HI usually experience both cognitive and physical disabilities and typically require rehabilitation services after acute hospitalization. Nevertheless, the incidence of severe long-term disability is small.

In contrast, few patients with severe HI recover completely to their preinjury state. The most common system to rate recovery is the Glasgow Outcome Scale: Good Recovery (GR), Moderate Disability (MD), Severe Disability (SD), Vegetative (V), and Death (D). y The tirilazad mesylate and PEG-SOD trials provide excellent information on current severe HI outcomes (llla(1le,l1„5i:3, ).

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