N

14

Head Injuries

Kevin M. Guskiewicz

In This Chapter

Concussion Cerebral contusion Cerebral hematoma Second impact syndrome Immediate management Return to sports

The immediate management of the head-injured athlete depends on the nature and severity of the injury. It is therefore important for the sports medicine clinician to be skilled in the early detection and follow-up evaluation procedures of these injuries.1 Several terms are used to describe the injury, the most global being traumatic brain injury, which can be classified into two types: focal and diffuse. Focal or post-traumatic intra-cranial mass lesions include subdural hematomas, epidural hematomas, cerebral contusions, and intracerebral hemorrhages and hematomas. These are considered uncommon in sport but are serious injuries; the sports medicine clinician must be able to detect signs of clinical deterioration or worsening symptoms during serial assessments in order to classify the injury and manage it appropriately. Signs and symptoms of these focal vascular emergencies can include LOC, cranial nerve deficits, mental status deterioration, and worsening symptoms. Concern for a significant focal injury should also be raised if the signs or symptoms occur after an initial lucid period in which the athlete seemed normal.1

Diffuse brain injuries can result in widespread or global disruption of neurologic function and are not usually associated with macroscopically visible brain lesions except in the most severe cases. Most diffuse injuries involve an acceleration/deceleration motion, in a linear plane, a rotational direction, or both. In these cases, lesions are caused by the brain being shaken within the skull.2,3 The brain is suspended within the skull in cerebrospinal fluid (CSF) and has several dural attachments to bony ridges that make up the inner contours of the skull. With a linear acceleration/deceleration mechanism (side to side or front to back), the brain experiences a sudden momentum change that can result in tissue damage. The key elements of injury mechanism are the velocity of the head before impact, the time over which the force is applied, and the magnitude of the force.2,3 Rotational acceleration/deceleration injuries are believed to be the primary injury mechanism for the most severe diffuse brain injuries. Structural diffuse brain injury (diffuse axonal injury) is the most severe type of diffuse injury because axonal disruption occurs, typically resulting in disturbance of cognitive functions, such as concentration and memory. In its most severe form, diffuse axonal injury can disrupt the brain stem centers responsible for breathing, heart rate, and wakefulness.2,3

Was this article helpful?

0 0
Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

Get My Free Ebook


Post a comment