Historical account Foot ball fatalities have been tracked since 1931 Second-impact syndrome was first described by Saunders in 1984 Between 1984 and 1991, only four cases were documented In 1994 it was discovered that a previously concussed football player was six times as likely to suffer a concussion In 2002 A high-school football student was concussed twice within two weeks. Collapsed on the field and died six days later. In 2010 the NFL made a new rule against leading with the head to prevent concussions
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Historical account
Foot ball fatalities have been tracked since 1931
Second-impact syndrome was first described by Saunders in 1984
Between 1984 and 1991, only four cases were documented
In 1994 it was discovered that a previously concussed football player was six times as likely to suffer a concussion
In 2002 A high-school football student was concussed twice within two weeks. Collapsed on the field and died six days later.
In 2010 the NFL made a new rule against leading with the head to prevent concussions
Historical Account
1966 Concussion defined as “A clinical syndrome characterized by Immediate and transient post traumatic impairment of neural function due to brainstem involvement” ( by the Committee of Head Injury Nomenclature of the Congress of Neurological Surgeons)
2001 It’s defined as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces”
Caused by direct or indirect blow to head Rapid onset of short lived impairment of neurologic function Acute clinical symptoms-functional disturbance May or may not be a loss of consciousness Associated with grossly normal structural neuroimaging
( By the Committee on head injury nomenclature of the Congress of Neurologic Surgeons)
Grades of a Concussion
Grade 1 Transient confusion No loss of
consciousness Mental status
abnormalities resolve in 15 minutes or less
Grade 2 Similar to grade one
differing only in duration. Symptoms lasting 15 minutes or more.
(eg. running the wrong direction) Significantly decreased playing
ability
The Scat CardThe SCAT Card(Sport Concussion Assessment Tool)MEDICAL EVALUATION Name: _____________________ Date: __________ Sport/Team: ________________ Mouth Guard? Y N 1) SIGNSWas there loss of consciousness or unresponsiveness? Y NWas there seizure or convulsive activity? Y NWas there a balance problem/unsteadiness? Y N 2) MEMORYModified Maddocks questions (check those correct) At what venue are we? ___ Which half is it? ___ Who scored last?
___What team did we play last? ___
Did we win last game? ___ 3) SYMPTOM SCORETotal number of positive symptoms (from “SYMPTOMS” box on
other side of the card) = ______ 4) COGNITIVE ASSESSMENT(Check those correct)5 word recall Immediate Delayed
neurologic or hospital assessment. 6) RETURN TO PLAY ATHLETES SHOULD NOT BE RETURNED TO PLAY THE SAME DAY
OF INJURY.When returning athletes to play, they should follow a stepwise
symptom-limited program, with stages of progression. For example:
1. rest until asymptomatic (physical and mental rest)2. light aerobic exercise (e.g. stationary cycle)3. sport-specific training4. non-contact training drills (start light resistance training)5. full contact training after medical clearance6. return to competition (game play) There should be approximately 24 hours (or longer) for each stage and
the athlete should return to stage 1 if symptoms recur. Resistance training should only be added in the later stages.
Medical clearance should be given before return to play.
Signs and Symptoms: Long term Symptoms increase with repeat concussions Chronic Headaches Chronic Dizziness Dementia Depression
Second impact syndrome death
Post concussive syndrome Continual display of symptoms such as headache, cognitive
dysfunction, irritability Chronic Traumatic Encephalopathy or CTE
TAU proteins Loss of ability to control muscles
Signs and Symptoms: Long Term EffectsChronic Traumatic Encephalopathy or CTE
• Memory Loss • Aggression • Confusion• Depression
Baby shaken syndrome
Symptoms and Signs
Small brain Inability to hold head
Damage to spinal cord and neck
Bleeding in the brain Metal retardation
Blindness Bleeding in retina
Fracture of bones
Neurological Findings
Postural Stability and Neuropsychological deficits
Design Baseline Pre-Season Follow up Post injury days
A second concussion tremendously increases ICP to the point that blood can no longer properly circulate through the brain resulting in extreme brain damage and death. (ischemia