Concussions in Sports

1. Concussions in Sports Enrique Saguil, MD

2. Concussion: To shake violently. A temporary disturbance of brain function without a structural change in the brain.

3. Also known as: Minor traumatic brain injury* Bell ringer Footballers migraine Boxers blow Wrestling headache Headband headache

4. Mild traumatic brain injury:concussion Traumatic brain injury: Cerebral contusion Intracranial hemorrhage Epidural hematoma Subdural hematoma Intracerebral hematoma Diffuse axonal injury

5. Coup Contra Coup

6. Force of Impact Ommaya: experimented with monkey brains on axial vs rotational forces findings were that rotation and not translation were responsible for coup-contra-coup, EEG slowing, and change in blood flow to brain

7. Brain changes With the linear and translational forcers combined with rotation= axonal injury and shearing occurs This leads to change in membrane permeability, swelling to nerve (axon) and metabolic change SIS!

8. Sports to beware of: Boxing Football Rugby Soccer Wrestling Judo MMA Touch/flag football Lacrosse Field hockey Ice hockey Biking Skateboarding Bmx Swimming

10. CDC statistics 5.3 million americans have disability –TBI 1.4 milliion sustain injury from TBI 1.1 are treated and released from ER 75% of TBI’s each year are concussions or mild TBI (Appx 1.6-3.8 million/yr are from sports or rec considered mild and not treated)

11. Wearing a helmet helps • Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle; • Playing a contact sport, such as football, ice hockey, or boxing; • Using in-line skates or riding a skateboard; • Batting and running bases in baseball or softball; • Riding a horse; or • Skiing or snowboarding

12. Wearing a seat belt helps • Wearing a seat belt every time you drive or ride in a motor vehicle • Children should start using a booster seat when they outgrow their child safety seats (usually when they weigh about 40 pounds). They should continue to ride in a booster seat until the lap/shoulder belts in the car fit properly, typically when they are 4’9” tall.12

13. Post concussive syndrome • Persistent headaches • Inability to concentrate • Irritability Torg

14. Punch-drunk encephalopathy (dementia pugilistica) Forgetfullness Slowness in thinking Dysarthric speech

15. Post concussive headache • Localized where scarring and entrapment of sensory nerve evident • Headache-migraine-cluster-tension that develops after trauma

16. Sudden Impact Syndrome Thought secondary to loss of autoregulation causing vascular engorgement of brain tissue Primed from the first injury where brain is noted to have membrane permeability, edema to nerve and metabolic change unresolved Malignant Brain Edema

17. Evaluation: • Emotionalresponse • Pain-headache • Memory (person place play) • Motor • Coordination • Exertional response • Re-evaluation

18. Diagnostic testing: • Neurological eval • CT • MRI • EEG • Neuropsychiatric testing

19. Univeral guidelines cantu

20. AAN Colorado Medical Society Ommaya

21. Return to sports Cantu

22. Rx • Antiinflammatory diet • Tylenol (with or without narcotics) • Muscle relaxers • Arnica, Capsicum • Tumeric, ginger, willow bark, boswelia • Massage • Insure sleep pattern • Avoid tobacco, etoh, caffeine, stimulants

23. Wear a Helmet!