MINOR HEAD INJURY AND TBI IN SPORT
Minor head injury15,16 accounts for 70–80% of admitted head injuries. Disagreement over the extent of resultant morbidity is partly explained by study entry criteria. Patients with a PTA of less than one hour, a minor head injury by Russell and Smith's PTA criteria of 1961, will generally be expected to have a better outcome than those with an admission GCS of 13 or 14. The “post-concussional” symptoms that follow may be somatic (headaches, dizziness, fatigue, sensitivity to light and noise, and sleep disturbance), cognitive (memory, attention, and concentration), or affective (anxiety, depression, and irritability). Most persons report problems and have measurable evidence of difficulties with attention, memory, and efficiency of information processing one week after an admission GCS of 13–15. The majority recover by three months, but about 20% have complaints at one year. This situation is complicated by misattribution to the TBI of symptoms that have a high prevalence in the general population, or can be explained by an earlier head injury, neuro/psychiatric disorder, or alcohol and substance abuse. Early problems, when somatic and cognitive complaints predominate, are largely the result of organic injury including frontotemporal contusions and DAI, often demonstrable on early MRI. Psychological factors including coping style or symptom exaggeration play a significant role in the development of persistent and especially late onset symptoms, which are often affective. Similar symptoms may result from coexisting post-traumatic stress disorder, which at times occurs despite loss of memory of the injury itself. These patients may report intrusions, including nightmares, avoidance behaviours, and hyperarousal, and may respond to cognitive–behavioural exposure techniques. Older age, abnormalities on early imaging, acute elevation of biochemical markers, particularly the serum protein S-100B, an (unlucky) admission GCS of 13, and a PTA of more than one hour, help predict the minority of patients at risk of persistent postconcussional symptoms, who may benefit from formal follow up.
TBI sustained during contact sports17 is usually minor, often repetitive, but occasionally severe. Severe or mortal injury, such as that sustained while boxing, is usually the result of translational acceleration resulting in an acute subdural haematoma with mass effect and brain swelling. Outcome correlates with time to craniotomy, and thus rapid neurosurgical access is mandatory. Repetitive TBI over a long period results in time in the cognitive, motor, and psychiatric symptoms of dementia pugilistica, reported in boxers, especially those with the APOE-e4 allele genotype, and steeplechase jockeys. Histological changes comprise neocortical neurofibrillary tangles and diffuse amyloid plaques. Exposure to repeated minor head injury in other sports including karate, ice hockey, and American and Association football, is associated with neuropsychological deterioration. Return to play guidelines, currently not universally agreed, are designed to reduce risk of second injury caused by suboptimal competence early post-injury, and also the cumulative effects of repeated concussion.
MINOR HEAD INJURY AND TBI IN SPORTMinor head injury15,16 accounts for 70–80% of admitted head injuries. Disagreement over the extent of resultant morbidity is partly explained by study entry criteria. Patients with a PTA of less than one hour, a minor head injury by Russell and Smith's PTA criteria of 1961, will generally be expected to have a better outcome than those with an admission GCS of 13 or 14. The “post-concussional” symptoms that follow may be somatic (headaches, dizziness, fatigue, sensitivity to light and noise, and sleep disturbance), cognitive (memory, attention, and concentration), or affective (anxiety, depression, and irritability). Most persons report problems and have measurable evidence of difficulties with attention, memory, and efficiency of information processing one week after an admission GCS of 13–15. The majority recover by three months, but about 20% have complaints at one year. This situation is complicated by misattribution to the TBI of symptoms that have a high prevalence in the general population, or can be explained by an earlier head injury, neuro/psychiatric disorder, or alcohol and substance abuse. Early problems, when somatic and cognitive complaints predominate, are largely the result of organic injury including frontotemporal contusions and DAI, often demonstrable on early MRI. Psychological factors including coping style or symptom exaggeration play a significant role in the development of persistent and especially late onset symptoms, which are often affective. Similar symptoms may result from coexisting post-traumatic stress disorder, which at times occurs despite loss of memory of the injury itself. These patients may report intrusions, including nightmares, avoidance behaviours, and hyperarousal, and may respond to cognitive–behavioural exposure techniques. Older age, abnormalities on early imaging, acute elevation of biochemical markers, particularly the serum protein S-100B, an (unlucky) admission GCS of 13, and a PTA of more than one hour, help predict the minority of patients at risk of persistent postconcussional symptoms, who may benefit from formal follow up.TBI sustained during contact sports17 is usually minor, often repetitive, but occasionally severe. Severe or mortal injury, such as that sustained while boxing, is usually the result of translational acceleration resulting in an acute subdural haematoma with mass effect and brain swelling. Outcome correlates with time to craniotomy, and thus rapid neurosurgical access is mandatory. Repetitive TBI over a long period results in time in the cognitive, motor, and psychiatric symptoms of dementia pugilistica, reported in boxers, especially those with the APOE-e4 allele genotype, and steeplechase jockeys. Histological changes comprise neocortical neurofibrillary tangles and diffuse amyloid plaques. Exposure to repeated minor head injury in other sports including karate, ice hockey, and American and Association football, is associated with neuropsychological deterioration. Return to play guidelines, currently not universally agreed, are designed to reduce risk of second injury caused by suboptimal competence early post-injury, and also the cumulative effects of repeated concussion.
การแปล กรุณารอสักครู่..