Neurosurgery
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Concussion is an important cause of morbidity in young student athletes. The prevention, accurate diagnosis, and prompt management of concussions require that players, parents, coaches, and medical personnel are accurately educated on current concussion data and guidelines. ⋯ There is currently no uniform educational program to disseminate information to student athletes regarding concussions. This article highlights a few nationally recognized educational programs that aim to accurately and effectively inform all members of the athletic, academic, and medical communities about the importance and urgency of concussion.
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Since the original descriptions of postconcussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and glutamate release result in significant energy demands and a period of metabolic crisis for the injured brain. These physiological perturbations can now be linked to clinical characteristics of concussion, including migrainous symptoms, vulnerability to repeat injury, and cognitive impairment. ⋯ Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction, and neurodegeneration. This "new and improved" article summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive brain injury. Furthermore, new connections are proposed between this neurobiology and early clinical symptoms as well as to cellular processes that may underlie long-term impairment.
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The management of patients with sports-related concussion (SRC) is comprehensive and includes preseason planning, education, initial evaluation, postinjury assessment, disposition, return-to-play decisions, and consideration of long-term brain health. Several recent publications have addressed sports concussion management using the best available evidence, and we review them here. ⋯ Although many questions remain unanswered, there are several areas of agreement including the importance of education, preseason assessment, the benefit and utility of a standardized multimodal assessment on the sidelines, individualized treatment and return-to-play protocols, and the benefit of a multidisciplinary team in managing complicated injuries. This paper reviews these current sports concussion guidelines and the best available evidence that guides current management of SRC.
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Sports-related concussions, which have become more prevalent in the past decade, are an extremely common phenomenon in organized athletics and create a substantial economic burden on the health care system. Furthermore, they can have devastating impacts on the athletic careers and long-term health of athletes. However, concussion evaluation remains a controversy with respect to diagnosis, management, and return-to-play guidelines for sports-related concussions. ⋯ Considerable effort has been directed toward developing reliable and valid sidelines assessment modalities for concussion evaluation with a goal of accurately determining whether an athlete requires rapid removal from or is able to return to competition. This paper discusses the role of the concussion specialist on the sidelines during athletic competition and examines the current tools and resources available for the sidelines assessment of concussion. Additionally, new technologies, including electronic applications for Smartphones and tablets, as well as future directions in sidelines assessment of concussion are examined.
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Traumatic brain injury is the leading cause of death and disability in the world for adolescents according to the World Health Organization. Sports-related concussion is a small but perhaps one of the most preventable causes of that morbidity. Legislation to protect student athletes is one of the ways in which we can advocate for safety in sports. ⋯ This history is viewed from the point of view of one of the participants in the efforts to pass laws in all 50 states. The key provisions of the Zackery Lystedt Law include (1) education for parents, athletes, and coaches; (2) immediate removal from play during a game or practice, after a suspected concussion with no return to play until (3); (3) written clearance by a concussion expert for return to play; and (4) uniformity of rules for all schools who use public land. Last, the nature of this legislative process, which included attorneys, legislators, and physicians, demonstrated that effective collaboration of local, state, and national leaders can address a critical public health challenge such as concussion affecting student athletes.