This document discusses the history of concussions and second impact syndrome in high school athletics. It covers several key points:
- Concussions were first described in football in the early 1900s and strategies were developed to monitor injured players.
- There are several misconceptions about concussions, such as only occurring in certain sports or requiring loss of consciousness. In reality, they can occur in many sports and without LOC.
- The condition of second impact syndrome was defined in the 1980s, where a second concussion before symptoms of an initial one resolve can have catastrophic results, including death.
- Incidence rates of concussions have been studied across many sports using different data sources, with wide
11. Cerebral Concussion Concussion is caused by a variety of mechanisms: Contact with an opponent (64%) Contact with a teammate (17%) Contact with ground (10%) Contact with objects on field (4%) Most concussions caused by poor technique Guskiewicz et al, 2000
17. Ommaya Grading System for Concussion Grade 1 Confusion without amnesia (stunned) Grade 2 Amnesia without coma. Grade 3 Coma lasting less than 6 hours (includes classic cerebral concussion, minor and moderate head injuries) Grade 4 Coma lasting 6-24 hours (severe head injuries) Grade 5 Comas lasting more than 24 hours (sever head injuries) Grade 6 Coma, death within 24 hours (fatal injuries) From Ommaya AK. Biomechanics of Head Injury: Experimental Aspects . In Nahum AM, Melvin J (eds): Biomedics of Trauma. Appleton & Lange, 1985, pp 245 -269
18. Colorado Medical Society Grading System for Concussion Grade 1 Confusion without amnesia; no loss of consciousness Grade 2 Confusion with amnesia; no loss of consciousness Grade 3 Loss of consciousness From report of the Sports Medicine Committee. Guidelines for the management of concussion in sports. Colorado Medical Society, 1991
31. Concussion + secondary insult day 1-7, = cell death or while still symptomatic Secondary Insults Include a second brain injury hypotension loss of autoregulation ischemia increased intracranial pressure anoxia
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39. "To know what you know and to know what you don’t know, that is knowledge” Confucius (551-479 BC)
46. Concussion Definition Symptom Breakdown Objectively Observable by Coach or Trainer Loss of Consciousness Seizure Loss of Balance Syncope “ Ding” Near-syncope Dazed Personality Change Stunned Drowsiness “ Fogginess” Visual Loss Amnesic period Headache Blurred Vision Dizziness Lethargy Light-headed Fatigue Unsteadiness Cognitive Dysfunction Tinnitus Hearing Loss Double Vision Probably Only Known by Player
47. Concussion Observation Across Sports Basketball Flow of Game Football Distance From Players Collisions View of Face Changes in Behavior Intermittent > 20 yards Too many to monitor Hidden by helmet Less visible More continuous < 10 yards Rare Unobstructed More visible The sport itself and the sport’s injury culture both affect reporting rates
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49. NCAA Game Concussion Rates by Sport 1998 vs. 2005- 2006 (Concussions/1000 exposures) 1998 Rate 2005 Rate Football (50) 2.6 3.1 Lacrosse (M) (20) 1.9 3.1 Ice Hockey (M) (20) 1.4 2.0 Lacrosse (W) (20) 0.8 2.0 Soccer (W) (20) 2.0 1.8 Ice Hockey (W) (20) 1.8 1.8 Soccer (M) (20) 1.3 1.4 Field Hockey (20) 0.8 0.9 Basketball (W) (10) 0.8 0.9 Basketball (M) (10) 0.4 0.4
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52. Traumatic Brain Injury Mod Mild Severe Severe GCS < 8 Moderate GCS 9 - 12 Mild GCS 13 - 15 Teasdale et al Lancet 1974; ii: 81-4 Sports concussion ? “ Minimal” Glasgow Coma Scale
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64. Above the Neck vs. Below the Neck Injured vs. hurt Always Injured
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66. Data Driven Cantu Revised Concussion Grading Guidelines Grade 1 No LOC* PTA ‡ /PCSS ‡‡ < 30 min (Mild) Grade 2 LOC <1 min or PTA > 30 min <24hrs, other (Moderate) PCSS >30 min <7days Grade 3 LOC > 1 min or PTA > 24 hrs, PCSS > 7 days (Severe) * Loss of consciousness ‡ Post-traumatic amnesia (antrograde/retrograde) ‡‡ Post-concussion sign/symptoms Cantu RC Post-tramatic (retrograde and anterograde) amnesia: pathophysiology and implications in grading and safe return to play. J of Athletic Training 36(3)244-248,2001 `
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68. Post Concussion Signs/Symptoms Checklist Bell rung Depression Dinged Dizziness Drowsiness Excess sleep Fatigue Feel “in a fog” Feel “slow down” Headache Inappropriate emotions or personality change Irritability Loss of consciousness Loss of orientation Memory problems Nausea Nervousness Numbness/Tingling Poor balance or coordination Poor concentration, easily distracted Ringing in the ears Sadness Seeing stars Sensitivity to light Sensitivity to noise Sleep disturbance Vacant stare/glassy eyed Vomiting A PCSS checklist is used not only for the initial evaluation but for each subsequent follow-up assessment which is periodically repeated until all PCSS have cleared at rest and exertion..
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71. Relative Contraindication to Return to Play after Concussion Duration of post concussion symptoms progressively last longer (months not days) Mild indirect blows (not directly to head) produce post concussion symptoms.
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73. USA TODAY 9/24/02 “ Webster was diagnosed in 1999 as having brain damage caused by repeated head injuries during his playing days.” According to his doctors, several concussions damaged his frontal lobe causing cognitive dysfunction. His doctors said the progressively worsening injury caused him to behave erratically at times.” USA TODAY
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78. B). Benoit Micro 1: Slides detailing x600 magnification of Chris Benoit's Tau-immunostained neocortex showing Neurofibrillary Tangles, Neuritic Threads, and several Ghost Tangles indicating CTE. For media inquiries or further questions please contact: Patrick Brady Widmeyer Communications 202-256-7824 Rexy Legaspi Widmeyer Communications 646-213-7245
79. C). Benoit Micro 2: Slides detailing x600 magnification of Chris Benoit's Tau-immunostained neocortex showing Neurofibrillary Tangles, Neuritic Threads, and several Ghost Tangles indicating CTE. For media inquiries or further questions please contact: Patrick Brady Widmeyer Communications 202-256-7824 Rexy Legaspi Widmeyer Communications 646-213-7245
