Closed Head Injuries in Athletes

Abstract

Nervous system sports-related injuries constitute a major source of serious morbidity and mortality in athletes. In particular, acute closed head injuries account for some 6000 potentially preventable deaths and literally millions of episodes of less severe head injuries each year. The long-term significance of chronic head injuries resulting from repetitive blows to the brain is only now being fully appreciated. Similarly subtle neuropsychological changes are being increasingly recognized resulting from milder head injuries. Although head injuries are almost inevitable and unavoidable sequelae of most contact and competitive sports, much can and should be done to reduce the serious acute and chronic neurologic complications inherent in these activities. Prevention of catastrophic sports injuries by careful preseason examination, education, training, and conditioning, and ongoing counseling of the athlete is of paramount importance. The use of carefully fitted protective headgear, and avoidance of maneuvers that may directly result in serious head injuries are also key. The immediate evaluation, evacuation, and triage of the injured athlete must take place carefully and expeditiously. Skillful, experienced, and compassionate definitive care must then ensue. In the long term, the complications and analysis of accurate statistical data on the magnitude of sports injuries in general, and nervous system involvement in particular, must be studied. Presently, only a few sports have accumulated such data, such as in the National Football Head and Neck Injury Registry. In the final analysis, it is the cooperative responsibility of the medical and athletic communities to strive to reduce these tragic injuries.