Traumatic Brain Injury in Sports

Abstract

Few physicians realize the detriment and prevalence of head injury in the athlete. Due to the development of organized athletics with more standardized rules, which help to decide how head injury should be managed and when players should return to play, and due to the development of newer and better protective equipment, fatal and near-fatal head injuries have been declining. Still, mild traumatic brain injury or concussion is under-recognized and continues to have a significant impact on the future well-being of the athlete. Given the tremendous popularity of sports in the United States and the world, there are large numbers of athletes—competitive and recreational—who sustain mild traumatic brain injury. In 1997, The Centers for Disease Control and Prevention had already proclaimed that concussions had reached epidemic proportions in the United States. Further, there is accumulating evidence that mild traumatic brain injury, including sports-related concussion, may be more common and more devastating than previously considered. Traumatic brain injury (TBI) in sports is relatively uncommon occurrence that may be associated with significant morbidity and occasional mortality. Although TBI in sports is infrequent, certain contact/collision and high velocity sports have an increased risk of TBI (Table 2.1). There are several brain injury syndromes that can be encountered in sports. These include acute traumatic brain injury (ATBI), the second impact syndrome (SIS) and chronic traumatic brain injury (CTBI). ATBI represents the immediate effects of traumatic forces involving the brain, whereas CTBI represents the more long-term cumulative effects of traumatic forces to the brain. The SIS is a syndrome in which an athlete who sustains a second TBI while still symptomatic from an initial concussion and experiences malignant cerebral edema and herniation. These three categories of TBI are discussed in detail.