Sports-related Head Injuries Research Articles

Assessment of Sports Concussion in Female Athletes: A Role for Neuroinformatics?

Over the past decade, the intricacies of sports-related concussions among female athletes have become readily apparent. Traditional clinical methods for diagnosing concussions suffer limitations when applied to female athletes, often failing to capture subtle changes in brain structure and function. Advanced neuroinformatics techniques and machine learning models have become invaluable assets in this endeavor. While these technologies have been extensively employed in understanding concussion in male athletes, there remains a significant gap in our comprehension of their effectiveness for female athletes. With its remarkable data analysis capacity, machine learning offers a promising avenue to bridge this deficit. By harnessing the power of machine learning, researchers can link observed phenotypic neuroimaging data to sex-specific biological mechanisms, unraveling the mysteries of concussions in female athletes. Furthermore, embedding methods within machine learning enable examining brain architecture and its alterations beyond the conventional anatomical reference frame. In turn, allows researchers to gain deeper insights into the dynamics of concussions, treatment responses, and recovery processes. This paper endeavors to address the crucial issue of sex differences in multimodal neuroimaging experimental design and machine learning approaches within female athlete populations, ultimately ensuring that they receive the tailored care they require when facing the challenges of concussions. Through better data integration, feature identification, knowledge representation, validation, etc., neuroinformaticists, are ideally suited to bring clarity, context, and explainabilty to the study of sports-related head injuries in males and in females, and helping to define recovery.

Do high-risk head trauma sports athletes have impaired vestibular function?

PurposeThe primary aim of this study was to examine the vestibular function of athletes involved in high-risk head trauma sports by means of complete vHIT testing of all six semicircular canals (SCCs). The secondary objective was to investigate whether the vestibular function is significantly reduced among athletes within certain high-risk sports. MethodsA prospective cross-sectional study of 137 adult athletes in football, handball, boxing, horseback riding, and ice hockey with a minimum of one reported sports-related head injury within the past five years. All subjects underwent screening with a complete examination of all six SCCs with vHIT and fulfillment of the dizziness handicap inventory (DHI). ResultsTwo subjects (1.5 %) fulfilled the criteria of having a pathological vHIT. Some degree of impairment of the vestibular function was seen when data was divided into individual sports and time since the last head injury. Likewise, no subjective dizziness was seen in the group of athletes when evaluated by total DHI scores. This score did not differ significantly between groups when subgrouped into number of head injuries or time since the last head injury. When divided into type of sport, total DHI scores differed significantly between groups. These total DHI-scores did, however, all fall within the range of the “no dizziness handicap” classification. ConclusionThe results suggest that the vestibular function of athletes in high-risk head trauma sports is unaffected by the practice of a high-risk head trauma sport. Therefore, vHIT has no clinical utility in the assessment of a sports-related concussion (SRC) in athletes with no subjective feeling of dizziness.

Bone Marrow Failure Associated with Short Telomeres and Digenic Variants of Uncertain Significance in Telomere Biology Genes

DISCUSSION Telomere Biology Disorders (TBD) are a group of heritable disorders characterized by abnormally short telomeres. There are at least 15 genes associated with TBD including ACD, CTC1, DKC1, NHP2, NOP10, PARN, POT1, RTEL1, STN1, TERC, TERT, TINF2, WRAP53 NAF1 and ZCCHC8, which can be inherited in autosomal dominant (AD), autosomal recessive (AR), or X-linked recessive patterns. Genetic anticipation has been described in some families with more severe symptoms appearing in each successive generation. We report two patients that presented with bone marrow failure, who were subsequently identified to have short telomeres and variants of uncertain significance (VUS) in two different telomere genes inherited from their parents. These cases suggest a potential for digenic inheritance of TBD. CASE 1: At age 6, patient was diagnosed with stage 4 neuroblastoma. He was treated with chemotherapy, surgery, immunotherapy, and autologous stem cell rescue. At age 10, he developed frequent and severe epistaxis and was found to have pancytopenia. He underwent a bone marrow aspirate and biopsy which revealed a hypocellular marrow and der (1;7), which is associated with myelodysplastic syndrome (MDS). Genetic evaluation revealed one pathogenic variant in DNAJC21 (from father) and VUS in NAF1 (c.1375C>T) (from father) and RTEL1 (c.533T>C) (from mother). Because NAF1 and RTEL1 are related to AD or AR TBD, telomere length testing was performed. Patient was found to have low telomere length, < 1st percentile, in granulocytes, lymphocytes, memory T cells and NK cells (Figure 1). The patient's mother was found to have borderline low telomere length >=1 and <10 th percentiles in her lymphocytes, naïve T cells, memory T cells, and B cells, and low telomere length in her granulocytes. Father had borderline low telomere length >=1 and <10 th percentiles in granulocytes but normal telomere length in all other subsets. Neither parent reported any symptoms that would be consistent with TBD. We interpreted these findings as consistent with the patient having TBD and the patient's mother either also having TBD or being a carrier, and the potential that genetic anticipation may be involved. The NAF1 variant appears likely to be benign as father's telomeres were normal in length except for low telomere length in his granulocyte compartment. It is possible that the patient's prior treatment for neuroblastoma may have contributed to the shortened telomeres. Over the course of a year, patient developed worsening bone marrow failure. He then underwent reduced intensity conditioning using busulfan, fludarabine and anti-thymocyte globulin for a 4/6 matched cord stem cell transplant. He engrafted on day +10. CASE 2: A 15-year-old male presented with a depressed skull fracture and scalp hematoma following a sports-related head injury. He was incidentally found to have a platelet count of 69 x 10 3/microliter, mild anemia with macrocytosis, and mild leukopenia. Bone marrow biopsy revealed a hypocellular marrow with multilineage maturation, mild fibrosis, and no cytogenetic abnormalities. The patient's telomere lengths were low, below the 1 st percentile, in all 6 white blood cell subsets (Figure 2). He underwent clinical trio exome sequencing along with his parents. He was found to have VUSs in TERT (c.3158-80G>A) (from mother), TINF2 (c.814T>C) (from mother) and SRP72 (c.1928C>T) (from father). Mother was also found to have low telomere length (<1 st percentile) in all 6 subsets. Both parents have normal blood counts while patient continues to have pancytopenia and is transfusion independent. It is presently unclear which of the VUSs are contributing to the patient's phenotype as the TERT and TINF2 variants are both associated with bone marrow failure and heterozygous germline variants in SRP72 is associated with familial MDS. Genes that cause TBD can be inherited through various modes of inheritance. These two patients who presented with bone marrow failure, identified to have VUSs in more than one TBD-associated genes and functional evidence of shortened telomeres, highlight the potential for a digenic mode of inheritance underlying TBD. Synergy between two variants contributes to a penetrant phenotype and can result in earlier or more severe onset of disease. Our patients' parents were asymptomatic or mildly affected, compared to our patients. Larger cohort studies are needed to determine the prevalence of this mode of inheritance.

Concussion in Kids

Abstract The incidence of concussions in kids has increased over the past decade. Concussions occur from blunt force trauma and are often caused by sports-related head injuries. Clinical presentation varies by individual, and symptoms typically resolve within a couple of weeks from the injury. Key domains for diagnosis, clinical presentation, and clinical management include somatic, cognitive, emotional, and sleep-related disturbances. Patient education is an essential component of care for concussion prevention and recovery. Pediatric nurses play a pivotal role in patient education and optimizing care for kids suffering from a concussion and associated complications. Most concussions resolve without complications over time, but with continued education and research, a mild traumatic brain injury will become less problematic through continued prevention methods and early diagnosis.

New Strategies Show Promise for Concussion

New Strategies Show Promise for Concussion

The biomechanical signature of loss of consciousness: computational modelling of elite athlete head injuries.

Sports related head injuries can cause transient neurological events including loss of consciousness and dystonic posturing. However, it is unknown why head impacts that appear similar produce distinct neurological effects. The biomechanical effect of impacts can be estimated using computational models of strain within the brain. Here, we investigate the strain and strain rates produced by professional American football impacts that led to loss of consciousness, posturing or no neurological signs. We reviewed 1280 National Football League American football games and selected cases where the team's medical personnel made a diagnosis of concussion. Videos were then analysed for signs of neurological events. We identified 20 head impacts that showed clear video signs of loss of consciousness and 21 showing clear abnormal posturing. Forty-one control impacts were selected where there was no observable evidence of neurological signs, resulting in 82 videos of impacts for analysis. Video analysis was used to guide physical reconstructions of these impacts, allowing us to estimate the impact kinematics. These were then used as input to a detailed 3D high-fidelity finite element model of brain injury biomechanics to estimate strain and strain rate within the brain. We tested the hypotheses that impacts producing loss of consciousness would be associated with the highest biomechanical forces, that loss of consciousness would be associated with high forces in brainstem nuclei involved in arousal and that dystonic posturing would be associated with high forces in motor regions. Impacts leading to loss of consciousness compared to controls produced higher head acceleration (linear acceleration; 81.5 g ± 39.8 versus 47.9 ± 21.4; P = 0.004, rotational acceleration; 5.9 krad/s2 ± 2.4 versus 3.5 ± 1.6; P < 0.001) and in voxel-wise analysis produced larger brain deformation in many brain regions, including parts of the brainstem and cerebellum. Dystonic posturing was also associated with higher deformation compared to controls, with brain deformation observed in cortical regions that included the motor cortex. Loss of consciousness was specifically associated with higher strain rates in brainstem regions implicated in maintenance of consciousness, including following correction for the overall severity of impact. These included brainstem nuclei including the locus coeruleus, dorsal raphé and parabrachial complex. The results show that in head impacts producing loss of consciousness, brain deformation is disproportionately seen in brainstem regions containing nuclei involved in arousal, suggesting that head impacts produce loss of consciousness through a biomechanical effect on key brainstem nuclei involved in the maintenance of consciousness.

A Very Unusual Case of Physical Disability after Spinal Epidural Hematoma in the Course of Sport-Related Head Injury

Spinal epidural hematoma (SEH) is blood accumulation between the dura mater of the spinal canal and the bone of the vertebrae. It is estimated to be an extremely rare incidence, affecting approximately 0.1 of 100,000 patients. When the suspected cause is a sport-related injury in the majority of cases it affects the trauma region. The aim of this case report was to outline the case of a 60-year-old man who was admitted to the Emergency Department due to acute, severe pain in the lumbar region which lasted 30 min. It occurred that 54 h prior to the admission, he suffered a head injury due to sport-related trauma during recreational skiing. When waiting for the laboratory and imaging test results the patient developed bilateral paralysis of the lower limbs. The MR examination results showed SEH at the level Th9-L1; therefore, immediate neurosurgical laminectomy was performed. After 36 months of rehabilitation, the patient can walk independently. In summary, SEH without immediate and appropriate treatment is linked with very poor clinical outcome. Moreover, a high mortality rate of 7% and the fact that more than half of patients do not return to full physical health incentives its inclusion in differential diagnosis every time when symptoms of spinal cord involvement are found. Furthermore, delayed aftermath in the form of paresis of the lower limbs requires long-term and intensive physical rehabilitation.

Sport-related head injuries: What is the burden on the radiology service? A single-centre experience

Sport-related head injuries: What is the burden on the radiology service? A single-centre experience

The measurement of neck strength: A guide for sports medicine clinicians

This masterclass aims to provide an overview of the measurement of neck strength and the factors which can increase the ecological validity of the testing protocol within an athletic population. Adopting a ‘gold standard’ method for measuring neck strength is of vital importance when determining strength differences across sports, ages and sexes. Without a ‘gold standard’ method current variations in testing procedure and equipment have created challenges in establishing normative neck strength data. With encouraging evidence that higher neck strength can have a protective effect against sports-related head and neck injuries, including concussion, new injury prevention knowledge may be impeded by a lack of consensus on how to accurately measure neck strength, with a number of different methods available. This masterclass will outline the factors clinicians should consider when selecting a device and measurement protocol when measuring maximal neck strength as well as how to interpret the results.

Athletic Training Educators' ConferenceApril 29–May 1, 2021

Athletic Training Educators' ConferenceApril 29–May 1, 2021

Use of a Simulation Model to Investigate the Mechanisms of Sports-related Head Injuries.

A simulation model was developed to better understand the mechanisms of brain injuries in sports. A three-dimensional model comprising approximately 1.22 million elements was constructed from cranial computed tomography images of adult male volunteers by the voxel method. To simulate contact sports that permit actions such as tackling, a sinusoidal wave with duration of 10 ms and maximum acceleration of 2000 m/s2 was applied to the lowest point of the model to apply rotational acceleration to the head from different directions. The von Mises stress was then observed at five points in the coronal plane of the brain: cingulate gyrus (CG), corpus callosum (CC), brain stem (BS), lateral temporal lobe (LT), and medial temporal lobe (MT). LS-DYNA universal finite element analysis software with explicit time integration was used for the analysis. Concentrations of stress started to appear in the CC and BS at 10 ms post-impact, after which they also became evident in the CG and MT. The maximum changes in stress at each location occurred 10–15 ms post-impact. The von Mises stress was 9–14 kPa in the CG, 8–24 kPa in the CC, 12–24 kPa in the BS, 7–12 kPa in the LT, and 12–18 kPa in the MT. The highest stress in every part of the brain occurred after lateral impact, followed by oblique impact and sagittal impact. Such simulations may help elucidate the mechanisms of brain injuries in sports and help develop measures to prevent chronic traumatic encephalopathy.

An Overview of the Effectiveness of Bicycle Helmet Designs in Impact Testing.

Cycling accidents are the leading cause of sports-related head injuries in the US. Conventional bicycle helmets typically consist of polycarbonate shell over Expanded Polystyrene (EPS) foam and are tested with drop tests to evaluate a helmet’s ability to reduce head kinematics. Within the last decade, novel helmet technologies have been proposed to mitigate brain injuries during bicycle accidents, which necessitates the evaluation of their effectiveness in impact testing as compared to conventional helmets. In this paper, we reviewed the literature to collect and analyze the kinematic data of drop test experiments carried out on helmets with different technologies. In order to provide a fair comparison across different types of tests, we clustered the datasets with respect to their normal impact velocities, impact angular momentum, and the type of neck apparatus. When we analyzed the data based on impact velocity and angular momentum clusters, we found that the bicycle helmets that used rotation damping based technology, namely MIPS, had significantly lower peak rotational acceleration (PRA) and Generalized Acceleration Model for Brain Injury Threshold (GAMBIT) as compared to the conventional EPS liner helmets (p < 0.01). SPIN helmets had a superior performance in PRA compared to conventional helmets (p < 0.05) in the impact angular momentum clustered group, but not in the impact-velocity clustered comparisons. We also analyzed other recently developed helmets that primarily use collapsible structures in their liners, such as WaveCel and Koroyd. In both of the impact velocity and angular momentum groups, helmets based on the WaveCel technology had significantly lower peak linear acceleration (PLA), PRA, and GAMBIT at low impact velocities as compared to the conventional helmets, respectively (p < 0.05). The protective gear with the airbag technology, namely Hövding, also performed significantly better compared to the conventional helmets in the analyzed kinematic-based injury metrics (p < 0.001), possibly due to its advantage in helmet size and stiffness. We also observed that the differences in the kinematic datasets strongly depend on the type of neck apparatus. Our findings highlight the importance and benefits of developing new technologies and impact testing standards for bicycle helmet designs for better prevention of traumatic brain injury (TBI).

Eight Weeks of Self-Resisted Neck Strength Training Improves Neck Strength in Age-Grade Rugby Union Players: A Pilot Randomized Controlled Trial.

Greater neck strength is associated with fewer head and neck injuries. Neck-strengthening programs are commonly burdensome, requiring specialist equipment or significant time commitment, which are barriers to implementation. Completing a neck-strengthening program will increase isometric neck strength in age-group rugby players. A pilot randomized controlled exercise intervention study. Level 2. Twenty-eight U18 (under 18) male regional age-group rugby union players were randomized (intervention n =15/control n = 13). An 8-week exercise program was supervised during preseason at the regional training center. Control players continued their "normal practice," which did not include neck-specific strengthening exercises. The 3-times weekly trainer-led intervention program involved a series of 15-second self-resisted contractions, where players pushed maximally against their own head, in forward, backward, left, and right directions. Peak isometric neck strength (force N) into neck flexion, extension, and left and right side flexion was measured using a handheld dynamometer. Postintervention between-group mean differences (MDs) in isometric neck strength change were adjusted for baseline strength and favored the intervention for total neck strength (effect size [ES] = 1.2, MD ± 95% CI = 155.9 ± 101.9 N, P = 0.004) and for neck strength into extension (ES = 1.0, MD ± 95% CI = 59.9 ± 45.4 N, P = 0.01), left side flexion (ES = 0.7, MD ± 95% CI = 27.5 ± 26.9 N, P = 0.05), and right side flexion (ES = 1.3, MD ± 95% CI = 50.5 ± 34.4 N, P = 0.006). This resource-efficient neck-strengthening program has few barriers to implementation and provides a clear benefit in U18 players' neck strength. While the present study focused on adolescent rugby players, the program may be appropriate across all sports where head and neck injuries are of concern and resources are limited. Greater neck strength is associated with fewer head and neck injuries, including concussion. Performing this neck exercise program independently, or as part of a whole-body program like Activate, an interactive guide for players and coaches, could contribute to lower sports-related head and neck injuries.

PIT2 Acute Care Costs of Pediatric Sports-Related Head Injuries in Australia: The Australasian Paediatric Head Injury Study (APHIRST)

Sports activities are a common cause of traumatic brain injury (TBI) in children. Annual costs of hospitalization for all sports-related injuries for children aged ≤16 years in Australia are approximately AU $40 million. We aimed to compare emergency department (ED) and hospital acute care costs for children with head injuries due to sports activities in Australia. This was a cost analysis of a multi-center prospective observational study of 17,841 children <18 years-old with head trauma. Sports-related head injuries were identified using the ICD-10-AM activity codes U50-U71. We stratified participants into two age-groups (younger: 5 to <12 years) and (older: 12 to <18 years). Taking a public-sector healthcare perspective, we applied costs from a single pediatric site to patient-level data and estimated acute care costs for ED visits and hospital admissions. All costs were inflated to 2018 Australian dollars ($). Total acute care costs for 2,812 children with sports-related head injuries were $2.7 million, and the average cost per episode was $954 (95%CI $832-$1,084). The younger age-group accounted for 44% of children and 38% of acute care costs ($1.0 million). Bicycle riding was the most common mechanism of head injury in the younger age-group and had the highest total acute care costs ($355,000), with an average cost per episode of $1,522 (95%CI $1,036-$2,008). Rugby was the most common head injury mechanism in older children, accounting for 10% of the cohort, 7.2% of total acute care costs ($192,000), and had an average cost of $682 (95% CI $564-$801). In the older age-group, skateboarding had the highest acute care costs ($430,000), with the average cost per episode of $3,797 (95% CI $1,082-$6,512). Sports-related trauma accounts for approximately 15% of pediatric head injuries and associated acute care costs in Australia. Injury prevention strategies should focus on targeted age-related mechanisms to reduce TBI in children.

Acute Subdural Hematoma in High School Rugby Players in Japan: The Importance of Playing Experience for Injury Prevention

Acute subdural hematoma (ASDH) is known to be devasting sport-related head injury but it is relatively rare in rugby compared with other contact sports. Certain cases of ASDH have happened in high school rugby players in Japan. To prevent them from the injury we report a background of the players. Data of high school rugby players who suffered ASDH were extracted from injury reports in the Japan Rugby Football Union between April 2004 and March 2020. The number of injured players, diagnosis on the report, school year, phase of play where the injury occurred, and playing career were analyzed. There were 30 cases of ASDH including 16 cases in the first year, 9 in the second year, and 5 in the third year of playing. Phase of play was mainly being tackled in 11 (37%), and tackling in 13 (43%). Novice players, defined as a player having less playing experience of rugby during junior high school, accounted for 77% of phase of tackling, 82% of being tackled. First year novice players accounted for 100% of phase of being tackled. Outcome within 6 months after injury was recovery in 14, morbidity in 6, mortality in 2, and unknown in8. Playing experience in high school rugby players should be considered as an important factor for prevention of ASDH-in particular, phase of being tackled is riskier than that of tackling for first year novice players.

Child participation in collision sports and football: what influences parental decisions?

ABSTRACT Objective Sport participation promotes health benefits for children. Current media and scientific coverage of sport-related head injury may influence a parent’s decision on sports participation. Physicians must understand what influences these decisions to effectively counsel patients and families. This study sought to better understand and quantify the parental decisions to allow/disallow collision sports, including football participation. Methods A 31-question survey related to child/parent demographics, sports history, and influences to allow/disallow sport participation was available to parents in the United States through a national volunteer registry, between November 2016 and September 2019. Pearson’s chi-squared and Wilcoxon’s signed-rank test were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression was performed to identify the most powerful factors associated with the decision. Results Of the 884 responses, 430 (49%) parents would disallow collision sport participation and 334 (38%) would disallow football. Parents who would allow collision sports more commonly cited child desire, while those parents who would disallow cited safety concern as the greatest influence to generally disallow a sport. Those who would disallow reported doctors (35.1% vs 25.3%; P = 0.002), media (12.8% vs 7.3%; P = 0.006) and other parents (11.2% vs 7.3%; P = 0.045) as influences. A child’s age (OR 1.039, 95%CI 1.007–1.073; P = 0.018) was independently associated with their parent responding that they would allow collision sports. Parent educational status showed that those with higher than a bachelor’s degree would be less likely to allow football participation (OR 0.635, 95%CI 0.443–0.910; P = 0.013). Conclusions Parents incorporate many sources of information into the decision to allow or disallow their child to participate in collision sports. A child’s desire to play a sport and child safety are driving factors for parents faced with the decision of whether to allow participation in collision sports. Physician input is more frequently influential to parents than the media, underscoring the responsibility of physicians to engage families on the risks, benefits, and resources available for sport participation.

Sport participation and related head injuries following craniosynostosis correction: a survey study.

Craniosynostosis (CS) affects about 1 in 2500 infants and is predominantly treated by surgical intervention in infancy. Later in childhood, many of these children wish to participate in sports. However, the safety of participation is largely anecdotal and based on surgeon experience. The objective of this survey study was to describe sport participation and sport-related head injury in CS patients. A 16-question survey related to child/parent demographics, CS surgery history, sport history, and sport-induced head injury history was made available to patients/parents in the United States through a series of synostosis organization listservs, as well as synostosis-focused Facebook groups, between October 2019 and June 2020. Sports were categorized based on the American Academy of Pediatrics groupings. Pearson's chi-square test, Fisher's exact test, and the independent-samples t-test were used in the analysis. Overall, 187 CS patients were described as 63% male, 89% White, and 88% non-Hispanic, and 89% underwent surgery at 1 year or younger. The majority (74%) had participated in sports starting at an average age of 5 years (SD 2.2). Of those participating in sports, contact/collision sport participation was most common (77%), and 71% participated in multiple sports. Those that played sports were less frequently Hispanic (2.2% vs 22.9%, p < 0.001) and more frequently had undergone a second surgery (44% vs 25%, p = 0.021). Only 9 of 139 (6.5%) sport-participating CS patients suffered head injuries; 6 (67%) were concussions and the remaining 3 were nondescript but did not mention any surgical needs. In this nationwide survey of postsurgical CS patients and parents, sport participation was exceedingly common, with contact sports being the most common sport category. Few head injuries (mostly concussions) were reported as related to sport participation. Although this is a selective sample of CS patients, the initial data suggest that sport participation, even in contact sports, and typically beginning a few years after CS correction, is safe and commonplace.

On–field management of sports–related head injuries

On–field management of sports–related head injuries

A Foundational "Survival Guide" Overview of Sports-Related Head Injuries.

Around 3.8 million traumatic brain injuries (TBI) occur every year from athletic participation. The signs and symptoms of each specific head injury can be difficult to delineate. Further, treatment for each injury varies significantly. While most sports-related head injuries are not life-threatening, prompt recognition of acute head injury with expedited care leads to better outcomes. Current medical education lacks in awareness of common sports-related head injuries and the acute management of these injuries. Due to this, a literature review was originally crafted to provide medical students with a brief education in the recognition, diagnosis, and acute management of sports-related head injuries. The objective is to provide a “survival guide” style of reference for medical students, but may also be useful for all primary care providers, first line responders, and athletic trainers. Current guidelines and primary studies were investigated to delineate common head injuries and their associated medical management. With this data, we developed a brief, overview regarding common head injuries that occur in sport-related activities. In addition to listing the most common brain injuries, we elaborate on how to develop acute care plans specific to each type of injury. The treatment plans could be enhanced via stratification into sex and age subcategories, as well as through studies including data regarding long-term observation.

A study on the usefulness of a new evaluation method using virtual reality for post-concussion dizziness

To clarify the effect of visual system on the post-concussion dizziness by using virtual reality system (VR). the post-concussion dizziness is most commonly reported and associated with prolonged symptom recovery. Therefore, the post-concussion dizziness is one of the most important issues. The study design was retrospective study. Facility is Toho University Ohashi Medical Center Neurosurgery Sports-related head injury clinic. The search period is April 2018 to February 2019. Inclusion criteria were as follows: 1) Sports-related head injury cases, 2) Physician-diagnosed Sports-related concussion, 3) Underwent evaluation by the same neurosurgeon, 4) More than 28 days continued follow-up. The examination items were as follows: 1) Age/sex, 2) Competition item, 3) The prediction score of persistent post concussive symptoms (PPCS) at the time of the first visit, 4) PPCS cases, 5) Reproducibility of symptoms by Virtual reality System, 6) The presence or absence of PPCS at the invasion after 60 days. Statistical analysis used t test. The 18 SRC participants (Group VR: GVR) were selected and matched with 18 healthy controls (Group HC: GHC). The average Age of both GVR and GHC was 23.1 (16-30) vs 21.7 (16-31) years. The most majority competition item of GVR was Rugby football. The prediction score of PPCS (Low: Medium: High) of both groups was the same as 10: 8: 0 (p > 0.05, no significant). PPCS cases of both GVR and GHC were 12 vs 18 (p 0.05, no significant). Our result suggests that a certain number of post-concussion dizziness cases that include visual system elements, leading to prolongation of symptoms if appropriate therapeutic intervention is not performed.