Vanderbilt Sports Concussion Center
Sports Concussion: Immediate, short- and long-term effects on the brain
Gary Solomon, Ph.D., FACPNAssociate Professor of Neurological Surgery, Psychiatry,
and Orthopaedic Surgery & RehabilitationCo-Director, Vanderbilt Sports Concussion Center
Team Neuropsychologist, Nashville PredatorsConsulting Neuropsychologist, Tennessee Titans
Vanderbilt Sports Concussion Center
• I receive consulting fees from the Nashville Predators and
Tennessee Titans.
• I am involved in beta testing a new version of ImPACT and receive free use of the test during the testing; I am a member of the ImPACT Professional Advisory Board and am reimbursed for travel expenses to Board meetings
• This presentation is not endorsed by any organization with which I am affiliated.
Disclosures/Competing Interests
Vanderbilt Sports Concussion Center
Objectives:
1. Overview of the brain
2. What happens in the brain during a concussion--- immediate, short, and long-term effects
3. How long it takes for the brain to recover from a concussion
4. Potential long-term effects a. Post-Concussion Syndrome (PCS) b. Chronic Traumatic Encephalopathy (CTE)
Vanderbilt Sports Concussion Center
Average Adult Human Brain
Weight = 1350 g (~3 lbs.)
Width = 140 mm (5.6”)
Length = 167 mm (6.68”)
Height = 93 mm (3.72”)
Brain = 2% of Total Body Weight
Average Adolescent Brain is Smaller
Vanderbilt Sports Concussion Center
We can think of the brain as a computer
it is composed of hardware (structure)
and software (function)
Vanderbilt Sports Concussion Center
Hardware (Structure) = brain tissue
Software (Function) = Electrical and chemical processes ongoing within the brain tissue that allows us to sense, think, feel, and act
Vanderbilt Sports Concussion Center
Sports related concussions rarely cause a hardware problem (structural injury)
When structural injuries do occur, they are usually due to tearing of a blood vessel (resulting in an epidural or subdural hematoma) or in some cases, tearing of nerve cells (traumatic axonal injury)
However, these structural injuries are extremely rare in sports.This is why the structural CT or MRI scan is normal 99+% of the time after a sports concussion
Sports concussion usually causes a disruption in brain function (software problem), which leads to the signs and symptoms described previously
The disruption in brain function hasbeen termed “the chemical cascade”
Vanderbilt Sports Concussion Center
The Chemical Cascade of Concussion
Blood flow to the brain is reduced immediately after a concussion
The brain operates on 2 kinds of fuel: glucose and oxygen
The brain gets glucose and oxygen from the blood supply
But because the brain is getting less blood flow after a concussion, the brain is not getting the typical amount of fuel (energy)
The difference between the energy the brain is getting and what the brain needs to operate fully results in an energy crisis and the symptoms
Vanderbilt Sports Concussion Center
PET Scans in Head Injury (Glucose)
Marvin Bergsneider, M.D., and David Hovda, Ph.D.UCLA School of Medicine
Vanderbilt Sports Concussion Center
fMRI Scan (Oxygen)
Drs. Mark Lovell and Micky Collins University of Pittsburgh Medical Center
Drs. Victoria Morgan and Megan Strother, Vanderbilt
Vanderbilt Sports Concussion Center
The short term effects of concussion are age- andpossibly gender dependent
Younger athletes take longer to recover than older athletes, probably because the brain is not fully developed physically until about age 23
Many studies have indicated that females may take longer to recover than males, although a recent VSCC study did not support this
Other factors affecting the duration and intensity of symptoms after a concussion can include concussion history and co-existing disorders such as ADHD, learning disabilities, sleep disorders, psychiatric illness, and migraine headaches
Vanderbilt Sports Concussion Center
To get back to the computer analogy, when we have a software problem, we usually shut down the computer and re-boot it.
After a concussion the brain typically repairs (re-boots) itself.
But how long does it take?
Vanderbilt Sports Concussion Center
First, there is no FDA-approved medication for concussion, although many drugs are used to treat the symptoms of concussion
In general and on average, the short term effects of concussion resolve within: 7 days for professional athletes 7-10 days for collegiate athletes 7-14 days for high school athletes 7-21 days for younger athletes
>90% of athletes with sport-related concussions recover within a month
Vanderbilt Sports Concussion Center
Second Impact Syndrome (SIS)
However, if an athlete does not recover fully from an initial concussion and sustains another concussion before the first has cleared completely, then he may be at risk for Second Impact Syndrome (SIS)
SIS is a very rare condition and typically occurs in teen aged males
SIS has never been reported in females or in professional athletes
SIS occurs when an athlete sustains an initial concussion that is unrecognized, not reported, or has not fully healed
Vanderbilt Sports Concussion Center
The brain remains in a vulnerable state from the initial concussion (energy crisis)
The athlete then sustains a second concussion which causes additional chemical changes in the brain that lead to severe brain swelling
The brain is encased in a hard skull and can only expand within certain limits
SIS usually results in permanent disability or death
Vanderbilt Sports Concussion Center
__________________________________________________________Effective January 1, 2014
Vanderbilt Sports Concussion Center
Sports Concussion: Long Term Effects
Post-Concussion Syndrome (PCS)
Chronic Traumatic Encephalopathy (CTE)
Vanderbilt Sports Concussion Center
Post-Concussion Syndrome (PCS)
The term was first used by an article by Strauss and Savitsky in 1934
Multiple definitions abound and vary somewhat, but all involve a constellation of symptoms after a blow to the head
Symptoms common to most definitions include a persistence of the initial concussion symptoms, including headaches, dizziness, fatigue, irritability, forgetfulness, poor concentration, blurred vision, sensitivity to light and noise, frustration, sleep disturbance, difficulty thinking, nausea, depression, increased emotionality
The diagnosis is made anywhere from 6 weeks to 3 months post-injury
Vanderbilt Sports Concussion Center
Most of the scientific research on PCS has been done on civilians, and more recently, on military personnel experiencing blast injuries Studies of PCS in athletes are now being conducted
In general, less than 10% of athletes are diagnosed with PCS
Most of these athletes recover within 6-12 months, although there is a small group that remains symptomatic longer
PCS typically involves multiple factors and usually requiresa multi-disciplinary treatment approach
Vanderbilt Sports Concussion Center
Chronic Traumatic Encephalopathy (CTE)
Punch-Drunk Syndrome: Martland, 1928, JAMA
Vanderbilt Sports Concussion Center
CTE has receive a resurgence of interest due to several professional athletes (especially football players) being diagnosed with CTE after death
The current definitions of CTE are somewhat different but common elements include the appearance of a tau protein in brain tissue, found on autopsy
Mood, behavioral, and cognitive changes occur priorto death
Vanderbilt Sports Concussion Center
CTE is an evolving area of study and merits close scientific investigation with well designed, well controlled research
CTE, like most neurodegenerative disorders, is a multi-faceted brain disease that involves a variety of genetic, athletic exposure, and lifestyle factors
Vanderbilt Sports Concussion Center
“…a cause and effect relationship has not yet been demonstrated between CTE and concussions or exposureto contact sports.”
Vanderbilt Sports Concussion Center
Thanks to all of you for being here today, and
special thanks to Rawlings for their support
Top Related