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Concussion

  • Author: David T Bernhardt, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Jul 25, 2016
 

Practice Essentials

Concussion, or mild traumatic brain injury (MTBI), is common among contact and collision sports participants.[1, 2, 3, 4, 5, 6, 7] One definition of concussion is a condition in which there is a traumatically induced alteration in mental status, with or without an associated loss of consciousness (LOC).[1] A broader definition is a traumatically induced physiologic disruption in brain function that is manifested by LOC, memory loss, alteration of mental state or personality, or focal neurologic deficits.

See Pediatric Concussion and Other Traumatic Brain Injuries, a Critical Images slideshow, to help identify the signs and symptoms of TBI, determine the type and severity of injury, and initiate appropriate treatment.

Also, see the Common Pediatric Sports and Recreational Injuries slideshow to help recognize some of the more common injuries and conditions associated with pediatric recreational activities.

Signs and symptoms

An athlete suffering from an MTBI may demonstrate the following:

  • Confusion: Athletes with an MTBI often appear acutely with a confused or blank expression or blunted affect
  • Delayed responses and emotional changes: Delayed response to simple questioning may be demonstrated, along with emotional lability; the emotional lability may become more evident as the athlete attempts to cope with his or her confusion
  • Pain/dizziness: Many athletes report an associated headache and dizziness
  • Visual disturbances: Visual complaints may include seeing stars, blurry vision, or double vision
  • Amnesia: Pretraumatic (retrograde) and posttraumatic (antegrade) amnesia may be present; usually, the duration of retrograde amnesia is quite brief, while the duration of posttraumatic amnesia is more variable (lasting seconds to minutes), depending upon the injury
  • Signs of increased intracranial pressure: A history of persistent vomiting may suggest a significant brain injury with associated elevated intracranial pressure; other signs of increased intracranial pressure include worsening headache, increasing disorientation, and a changing level of consciousness

Physical examination

The physical examination should include assessment of the following:

  • Appearance: The initial clinical examination should include a careful inspection of the athlete's general appearance
  • Head and neck: Palpating the head and neck is important when looking for an associated skull or cervical injury
  • Facial bones: Palpate the facial bones and the periorbital, mandibular, and maxillary areas after any head trauma
  • Jaws: Open and close the mouth to help in the evaluation of possible temporomandibular joint (TMJ) pain, malocclusion, or mandibular fracture
  • Nose: Inspect the nose for deformity and tenderness, which may indicate a possible nasal fracture
  • Presence of discharge: Persistent rhinorrhea or otorrhea (clear) indicates a possible associated skull fracture.
  • Vision: Perform a careful, detailed neurologic examination that includes evaluation of the visual fields, extraocular movements, pupillary reflexes, and level of the eyes
  • Strength and sensation: Assess upper-extremity and lower-extremity strength and sensation
  • Coordination and balance: Concussed patients often have difficulty with the finger-nose-finger test and will use slow, purposeful movements to complete the task

Postconcussive syndrome

Postconcussive syndrome consists of prolonged symptoms that are related to the initial head injury. Symptoms usually consist of the following:

  • Persistent, recurrent headaches
  • Dizziness
  • Memory impairment
  • Loss of libido
  • Ataxia
  • Sensitivity to light and noise
  • Concentration and attention problems
  • Depression
  • Anxiety

See Clinical Presentation for more detail.

Diagnosis

Imaging

The following imaging studies can be used in the examination of head injury (Note: Although the following studies may be useful in the evaluation of head trauma, they will be negative for a concussion with no other injury.):

  • Computed tomography scanning: CT scanning continues to be the imaging study of choice for evaluating acute head injury
  • Magnetic resonance imaging: MRI is the imaging study of choice for patients who have prolonged symptoms (>7 days) or when a late change occurs in an individual's neurologic signs or symptoms

Although positron emission tomography (PET) scanning and functional MRI (fMRI) may be used in evaluating patients with concussion, their clinical application in most cases of MTBI is uncertain.[8, 9, 10]

Neuropsychological testing

Detailed neuropsychologic testing is employed more often at the professional level and in research in athletes with MTBI.

See Workup for more detail.

Management

Most patients with MTBI recover in 48-72 hours, even with detailed neuropsychological testing, and are headache free within 2-4 weeks of the injury.

A clinical report by the American Academy of Pediatrics (AAP) on the diagnosis and management of sports-related concussions in adolescents and children noted the following[11] :

  • Cognitive and physical rest is the mainstay of management of patients with concussion
  • Ongoing neuropsychological testing is a helpful tool during management

Although several different guidelines regarding return to play have been established, the main criteria for an athlete's return to play after a concussion include the following:

  • Complete clearing of all symptoms
  • Complete return of all memory and concentration
  • No symptoms after provocative testing: Provocative testing includes jogging, sprinting, sit-ups, or pushups (ie, exercise that raises the athlete's blood pressure and heart rate)

Davis and Purcell have released an assessment of the evaluation and management of acute concussion in young children.[12]

In 2013, the American Academy of Neurology issued updated guidelines for the evaluation and management of sports concussion.[13]

See Treatment and Medication for more detail.

Next

Background

Concussion has many different meanings to patients, families, and physicians.[1, 14, 15, 16] One definition of concussion is a condition in which there is a traumatically induced alteration in mental status, with or without an associated loss of consciousness (LOC).[1] A broader definition for concussion is a traumatically induced physiologic disruption in brain function that is manifested by LOC, memory loss, alteration of mental state or personality, or focal neurologic deficits.[1] Concussions usually result in relatively temporary impairment of neurologic function.[8, 16, 17]

Concussion or mild traumatic brain injury (MTBI) is common among most contact and collision sports participants.[1, 2, 3, 4, 5, 6, 7] For many physicians, even those who specialize in MTBI, this area is confusing due to the paucity of scientific evidence to support much of the clinical decision making that is faced in the office.[4, 9, 14, 15, 18] The inconsiderable amount of good scientific research in the area of MTBI is due to problems with ambiguous definitions of concussion, inconsistent criteria when selecting patients to study, variability of injury mechanisms and locations, and differing means of measuring cognitive function.[19, 20] The purpose of this article is to review the epidemiology and diagnosis (but not necessarily the classification) of MTBI, as well as the role of imaging studies, issues regarding return to play, and complications surrounding MTBI.

For patient education information, see the Back, Ribs, Neck, and Head Center, Brain and Nervous System, and Dementia Center, as well as Concussion, Head Injury, and Dementia in Head Injury.

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Epidemiology

Frequency

United States

The incidence of head injury varies with the sport and the age of the participants; many head injuries are likely unreported due to their supposed mild nature; mild concussions may go unnoticed by teammates, coaches, and even the athletes themselves.[1] An athlete's fear of medical disqualification may also lead to underreporting. Studies of high school athletes show the rate of concussions per 1000 exposures as follows: 0.59 for football (boys), 0.25 for wrestling (boys), 0.18 for soccer (boys; 0.23 for girls), 0.09 for field hockey (girls), and 0.11 for basketball (boys; 0.16 for girls). The data from one study noted that concussions account for nearly 15% of all sport-related injuries in high school athletes.[21]

Among National Collegiate Athletic Association (NCAA) soccer players, the rate of injury has been reported as 0.4-0.6 per 1000 athlete exposures[6] ; 72% of these injuries were described as mild and were almost always secondary to direct contact with an opponent. None of the injuries in this group of Atlantic Coast Conference (ACC) soccer players was noted to be a direct result of heading the ball. In contrast, boxing is the sport with the highest rate of head injuries and has more deaths than any other organized athletic activity. At the professional level, many of the boxing bouts end with a technical knockout (ie, brain injury).

Sports activities that place the athlete at high risk for a head injury include boxing, football, ice hockey, wrestling, rugby, and soccer. Physicians and other allied health providers who are responsible for the medical care of such contact or collision sports participants should be adept at evaluating, treating, and making playability decisions related to the short- and long-term consequences of an injury to the brain.

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Sport-Specific Biomechanics

The mechanisms of brain injury may differ among sports activities. Possible mechanisms of injury include compressive forces, which may directly injure the brain at the point of contact (coup); tensile forces produce injury at the point opposite the injury (contrecoup) because the axons and nerves are stretched; finally, rotational forces may result in a shearing of axons. Therefore, the direct force at the point of contact may not be solely responsible for the severity of an injury if a high rotational component with a significant shear effect occurs.

All of the different mechanisms may result in biochemical changes related to perfusion, energy demand, and utilization at the site of injury that are not well understood. At this time, it is unclear whether any experimental animal model or human studies on more severe brain-injured patients accurately reflect the pathophysiology of the typical mild traumatic alteration in brain function.

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Contributor Information and Disclosures
Author

David T Bernhardt, MD Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics/Ortho and Rehab, Division of Sports Medicine, University of Wisconsin School of Medicine and Public Health

David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Joseph P Garry, MD, FACSM, FAAFP Associate Professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

Joseph P Garry, MD, FACSM, FAAFP is a member of the following medical societies: American Academy of Family Physicians, American Medical Society for Sports Medicine, Minnesota Medical Association, American College of Sports Medicine

Disclosure: Nothing to disclose.

References
  1. Kelly JP, Nichols JS, Filley CM, et al. Concussion in sports. Guidelines for the prevention of catastrophic outcome. JAMA. 1991 Nov 27. 266(20):2867-9. [Medline].

  2. Moser RS, Iverson GL, Echemendia RJ, et al. Neuropsychological evaluation in the diagnosis and management of sports-related concussion. Arch Clin Neuropsychol. 2007 Dec. 22(8):909-16. [Medline].

  3. Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery. 2005 Oct. 57(4):719-26; discussion 719-26. [Medline].

  4. Powell JW, Barber-Foss KD. Traumatic brain injury in high school athletes. JAMA. 1999 Sep 8. 282(10):958-63. [Medline]. [Full Text].

  5. Pieter W, Zemper ED. Head and neck injuries in young taekwondo athletes. J Sports Med Phys Fitness. 1999 Jun. 39(2):147-53. [Medline].

  6. Boden BP, Kirkendall DT, Garrett WE Jr. Concussion incidence in elite college soccer players. Am J Sports Med. 1998 Mar-Apr. 26(2):238-41. [Medline].

  7. Cantu RC. Second-impact syndrome. Clin Sports Med. 1998 Jan. 17(1):37-44. [Medline].

  8. Ptito A, Chen JK, Johnston KM. Contributions of functional magnetic resonance imaging (fMRI) to sport concussion evaluation. NeuroRehabilitation. 2007. 22(3):217-27. [Medline].

  9. Henninger N, Sicard KM, Li Z, et al. Differential recovery of behavioral status and brain function assessed with functional magnetic resonance imaging after mild traumatic brain injury in the rat. Crit Care Med. 2007 Nov. 35(11):2607-14. [Medline].

  10. Kirov I, Fleysher L, Babb JS, et al. Characterizing 'mild' in traumatic brain injury with proton MR spectroscopy in the thalamus: Initial findings. Brain Inj. 2007 Oct. 21(11):1147-54. [Medline].

  11. Halstead ME, Walter KD,. American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents. Pediatrics. 2010 Sep. 126(3):597-615. [Medline].

  12. Davis GA, Purcell LK. The evaluation and management of acute concussion differs in young children. Br J Sports Med. 2013 Apr 23. [Medline].

  13. Giza CC, Kutcher JS, Ashwal S, Barth J, Getchius TS, Gioia GA, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013 Mar 18. [Medline].

  14. Slobounov S, Cao C, Sebastianelli W, Slobounov E, Newell K. Residual deficits from concussion as revealed by virtual time-to-contact measures of postural stability. Clin Neurophysiol. 2007 Dec 6. epub ahead of print. [Medline].

  15. Pearce JM. Observations on concussion: a review. Eur Neurol. 2007 Nov 30. 59(3-4):113-9. [Medline].

  16. Lee LK. Controversies in the sequelae of pediatric mild traumatic brain injury. Pediatr Emerg Care. 2007 Aug. 23(8):580-3; quiz 584-6. [Medline].

  17. Capruso DX, Levin HS. Cognitive impairment following closed head injury. Neurol Clin. 1992 Nov. 10(4):879-93. [Medline].

  18. McCrea M, Guskiewicz KM, Marshall SW, et al. Acute effects and recovery time following concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19. 290(19):2556-63. [Medline]. [Full Text].

  19. Bigler ED. Neuropsychology and clinical neuroscience of persistent post-concussive syndrome. J Int Neuropsychol Soc. 2008 Jan. 14(1):1-22. [Medline].

  20. McCrea M, Kelly JP, Kluge J, Ackley B, Randolph C. Standardized assessment of concussion in football players. Neurology. 1997 Mar. 48(3):586-8. [Medline].

  21. Meehan WP 3rd, d'Hemecourt P, Collins CL, Comstock RD. Assessment and management of sport-related concussions in United States high schools. Am J Sports Med. 2011 Nov. 39(11):2304-10. [Medline].

  22. Ruhe A, Gansslen A, Klein W. The incidence of concussion in professional and collegiate ice hockey: are we making progress? A systematic review of the literature. Br J Sports Med. 2013 May 3. [Medline].

  23. Melville NA. Athletes with vestibular symptoms after concussion at risk. Medscape Medical News. June 3, 2013. [Full Text].

  24. De Beaumont L, Lassonde M, Leclerc S, Theoret H. Long-term and cumulative effects of sports concussion on motor cortex inhibition. Neurosurgery. 2007 Aug. 61(2):329-36; discussion 336-7. [Medline].

  25. Guskiewicz KM, Marshall SW, Bailes J, et al. Recurrent concussion and risk of depression in retired professional football players. Med Sci Sports Exerc. 2007 Jun. 39(6):903-9. [Medline].

  26. Guskiewicz KM, McCrea M, Marshall SW, et al. Cumulative effects associated with recurrent concussion in collegiate football players: the NCAA Concussion Study. JAMA. 2003 Nov 19. 290(19):2549-55. [Medline]. [Full Text].

  27. McCrory PR, Berkovic SF. Second impact syndrome. Neurology. 1998 Mar. 50(3):677-83. [Medline].

  28. McCrea M, Kelly JP, Randolph C, et al. Standardized assessment of concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil. 1998 Apr. 13(2):27-35. [Medline].

  29. Young CC, Jacobs BA, Clavette K, Mark DH, Guse CE. Serial sevens: not the most effective test of mental status in high school athletes. Clin J Sport Med. 1997 Jul. 7(3):196-8. [Medline].

  30. Moser RS, Schatz P, Neidzwski K, Ott SD. Group versus individual administration affects baseline neurocognitive test performance. Am J Sports Med. 2011 Nov. 39(11):2325-30. [Medline].

  31. McCrory P, Johnston K, Meeuwisse W, et al. Summary and agreement statement of the 2nd International Conference on Concussion in Sport, Prague 2004. Br J Sports Med. 2005 Apr. 39(4):196-204. [Medline].

  32. Lynall RC, Mauntel TC, Padua DA, Mihalik JP. Acute Lower Extremity Injury Rates Increase following Concussion in College Athletes. Med Sci Sports Exerc. 2015 Jun 8. 16 (1):33-7. [Medline].

  33. Cantu RC. Second impact syndrome. Phys Sports Med. 1992. 20(9):55-66.

  34. Ommaya AK, Gennarelli TA. Cerebral concussion and traumatic unconsciousness. Correlation of experimental and clinical observations of blunt head injuries. Brain. 1974 Dec. 97(4):633-54. [Medline].

  35. Colorado Medical Society School and Sports Medicine Committee. Guidelines for the management of concussion in sports. Colo Med. 1990. 87:4.

  36. American Academy of Neurology. Practice parameter: the management of concussion in sports (summary statement). Report of the Quality Standards Subcommittee. Neurology. 1997 Mar. 48(3):581-5. [Medline].

  37. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. CDC tool kit on concussion for high school coaches. February 2005. [Full Text].

  38. Sullivan SJ, Schneiders AG, McCrory P, Gray AR. Physiotherapists' use of information in identifying a sports concussion: an extended Delphi approach. Br J Sports Med. 2007 Nov 29. epub ahead of print. [Medline].

  39. Lovell MR, Iverson GL, Collins MW, McKeag D, Maroon JC. Does loss of consciousness predict neuropsychological decrements after concussion?. Clin J Sport Med. 1999 Oct. 9(4):193-8. [Medline].

  40. Aligene K, Lin E. Vestibular and balance treatment of the concussed athlete. NeuroRehabilitation. 2013 Jan 1. 32(3):543-53. [Medline].

  41. Catena RD, van Donkelaar P, Chou LS. Different gait tasks distinguish immediate vs. long-term effects of concussion on balance control. J Neuroeng Rehabil. 2009 Jul 7. 6:25. [Medline]. [Full Text].

  42. Hughes S. Vision Test Improves Concussion Detection. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821495. Accessed: March 10, 2014.

  43. Placeholder.

  44. Delaney JS, Al-Kashmiri A, Drummond R, Correa JA. The effect of protective headgear on head injuries and concussions in adolescent football (soccer) players. Br J Sports Med. 2007 Jul 5. epub ahead of print. [Medline].

  45. McGuine T, Nass S. Football Helmet Fitting Errors in Wisconsin High School Players: Safety in American Football. West Conshohocken, Pa: American Society for Testing and Materials; 1997. 83-8.

  46. Castellani RJ. Chronic traumatic encephalopathy: A paradigm in search of evidence?. Lab Invest. 2015 Jun. 95 (6):576-84. [Medline].

  47. Diseases and conditions: chronic traumatic encephalopathy. Mayo Clinic. Available at http://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/basics/definition/con-20113581. Accessed: Sep 22, 2015.

  48. What is CTE?. BU CTE Center. Available at http://www.bu.edu/cte/about/what-is-cte/. Accessed: Sep 22, 2015.

  49. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009 Jul. 68 (7):709-35. [Medline].

  50. Hanna J, Goldschmidt D, Flower K. 87 of 91 tested ex-NFL players had brain disease linked to head trauma. CNN. Available at http://www.cnn.com/2015/09/18/health/nfl-brain-study-cte/. Sep 20, 2015;

  51. Breslow JM. 87 Deceased NFL Players Test Positive for Brain Disease. Available at http://www.pbs.org/wgbh/pages/frontline/sports/concussion-watch/new-87-deceased-nfl-players-test-positive-for-brain-disease/. Sep 18, 2015;

  52. Jeret JS, Mandell M, Anziska B, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery. 1993 Jan. 32(1):9-15; discussion 15-6. [Medline].

  53. Stein SC, Ross SE. Mild head injury: a plea for routine early CT scanning. J Trauma. 1992 Jul. 33(1):11-3. [Medline].

  54. Strauss SB, Kim N, Branch CA, Kahn ME, Kim M, Lipton RB, et al. Bidirectional Changes in Anisotropy Are Associated with Outcomes in Mild Traumatic Brain Injury. AJNR Am J Neuroradiol. 2016 Jun 9. [Medline].

  55. Anderson P. Neuroimaging May Predict Recovery After Mild TBI. Medscape Medical News. Available at http://www.medscape.com/viewarticle/866419#vp_2. July 21, 2016; Accessed: July 25, 2016.

  56. Papa L, Brophy GM, Welch RD, Lewis LM, Braga CF, Tan CN, et al. Time Course and Diagnostic Accuracy of Glial and Neuronal Blood Biomarkers GFAP and UCH-L1 in a Large Cohort of Trauma Patients With and Without Mild Traumatic Brain Injury. JAMA Neurol. 2016 May 1. 73 (5):551-60. [Medline].

  57. Hughes S. Concussion Biomarker Useful Up to 7 Days After Injury. Medscape Medical News. Available at http://www.medscape.com/viewarticle/862864. May 04, 2016; Accessed: July 25, 2016.

  58. Jeffrey S. AAN Releases New Sports Concussion Guidelines. Available at http://www.medscape.com/viewarticle/780973. Accessed: March 25, 2013.

  59. Boggs W. Acute Concussion Evaluation Tools Improve Adherence to Management Recommendations. Medscape Medical News. Available at http://www.medscape.com/viewarticle/821832. Accessed: March 24, 2014.

  60. Zuckerbraun NS, Atabaki S, Collins MW, Thomas D, Gioia GA. Use of Modified Acute Concussion Evaluation Tools in the Emergency Department. Pediatrics. 2014 Mar 10. [Medline].

  61. Kirkwood MW, Peterson RL, Connery AK, Baker DA, Grubenhoff JA. Postconcussive Symptom Exaggeration After Pediatric Mild Traumatic Brain Injury. Pediatrics. 2014 Mar 10. [Medline].

  62. Osterweil N. Mood Disorders Linked to Lingering Concussion Effect in Kids. Medscape Medical News. Oct 24 2014. [Full Text].

  63. Anderson P. Hyperbaric Oxygen No Better Than Sham After Concussion. Medscape Medical News. Nov 26 2014. [Full Text].

  64. Miller RS, Weaver LK, Bahraini N, et al. Effects of Hyperbaric Oxygen on Symptoms and Quality of Life Among Service Members With Persistent Postconcussion Symptoms: A Randomized Clinical Trial. JAMA Intern Med. 2014 Nov 17. [Medline].

  65. Brooks M. Analgesic Overuse May Fuel Persistent Headache After Concussion. Medscape Medical News. Available at http://www.medscape.com/viewarticle/813762. Accessed: November 12, 2013.

  66. Hughes S. Brain Injury Lingers at Least 4 Months After Concussion. Medscape Medical News. Nov 26 2013. [Full Text].

  67. Ling JM, Klimaj S, Toulouse T, et al. A prospective study of gray matter abnormalities in mild traumatic brain injury. Neurology. 2013 Nov 20. [Medline].

  68. Eisenberg MA, Andrea J, Meehan W, Mannix R. Time interval between concussions and symptom duration. Pediatrics. 2013 Jun 10. [Medline].

  69. MacReady N. Concussion: Kids' Symptoms May Linger and Change Over Time. Medscape Medical News. Available at http://www.medscape.com/viewarticle/824976. Accessed: May 22, 2014.

  70. Eisenberg MA, Meehan WP 3rd, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014 Jun. 133(6):999-1006. [Medline].

  71. American Academy of Neurology. Position Statement On Sports Concussion. October 2010. Accessed November 14, 2010. [Full Text].

  72. Broglio SP, Puetz TW. The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis. Sports Med. 2008. 38(1):53-67. [Medline].

  73. Brooks M. New Position Statement on Sport-Related Concussion. Medscape Medical News. Jan 17 2013. [Full Text].

  74. Chaput G, Giguere JF, Chauny JM, Denis R, Lavigne G. Relationship among subjective sleep complaints, headaches, and mood alterations following a mild traumatic brain injury. Sleep Med. 2009 Aug. 10(7):713-6. [Medline].

  75. Covassin T, Schatz P, Swanik CB. Sex differences in neuropsychological function and post-concussion symptoms of concussed collegiate athletes. Neurosurgery. 2007 Aug. 61(2):345-50; discussion 350-1. [Medline].

  76. Croall ID, Cowie CJ, He J, et al. White matter correlates of cognitive dysfunction after mild traumatic brain injury. Neurology. 2014 Jul 16. [Medline].

  77. Dave Singh G, Maher GJ, Padilla RR. Customized mandibular orthotics in the prevention of concussion/mild traumatic brain injury in football players: a preliminary study. Dent Traumatol. 2009 Jul 9. epub ahead of print. [Medline].

  78. Deibert E. Concussion and the neurologist: A work in progress. Neurology. 2014 Jul 9. [Medline].

  79. Dhawan P, Starling A, Tapsell L, et al. King-Devick test identifies symptomatic concussion in real-time and asymptomatic concussion over time [abstract S11.003]. Presented at: American Academy of Neurology (AAN) 66th Annual Meeting; April 29, 2014; Philadelphia, Pa. [Full Text].

  80. Fazio VC, Lovell MR, Pardini JE, Collins MW. The relation between post concussion symptoms and neurocognitive performance in concussed athletes. NeuroRehabilitation. 2007. 22(3):207-16. [Medline].

  81. Harmon KG, Drezner J, Gammons M, Guskiewicz K, Halstead M, Herring S, et al. American medical society for sports medicine position statement: concussion in sport. Clin J Sport Med. 2013 Jan. 23(1):1-18. [Medline].

  82. Heegaard W, Biros M. Traumatic brain injury. Emerg Med Clin North Am. 2007 Aug. 25(3):655-78, viii. [Medline].

  83. Hughes S. DTI Shows Brain Changes in Mild Head Injury. Medscape Medical News. Jul 28 2014. [Full Text].

  84. Hughes S. New ethical guidelines on managing sports concussion. Medscape Medical News. July 9, 2014. [Full Text].

  85. Hughes S. Vision test improves concussion detection. Medscape Medical News. April 29, 2014. [Full Text].

  86. Kelly JP, Rosenberg JH. Diagnosis and management of concussion in sports. Neurology. 1997 Mar. 48(3):575-80. [Medline].

  87. Kennedy JE, Jaffee MS, Leskin GA, et al. Posttraumatic stress disorder and posttraumatic stress disorder-like symptoms and mild traumatic brain injury. J Rehabil Res Dev. 2007. 44(7):895-920. [Medline].

  88. Kiraly M, Kiraly SJ. Traumatic brain injury and delayed sequelae: a review--traumatic brain injury and mild traumatic brain injury (concussion) are precursors to later-onset brain disorders, including early-onset dementia. ScientificWorldJournal. 2007. 7:1768-76. [Medline].

  89. Kirschen MP, Tsou A, Bird Nelson S, Russell JA, Larriviere D. Legal and ethical implications in the evaluation and management of sports-related concussion. Neurology. 2014 Jul 9. [Medline].

  90. Lau BC, Kontos AP, Collins MW, Mucha A, Lovell MR. Which On-field Signs/Symptoms Predict Protracted Recovery From Sport-Related Concussion Among High School Football Players?. Am J Sports Med. 2011 Nov. 39(11):2311-8. [Medline].

  91. Lew HL, Thomander D, Chew KT, Bleiberg J. Review of sports-related concussion: Potential for application in military settings. J Rehabil Res Dev. 2007. 44(7):963-74. [Medline].

  92. Lewis R. Repeated concussions may mean slower recovery in adolescents. Medscape Medical News. June 10, 2013. [Full Text].

  93. Lovell MR, Pardini JE, Welling J, et al. Functional brain abnormalities are related to clinical recovery and time to return-to-play in athletes. Neurosurgery. 2007 Aug. 61(2):352-9; discussion 359-60. [Medline].

  94. Ono K, Wada K, Takahara T, Shirotani T. Indications for computed tomography in patients with mild head injury. Neurol Med Chir (Tokyo). 2007 Jul. 47(7):291-7; discussion 297-8. [Medline]. [Full Text].

  95. Piebes SK, Gourley M, Valovich McLeod TC. Caring for student-athletes following a concussion. J Sch Nurs. 2009 Aug. 25(4):270-81. [Medline].

  96. Simpson G, Tate R. Suicidality in people surviving a traumatic brain injury: prevalence, risk factors and implications for clinical management. Brain Inj. 2007 Dec. 21(13):1335-51. [Medline].

  97. Ventura R, Marinides Z, Galetta S, Clugston J, Balcer L. Vision testing is additive to the sideline assessment of sports-related concussion [abstract S19.006]. Presented at: American Academy of Neurology (AAN) 66th Annual Meeting; April 29, 2014; Philadelphia, Pa. [Full Text].

  98. Wojtys EM, Hovda D, Landry G, et al. Current concepts. Concussion in sports. Am J Sports Med. 1999 Sep-Oct. 27(5):676-87. [Medline].

  99. Zemper E. Relative risk of cerebral concussion in football [abstract]. Paper presented at: Annual Meeting of the American College of Sports Medicine; June 1-5, 1999; Seattle, Washington.

 
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