00:01
Let's talk about each of the categories
of TBI, mild, moderate and severe.
00:06
Mild TBI may be as mild as a
concussion we call mild TBI concussion.
00:10
Common clinical symptoms
include headache,
dizziness, poor
concentration, and insomnia.
00:16
We can also see other symptoms, emotional
mood lability, irritability symptoms,
visual disturbances,
decreased appetite.
00:25
And mild TBI can range
from mild symptoms
immediately after the injury
that resolves rapidly,
or symptoms that persist for a short
period of time, 1-2 weeks typically.
00:38
In terms of our evaluation
of mild TBI or concussion,
neuroimaging is not
required for those patients,
particularly in mild TBI patients who are
asymptomatic or neurologically normal.
00:48
So that clinical exam, the sporting
exam or immediately after a fall,
or after a motor vehicle accident is
critical in evaluating those patients.
00:58
In patients who do have underlying
symptoms or neurologic abnormalities,
imaging is important in the
evaluation of those patients.
01:05
And treatment really begins
with removing the patient
from potential
furthering of harm,
whether that be a motor
vehicle or an at risk situation
or a sporting event or
those sorts of things.
01:19
What about sports-related TBI?
Let's talk about that just a minute
as it gets a lot of interest.
01:25
This is simply a TBI like any other but the
mechanism here is a sports-related process.
01:31
Sports-related concussion
is like other TBI.
01:33
So we're going to use the
information we just talked about
to think about this setting.
01:38
This is the clinical syndrome
of biomechanically induced
alteration of brain function as a result
of an injury during a sporting event.
01:47
Typically affects things like memory,
orientation, mood, and dizziness,
may involve some level
of loss of consciousness
depending on the severity of
the sports-related trauma.
01:59
What are some of the risk factors
for a sports-related concussion?
I want you to think about a
number of different areas.
02:05
First is the sport.
02:06
High contact sports have a
higher risk of concussions.
02:10
So we think about those with
football, rugby, hockey or soccer.
02:14
But any sporting event where
there can be injury to the head
potentially puts a person or a
patient at risk for concussion.
02:22
What about gender?
Differences in risk between
men and women athletes
have not been demonstrated universally
in the vast majority of sports.
02:30
And so there's an equal
risk in both men and women.
02:33
The issue is the
sports-related event
as opposed to the underlying
gender of the individual.
02:39
There is some exceptions
with soccer and basketball
where there's some strong evidence
to suggest that the risk is greater
in female athletes
in these sports.
02:48
And then lastly, and most
importantly, prior concussion.
02:52
So history of
concussion or a mild TBI
is a significant risk factor
for additional concussions.
02:58
And so we really need to look
at the lifetime of that athlete
as we're evaluating both before each season
of play and longitudinally over time.
03:07
We want to evaluate a
patient with concussion,
but also consider the lifetime of
their risk during that sporting event.
03:16
A second concussion and significant
brain injury is more likely to occur
within 10 days after
a prior concussion.
03:23
And this is really important,
that second hit second injury that we
talked about after a traumatic event
is at much higher
risk in patients
who have recently experienced
an initial concussion
within the first 10 days.
03:35
And so we really want to
avoid the potential of factors
that could contribute to concussion
within the first 1-2 weeks
after a patient who has suffered
sports-related concussion or mild TBI.
03:50
And then equipment use of
helmet reduces the risk
but does not eliminate
the risk of concussion.
03:54
It's really the type of action
that is contributing to concussion.
03:58
Helmets are important.
03:59
We need to wear them in sports-related
and nonsports-related activities
where the brain could be injured
and they do reduce the risk,
but obviously do
not eliminate it.
04:10
And then how about age or competition
level or position in a sport?
There's really not evidence to say that
age, competition, level or position
increased the risk substantially
of a sports-related concussion.
04:24
And interestingly,
patients during practice,
such as football practice
sustain more micro head injuries,
small subconcussive injuries that over
the lifetime of a sporting activity
can contribute to long
term brain changes,
then some of those major hits
that we may see in a game
or actual professional activity.
04:47
How do we evaluate patients?
CT imaging, as we've talked about
is important in evaluating TBI
and can be used and can be necessary for
patients with sports-related concussion.
04:58
But it's not required
particularly in patients
who have a mild traumatic brain
injury or mild concussion.
05:04
Imaging can be obtained to
rule out more serious TBI
or associated injuries such as intracranial
hemorrhage or an open skull fracture.
05:14
And this is particularly
important for patients
who have evidence of prolonged
loss of consciousness,
posttraumatic amnesia
or persistent alteration
in mental status focal
neurologic deficits
or impairment in their
Glasgow Coma Scale.
05:28
When should athletes
return to play?
Athletes should be prohibited
from returning to play or practice
until a licensed
healthcare professional
has judged that the concussion
has completely resolved.
05:41
And we're really looking at symptoms,
we're looking at symptoms at rest,
we're looking at symptoms
that at activity
to guide us on whether the
concussion has completely resolved
both cognitive,
emotional and physical symptoms
are important to evaluate
in these patients.
05:57
Individuals supervising athletes
should prohibit the athlete
with concussion from
returning to play or practice
until the athlete is completely
asymptomatic and off medications.
06:07
And that's really important as we
stratify their risk of a second injury
and the safety in
returning to play.
06:14
In cases of athletes in high school age or
younger who are diagnosed with concussion,
they really should be managed more
conservatively regarding return to play.
06:23
And this is important to be evaluated
by a licensed healthcare professional.
06:30
What's the role of the physician,
the neurologist or other physicians
in evaluating these patients in return
and determining or assisting with
return to play guidance?
Neurologist may be helpful
in supplementing information
and evaluation of
these patients,
particularly in conducting
neurocognitive testing
or neurologic examination and can assist
in determining concussion resolution.
06:53
We're looking for
symptom resolution,
which a detailed neurologic
exam can help to guide.
06:59
We counsel athletes with a
history of multiple concussions
and persistent
neurobehavioral impairments
about the risk of long
term and permanent injury
which is important in
counseling these patients.