1
|
Pedrosa M, Martins B, Araújo R. It's in the game: A review of neurological lesions associated with sports. J Neurol Sci 2023; 455:122803. [PMID: 37995461 DOI: 10.1016/j.jns.2023.122803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/24/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
INTRODUCTION The practice of sports may lead to neurological injuries. While relatively uncommon (overall incidence of approximately 2.5%), and mostly benign and transient, some conditions may be life-threatening and permanent. Thus, both clinical neurologists and sports physicians should be aware of their existence and relevance. We aimed to review all sports-related neurological injuries and illnesses reported in the literature. METHODS Following SANRA guidelines, we performed a narrative review and searched PubMed and Scopus databases. Relevant sports were selected based on their recognition as an Olympic sport by the International Olympic Committee. Chronic traumatic encephalopathy (CTE) and other neurodegenerative disorders were not included. RESULTS A total of 292 studies were included concerning 33 different sports. The most reported neurological injury was damage to the peripheral nervous system. Traumatic injuries have also been extensively reported, including cerebral haemorrhage and arterial dissections. Non-traumatic life-threatening events are infrequent but may also occur, e.g. posterior reversible encephalopathy syndrome, cerebral venous thrombosis, and arterial dissections. Some conditions were predominantly reported in specific sports, e.g. yips in baseball and golf, raising the possibility of a common pathophysiology. Spinal cord infarction due to fibrocartilaginous embolism was reported in several sports associated with minor trauma. CONCLUSION Sports-related neurological injuries are increasingly receiving more social and medical attention and are an important cause of morbidity and mortality. This review may serve as a guide to physicians managing these challenging situations.
Collapse
Affiliation(s)
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Rui Araújo
- Neurology Department, Centro Hospitalar Universitário de São João, E.P.E., Porto, Portugal; Clinical Neuroscience and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
2
|
Abed V, Hawk GS, Akarakian R, Stone AV. Epidemiological analysis of concussions in youth ice hockey players: A national emergency room database study. Am J Emerg Med 2023; 67:130-134. [PMID: 36871481 DOI: 10.1016/j.ajem.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE To evaluate the epidemiology of concussions in youth ice hockey players. METHODS The National Electronic Injury Surveillance System (NEISS) database was used to gather data. Concussions occurring during ice hockey participation in youth patients (4-21 years old) from 2012 to 2021 was gathered. Concussion mechanisms were grouped into 7 categories: head-to-player, head-to-puck, head-to-ice, head-to-board/glass, head-to-stick, head-to-goal post, and unknown. Hospitalization rates were also tabulated. Linear regression models were used to assess changes in yearly concussion and hospitalization rates over the study period. Results from these models were reported using parameter estimates [with 95% confidence intervals (CI)] and the estimated Pearson correlation coefficient. Additionally, logistic regression was used to model the risk of hospitalization across the different cause categories. RESULTS A total of 819 ice hockey related concussions were analyzed between 2012 and 2021. The average age of our cohort was 13.4 years, with 89.3% (n = 731) of concussions occurring in males. The incidence of head-to-ice, head-to-board/glass, head-to-player, and head-to-puck concussion mechanisms decreased significantly over the study period (slope estimate = -2.1 concussions/year [CI: (-3.9, -0.2)], r = -0.675, p = 0.032), (slope estimate = -2.7 concussions/year [CI: (-4.3, -1.2)], r = -0.816, p = 0.004), (slope estimate = -2.2 concussions/year [CI: (-3.4, -1.0)], r = -0.832, p = 0.003), and (slope estimate = -0.4 concussions/year [CI: (-0.62, -0.09)], r = -0.768, p = 0.016), respectively. Majority of patients were discharged from the emergency department (ED) to their home, as only 20 people (2.4%) were hospitalized over our study period. The majority of concussions were due to head-to-ice (n = 285, 34.8%), followed by head-to-board/glass (n = 217, 26.5%) and head-to-player (n = 207, 25.3%). The most common cause for hospitalizations due to concussions was head-to-board/glass (n = 7, 35%), followed by head-to-player (n = 6, 30%) and head-to-ice (n = 5, 25%). CONCLUSION The most common mechanism of youth ice hockey concussions was head-to-ice in our 10-year study period, while head-to-board/glass was the most common cause of hospitalizations. IRB: This project did not require review by the institutional review board.
Collapse
Affiliation(s)
- Varag Abed
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, United States of America.
| | - Gregory S Hawk
- Department of Statistics, University of Kentucky, United States of America.
| | - Roy Akarakian
- Department of Emergency Medicine, Keck School of Medicine of USC, United States of America.
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, United States of America.
| |
Collapse
|
3
|
Al-Husseini A, Fazel Bakhsheshi M, Gard A, Tegner Y, Marklund N. Shorter recovery time in concussed elite ice hockey players by early head-and-neck cooling - a clinical trial. J Neurotrauma 2022. [PMID: 36222612 DOI: 10.1089/neu.2022.0248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A sports-related concussion (SRC) is most commonly sustained in contact sports, and is defined as a mild traumatic brain injury. An exercise-induced elevation of core body temperature is associated with increased brain temperature that may accelerate secondary injury processes following SRC, and exacerbate the brain injury. In a recent pilot study, acute head-neck cooling of 29 concussed ice hockey players resulted in shorter time to return-to-play. Here, we extended the clinical trial to include players of 19 male elite Swedish ice hockey teams over 5 seasons (2016-2021). In the intervention teams, acute head-neck cooling was implemented using a head cap for ≥45 minutes in addition to the standard SRC management used in controls. The primary endpoint was time from SRC until return-to-play (RTP). Sixty-one SRCs were included in the intervention group and 71 SRCs in the control group. The number of previous SRCs was 2 (median and interquartile range (IQR): 1.0 - 2.0) and 1 (IQR 1.0 - 2.0) in the intervention and control groups, respectively; p= 0.293. Median time to initiate head-neck cooling was 10 min (IQR 7-15; range 5-30 min) and median duration of cooling was 45 min (IQR 45-50; range 45-70 min). The median time to RTP was 9 days in the intervention group (IQR 7-13.5 days) and 13 days in the control group (IQR 9-30; p<0.001). The proportion of players out from play for more than the expected recovery time of 14 days was 24.7% in the intervention group, and 43.7% in controls (p<0.05). Study limitations include that a) allocation to cooling or control management was at the discretion of the medical staff of each teams, decided prior to each season, and not by strict randomization, b) no sham cap was used and evaluations could not be performed by blinded assessors and c) it could not be established with certainty that injury severity was similar between groups. While the results should thus be interpreted with caution, early head-neck cooling, with the aim of attenuating cerebral hyperthermia, may reduce post-SRC symptoms and lead to earlier return-to-play in elite ice hockey players.
Collapse
Affiliation(s)
- Ali Al-Husseini
- Lund University, 5193, Department of Clinical Sciences, Neurosurgery, Lund, Sweden;
| | | | - Anna Gard
- Lund University, 5193, Department of Clinical Sciences Lund, Entregatan 7, Hisshall EA, plan 4, Lund, Lund, Skane, Sweden, 22242;
| | - Yelverton Tegner
- Luleå University of Technology, Division of Medical Sciences, Department of Health Sciences, Department of Health Sciences, Luleå, Sweden, SE 971 87;
| | - Niklas Marklund
- Lund University, 5193, Clinical Sciences, Neurosurgery, Klinikgatan 17B, Lund, Sweden, 221 85.,Skåne University Hospital Lund, 59564, Neurosurgery, Lund, Sweden, 221 85;
| |
Collapse
|
4
|
Gard A, Tegner Y, Bakhsheshi MF, Marklund N. Selective head-neck cooling after concussion shortens return-to-play in ice hockey players. Concussion 2021; 6:CNC90. [PMID: 34084556 PMCID: PMC8162197 DOI: 10.2217/cnc-2021-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We aimed to investigate whether selective head–neck cooling could shorten recovery after sports-related concussions (SRCs). In a nonrandomized study of 15 Swedish professional ice hockey teams, 29 concussed players received immediate head and neck cooling for ≥30 min (initiated at 12.3 ± 9.2 min post-SRC by a portable cooling system), and 52 SRC controls received standard management. Players receiving head–neck cooling had shorter time to return-to-play than controls (7 vs 12.5 days, p < 0.0001), and 7% in the intervention group versus 25% in the control group were out of play for ≥3 weeks (p = 0.07). Immediate selective head–neck cooling is a promising option in the acute management of SRC that should be addressed in larger cohorts.
Collapse
Affiliation(s)
- Anna Gard
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden
| | - Yelverton Tegner
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Mohammad Fazel Bakhsheshi
- Lund University, Family Medicine & Community Medicine, Lund, Sweden.,BrainCool AB, Medicon Village, Lund, Sweden
| | - Niklas Marklund
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden
| |
Collapse
|
5
|
Navarro SM, Pettit RW, Haeberle HS, Frangiamore SJ, Rahman NM, Farrow LD, Schickendantz MS, Ramkumar PN. Short-Term Impact of Concussion in the NHL: An Analysis of Player Longevity, Performance, and Financial Loss. J Neurotrauma 2018; 35:2391-2399. [DOI: 10.1089/neu.2017.5611] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Sergio M. Navarro
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Rowland W. Pettit
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Heather S. Haeberle
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | | | | | | | | | | |
Collapse
|
6
|
Yengo-Kahn AM, Zuckerman SL, Stotts J, Zalneraitis BH, Gardner RM, Kerr ZY, Solomon GS. Performance following a first professional concussion among National Basketball Association players. PHYSICIAN SPORTSMED 2016; 44:297-303. [PMID: 27294806 DOI: 10.1080/00913847.2016.1200956] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Basketball is a physical game played on a hardwood floor among high-jumping athletes at risk for injury. It is currently unknown how sport-related concussion (SRC) affects player performance after injury among professional basketball players. The objective of this study was to explore the impact of SRC on basketball performance among National Basketball Association (NBA) players. METHODS A retrospective, archival cohort study was performed that compared NBA player performance following concussion to pre-concussive performance. A comprehensive NBA injury database, compiled from publically available sources, was queried for NBA players who suffered concussion from 2005-06 to 2014-15 (10 seasons). Intra-and inter-player analyses were performed against a matched control group of players who missed playing time for personal reasons. RESULTS Following application of inclusion/exclusion criteria and a matching process, 51 concussed players and 51 control players were included in analysis. There were no statistically significant decrements in baseline to post-concussion performance metrics in intra-player or player vs. controls after 5 return games. CONCLUSIONS Our findings suggest that at the NBA level, an athlete's performance in the initial 5 games following injury does not suffer from the after-effects of concussive injury. These results may be useful in counseling professional athletes following a concussion.
Collapse
Affiliation(s)
- Aaron M Yengo-Kahn
- a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Scott L Zuckerman
- a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA.,b Department of Neurological Surgery , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Jeff Stotts
- c Department of Athletic Training , St. Vincent Health System , Little Rock , AR , USA
| | - Brian H Zalneraitis
- a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Ryan M Gardner
- a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Zachary Y Kerr
- d Datalys Center for Sports Injury Research and Prevention , Indianapolis , IN , USA
| | - Gary S Solomon
- a Vanderbilt Sports Concussion Center , Vanderbilt University School of Medicine , Nashville , TN , USA.,b Department of Neurological Surgery , Vanderbilt University School of Medicine , Nashville , TN , USA
| |
Collapse
|
7
|
Yengo-Kahn AM, Hale AT, Zalneraitis BH, Zuckerman SL, Sills AK, Solomon GS. The Sport Concussion Assessment Tool: a systematic review. Neurosurg Focus 2016; 40:E6. [DOI: 10.3171/2016.1.focus15611] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Over the last 2 decades, sport-related concussion (SRC) has garnered significant attention. Even with increased awareness and athlete education, sideline recognition and real-time diagnosis remain crucial. The need for an objective and standardized assessment of concussion led to the eventual development of the Sport Concussion Assessment Tool (SCAT) during the Second International Conference on Concussion in Sport in 2004, which is now in its third iteration (SCAT3). In an effort to update our understanding of the most well-known sideline concussion assessment, the authors conducted a systematic review of the SCAT and the evidence supporting its use to date.
METHODS
English-language titles and abstracts published between 1995 and October 2015 were searched systematically across 4 electronic databases and a review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines adapted for the review of a heterogeneous collection of study designs. Peer-reviewed journal articles were included if they reported quantitative data on any iteration of the SCAT, Standardized Assessment of Concussion (SAC), or modified Balance Error Scoring System (mBESS) data at baseline or following concussion in an exclusively athlete population with any portion older than 13 years of age. Studies that included nonathletes, only children less than 13 years old, exclusively BESS data, exclusively symptom scale data, or a non–SCAT-related assessment were excluded.
RESULTS
The database search process yielded 549 abstracts, and 105 full-text articles were reviewed with 36 meeting criteria for inclusion. Nineteen studies were associated with the SAC, 1 was associated with the mBESS exclusively, and 16 studies were associated with a full iteration of the SCAT. The majority of these studies (56%) were prospective cohort studies. Male football players were the most common athletes studied. An analysis of the studies focused on baseline differences associated with age, sex, concussion history, and the ability to detect an SRC.
CONCLUSIONS
Looking toward the upcoming Concussion in Sport Group meeting in fall 2016, one may expect further revision to the SCAT3. However, based on this systematic review, the authors propose further, in-depth study of an already comprehensive concussion test, with acute, diagnostic, as well as long-term use.
Collapse
Affiliation(s)
| | | | | | - Scott L. Zuckerman
- 1Vanderbilt Sports Concussion Center, and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Allen K. Sills
- 1Vanderbilt Sports Concussion Center, and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Gary S. Solomon
- 1Vanderbilt Sports Concussion Center, and
- 2Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|