Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population.
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Athletic concussion is a growing focus of attention for pediatricians. Although numerous literature reviews and clinical guidelines are now available pertaining to athletic concussion, few have focused on the pediatric athlete in particular. Sport-related concussions occur relatively frequently in children and adolescents, and primary health care providers are often responsible for coordinating clinical management. Here we summarize the scientific literature pertinent to the care of young athletes. We examine how concussion affects younger and older athletes differently at biomechanical, pathophysiological, neurobehavioral, and contextual levels. We also discuss important issues in clinical management, including preparticipation assessment, concussion evaluation and recovery tracking, and when and how to return pediatric athletes to play sports. We also briefly cover non-sport-related interventions (eg, school support). With proper management, most children and adolescents sustaining a sport-related concussion can be expected to recover fully. (+info)
Effectiveness of cerebral hemispherotomy for improving behavioral disorders associated with intractable post-traumatic seizures.
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A 25-year-old man presented with intractable post-traumatic seizures after suffering cerebral contusion in a traffic accident at age 5 years. Cerebral hemispherotomy was performed to transect the neuronal fibers to interrupt connections between seizure foci in wide areas of the brain, and to minimize the resected brain parenchyma. His seizures resolved and behavioral disorders improved, which had been impaired since age 8 years. Increased glucose metabolism in the normal frontal lobe detected by interictal fluorodeoxyglucose-positron emission tomography was correlated with the improvements in behavioral disorders. These findings suggest that the effects of seizures may be reversible in brain areas connected with, but remote from, the epileptogenic cortex. (+info)
Does history of concussion affect current cognitive status?
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The association between self reported history of concussion and current neurocognitive status is controversial. Some football studies suggest that athletes with a history of concussion display cognitive impairment relative to athletes with no history of concussion, but other studies have not been able to reproduce such findings. This study shows that there is no relation between the number of previous self reported episodes of concussion and current cognitive state, directly contradicting the findings of previous research. (+info)
Differences in the risk associated with head injury for pediatric ice skaters, roller skaters, and in-line skaters.
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OBJECTIVE: The goals were to describe the epidemiologic features of pediatric skating-related injuries sustained from 1993 to 2003 and to compare ice skating-related injuries with roller skating--and in-line skating-related injuries. METHODS: An analysis of pediatric skating-related injury data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission was performed. RESULTS: An estimated 1 235 467 pediatric skating participants presented to hospital emergency departments with injuries between 1993 and 2003. These children had a mean age of 10.9 years (SD: 3.2 years; range: 1-18 years), and 50.0% were male. The most common mechanism of injury was a fall (83.1%). Ice skaters sustained a greater proportion of head injuries (13.3%), compared with roller skaters (4.4%) and in-line skaters (5.0%). Ice skaters also experienced a greater proportion of concussions (4.3%), compared with roller skaters (0.6%) and in-line skaters (0.8%). The proportion of facial injuries among ice skaters was greater than the proportions among roller skaters and in-line skaters. The majority of roller skating-and in-line skating-related injuries were upper-extremity fractures (53.9% and 59.7%, respectively). Children < or = 6 years of age experienced a greater proportion of head and facial injuries than did older children in each skating activity. CONCLUSIONS: The epidemiologic features of pediatric ice skating-related injuries differ from those of roller skating--and in-line skating-related injuries. Children should wear helmets during all recreational skating activities, especially ice skating, because of the risk of serious head injuries. Wrist guards should be worn to protect against the common upper-extremity fractures sustained during skating. (+info)
Reliable change assessment with practice effects in sport concussion research: a comment on Hinton-Bayre.
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In his comments on our previous article, Hinton-Bayre advocates the use of the regression based approach in most cases of determining reliable change. This article comments on Hinton-Bayre's argument, discusses cases where the regression method might not be the preferred method, and presents adjustments that make the method more generally preferable. (+info)
Concussion history is not a predictor of computerised neurocognitive performance.
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BACKGROUND: The long term effects of self reported concussion on neurocognitive functioning have been found to be variable. OBJECTIVES: To evaluate cognitive performance on the Headminder concussion resolution index (CRI) and ImPACT assessment tests of subjects with and without a history of self reported concussion. METHODS: A retrospective analysis was completed on 235 Headminder CRI baseline assessments and 264 ImPACT baseline assessments. Participants were divided into four groups on the basis of reported number of concussions (zero, one, two, or three). Multivariate analysis of variance was used to evaluate differences between the concussion history groups on the two computer based concussion assessment programs. RESULTS: Multivariate analysis of variance indicated no significant difference between those with and without a history of concussion on the CRI (Lambda = 0.963, F((15, 627.05)) = 0.57, p = 0.898). It also revealed no significant differences between groups on the ImPACT test (Lambda = 0.951, F((12, 672.31)) = 1.07, p = 0.381). CONCLUSIONS: The results suggest that either long term cognitive decrements may not be associated with a history of concussion or the decrements may be subtle and undetectable by these computer programs. (+info)
Sex differences in baseline neuropsychological function and concussion symptoms of collegiate athletes.
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OBJECTIVE: To investigate sex differences in baseline neuropsychological function and concussion symptoms between male and female collegiate athletes. METHODS: A post-test only design was used to examine baseline neuropsychological test scores and concussion symptoms. A total of 1209 NCAA Division I collegiate athletes from five northeastern universities in the USA completed a baseline ImPACT test. ImPACT, a computerised neuropsychological test battery, was administered during an athlete's pre-season. RESULTS: Female athletes performed significantly better than male athletes on baseline verbal memory scores (p = 0.001), while male athletes performed significantly better than female athletes on baseline visual memory scores (p = 0.001). Female athletes endorsed a significant number of mild baseline symptoms as compared to male athletes. CONCLUSIONS: Male and female athletes exhibit differences on baseline neuropsychological test performance and concussion symptoms. (+info)
A nodular calcification of the alar ligament simulating a fracture in the craniovertebral junction.
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We report a case of an incidental nodular calcification of the alar ligament simulating a fracture in the craniovertebral junction of a previously healthy 24-year-old man. Three-dimensional CT and MR imaging revealed a 7.2 x 7.6 x 4.0 mm nodular calcification in the right alar ligament with normal adjacent bony structures. Serial cervical dynamic radiographs and open-mouth views showed that the cervical spine was stable without any change in the calcification. (+info)