Sports Medicine: Just the Facts

CHAPTER 34 • NEUROLOGY 201

CONCUSSION

• Mild traumatic brain injury, or concussion, is a com-
  mon consequence of collisions, falls, and other forms
  of contact in sports. The rapid yet accurate determina-
  tion of which athletes require immediate emergency
  room evaluation may be critical to an athlete’s survival.


• The severity of an injury may not correlate with loss of
  consciousness in traumatic brain injury (Kushner, 2001).


• Second impact syndrome is typically seen in football
  players, hockey players, and boxers in whom a relatively
  minor blow to the head is followed within one week by
  a second concussive trauma incident. In the worst case
  scenario, the athlete undergoes rapid neurologic demise
  and death within hours of the second head injury.


• While various theories account for the cause of death in
  second-impact syndrome, it appears that the initial
  trauma causes a loss of vasomotor tone allowing for an
  increase in intracranial volume. Receiving a second
  minor head impact during this brief period of decreased
  intracranial compliance may cause diffuse and uncon-
  trollable cerebral edema and subsequent death.
  
  
  • Most guidelines for concussion classification and
    return to lay criterion classify concussions as Grade I,
    II, or III and require an athlete to be completely
    asymptomatic for some period of time prior to return-
    ing to competition (Tables 34-3, 34-4, 34-5).
  
  
  • The standardized assessment of concussion(SAC) is
    a simple, reproducible, and fast method of providing a
    gross measurement of mental status. The SAC evalu-
    ates orientation, immediate memory, concentration,
    and delayed memory recall (Johnston et al, 2001).
  
  
  
  

POSTCONCUSSIVE SYNDROME

• The most common symptoms of postconcussive syn-
  drome include headaches, dizziness, tinnitus, diplopia,
  blurred vision, irritability, anxiety, depression, fatigue,
  sleep disturbance, poor appetite, poor memory,
  impaired concentration, and slowed reaction times.


• Because the symptoms are so wide ranging and neu-
  rologic examination is usually normal, neuropsycho-
  logic testing and treatment is indicated in any

TABLE 34-2 Headache Medications for Athletes

CATEGORY/AGENT TRADE NAME ROUTE DOSING
Analgesics

Acetaminophen Tylenol Oral 325–1000 mg every 4–6 h as needed

Nonsteroidal Anti-Inflammatories
Aspirin Ecotrin Oral 325–650 mg every 4–6 h as needed
Ibuprofen Motrin, Advil Oral 400–800 mg every 8 h as needed
Naproxen Naprosyn, Anaprox, Alleve Oral 220–500 mg every 12 h as needed

Muscle Relaxants (Potential Sedating Effect)

Cyclobenzaprine Flexeril Oral 10 mg every 12 h as needed

Methocarbamol Robaxin Oral 500–1500 mg every 6 h as needed

Migraine Sedatives (Potential Sedating Effect)

Butalbital, Fioricet Oral One every 6 h as needed

Acetaminophen,

Caffeine

Butalbital, Fiorinal Oral One every 6 hours as needed

Aspirin,

Caffeine

Isometheptine, Midrin Oral Two at onset, then one per hour until headache relieved.

Dichloralphenazone,

Acetaminophen

Ergotamines
Ergotamine tartrate, Cafergot Oral Two at onset, then one per hour until headache relieved.
Caffeine
Dihydroergotamine Migranol Nasal Nasal One spray in each nostril, repeat in 15 min if needed.
mesylate, caffeine

Triptans
Sumatriptan Imitrex Oral One at onset, repeat every 2 h as needed to max of 200 mg.
Imitrex Nasal One spray in each nostril, repeat may repeat once in two hours.
Imitrex Subcutaneous One injection at onset, may repeat once after 1 h.