40 HEAD INJURIES
Robert C Cantu, MD, FACS, FACSM
- If we define a direct fatality as one occurring
directly from participation in the skills of a sport, as
opposed to an indirect fatality which is one caused
by systemic failure as a result of exertion while par-
ticipating in a sport, head injury is the most frequent
direct cause of death in sport (Mueller and Blyth,
1985).
- Injury to the head takes on a singular importance
when we realize the brain is neither capable of regen-
eration nor, unlike many other body parts and organs,
of transplantation.
•Every effort must be made to protect the athlete’s
head as injury can lead to dementia, epilepsy, paraly-
sis, and death.
- Starting with President Theodore Roosevelt’s threat to
ban American football in 1904, injuries from this
sport have received more media attention and reports
in the medical literature than any other organized
sport because none has contributed more fatalities
(Kraus and Conroy, 1984).
- Brain injuries have been the most common direct
cause of death among American football players since
the annual recording of football-related deaths began
in 1931 (Cantu and Mueller, 2003).
- Brain injury-related fatalities accounted for 69% of all
football fatalities from 1945 through 1999 (Cantu and
Mueller, 2003).
- Most brain injury-related fatalities involved a sub-
dural hematoma sustained by high school football
players while either tackling or being tackled in a
game (Cantu and Mueller, 2003).
•Fatalities in American football from 1973 to 1983
exceeded deaths in all other competitive sports com-
bined (Kraus and Conroy, 1984).
•Yet per 100,000 participants American football is not as
likely to result in a fatal head injury as horseback riding
(Barclay, 1978; Barber, 1973), sky diving (Krel, 1965;
Petras and Hoffman, 1983), or car or motorcycle
racing.
•Football has about the same risk of a fatal head injury
as gymnastics and ice hockey (Goldberg, 1980; Fekete,
1968).
- Other sports historically shown to have a high rate of
head injury including boxing (Hillman, 1980; Van,
1983; Lundberg, 1983), the martial arts (McLarchie,
Davies, and Caulley, 1980), and rugby football (McCoy
et al, 1984), although a fatal head injury in rugby is rare
(Gibbs, 1994; Ryan and McQuillen, 1992).
•A cerebral concussion is the most common athletic
head injury (Cantu, 1991).
- More than 90% of all cerebral concussions fall into
this most mild category where there has not been a
loss of consciousness but rather only a brief period of
posttraumatic amnesia or loss of mental alertness
(Cantu, 1991).
CEREBRAL CONCUSSION
- Concussion is derived from the Latin concussus
which means “to shake violently.” Initially it was
thought to produce only a temporary disturbance of
brain function due to neuronal, chemical, or neuro-
electrical changes without gross structural damage.
We now know that structural damage with loss of
brain cells does occur with some concussions.
- The rates of concussion in some popular sports are
listed in Tables 40-1 and 40-2.
239
Section 4
MUSCULOSKELETAL PROBLEMS
IN THE ATHLETE
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