Yale-New Haven Hospital's neurosciences program brings together state-of the-art resources with the professional experience and expertise found at few other medical centers in the country. In HealthLINK: Neurosciences, some of YNHH's best minds weigh in on developments and controversies in one of medicine's most complex disciplines.

January 2011
February 2011

American Academy of Neurology issues
new guidelines for athletes

According to the Centers for Disease Control and Prevention (CDC), each year, as many as 3.8 million sports- and recreation-related concussions occur in the United States. Concussions are traumatic head injuries that occur from both mild and severe blows to the head. Some head injuries may appear to be mild but research is finding that concussions can have serious, long-term effects, especially repeat head injuries or cumulative concussions. The CDC reports that among people age 15 to 24 years, sports are now second only to motor vehicle accidents as the leading cause of traumatic brain injury.

What the news means to you

It is crucial that injuured athletes are removed from play.

By Michael DiLuna, MD

Learn more

In November 2010, the American Academy of Neurology (AAN) issued a position statement on amateur sports leagues to heighten safety standards for injured athletes and new guidelines for managing sports concussions. In the position statement — published in the November issue of the Neurology Journal — the AAN states that any athlete who is suspected of having a concussion be removed from play until the athlete is evaluated by a physician with training in the assessment and management of sports concussion. The new position statement follows rules already adopted in college sports and pro football aimed at preventing and better treating trauma to the head. Research involving NFL players suggests repeated concussions may have long-term consequences such as dementia and Alzheimer's disease.

The AAN also recommends a certified athletic trainer be present at all sporting events, including practices, where athletes are at risk for concussion.

"While the majority of concussions are self-limited injuries, catastrophic results can occur, and we do not yet know the long-term effects of multiple concussions," said Jeffrey Kutcher, MD, a sports neurologist and chair of the sports neurology section of the AAN. "We owe it to athletes to advocate for policy measures that promote high-quality, safe care for those participating in contact sports. We need to make sure coaches, trainers and even parents, are properly educated on this issue, and that the right steps have been taken before an athlete returns to the field."

What the news means to you

Formal concussion guidelines have been debated for some time and the AAN consensus statement is long overdue. Concussions have garnered a lot of attention from the media, especially in light of the psychiatric and even autopsy data that has emerged on NFL players. Now that organized physician groups are finally weighing in, health professionals on the field during sporting events are more vigilant in identifying concussions and removing the athlete from play. Every week a professional athlete is sidelined with a concussion, and while the injury is unfortunate and scary, the fact that they are being removed from play and allowed to properly recover is a recent advance.

If someone is suspected to have suffered a concussion, it is crucial that he or she be removed from play. It is important to recognize the signs and symptoms of post-concussive syndrome (PCS) and initiate the proper steps to ensure a safe recovery, prior to any mental or physical exertion. The greatest danger comes when a person returns to play too quickly and suffers a second concussion. Second-impact syndrome is a catastrophic event where the brain swells uncontrollably following a second concussion. It typically occurs when the second concussion happens within minutes to days following the first. This is a rare event and accounts for 1 to 6 concussion-related deaths in the United States yearly. More common is that a second concussion in close succession after the first leads to more severe symptoms and a longer recovery.

PCS can occur in up to 80 percent of people who suffer from even the mildest of concussions. The symptoms might not appear immediately following a concussion; however, they can be quite severe within the first 12 to 24 hours after a head injury.

The most common symptoms associated with PCS are:

  • Headache
  • Fatigue
  • Difficulty concentrating
  • Difficulty initiating sleep
  • Dizziness
  • Memory problems
  • Personality changes, including irritability
  • Apathy
  • Light or noise intolerance

Even seemingly mundane activities like studying or working on the computer can greatly exacerbate symptoms. PCS symptoms can be enormously frustrating and it is important that schools, coaches, parents and physicians recognize the symptoms and offer the proper support to ensure timely recovery. Students often need extended time to complete their work or should be excused from class and allowed to go to the nurse's office to rest. It is also important to stay hydrated and avoid caffeinated beverages.

The willingness of schools and coaches to accommodate athletes with concussions varies widely across Connecticut. Physicians play a significant role in reporting and educating on the management and treatment of concussions to help athletes recovery properly. Although there is no consensus, in general, the current concussion management guidelines are simple to follow. Once it is recognized that someone has had a concussion, he or she must refrain from any strenuous physical or mental activities until the symptoms are 100 percent gone. This can take weeks to months depending upon the severity of the concussion and PCS. Once symptoms have resolved, light exercise can begin. If the symptoms remain gone, then one can return to play or normal daily activities. If the symptoms return during or after the exercise, then one must rest for another week until exercise is attempted again. Ideally, this stepwise process should be monitored by someone familiar with concussion management like an athletic trainer or a physician.

At Yale-New Haven Hospital, we treat upwards of 25 concussions a week. Patients undergo a multidisciplinary evaluation that includes advanced imaging, neuropsychological and cognitive testing, and learning exams to determine the extent of the injury, as well as the patient's ability to return to school, work and/or the playing field.

For additional information:

Dr. DiLuna, a pediatric neurosurgeon at Yale-New Haven Children's Hospital, is an assistant professor of neurosurgery and of pediatrics at Yale School of Medicine.

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