Cerebral Concussion

Concussion is the most common head injury in sports. Its hallmarks are confusion and amnesia. When an object such as a pitched baseball imparts its kinetic energy to a person's skull, considerable pathologic consequences may ensue. Shearing strains produce hemorrhage and destroy neurons. At present, there are several schemes available for the classification of concussions. These may provide guidelines for injury management. Although the symptoms of concussion are usually self-limited, a small number of patients develop postconcussion syndrome.

Although concussions are extremely common, they are potentially dangerous. Indeed, head injuries are the leading cause of death among people under 24 years of age (Fick, 1995, pp. 53-60). Of all the mild head injuries though, sports-related concussive events have the following distinct characteristics: (1) They are generally milder in degree; (2) they are not often associated with other injury; (3) they are frequently witnessed; (4) they are often managed by nonmedical personnel; and (5) management decisions can be influenced by nonmedical considerations (e.g., a player's desire to return to competitive play) (Vollmer & Dacey, 1991, pp. 437-452).

Head injuries occur in a variety of different sports. They may ensue when athletes impelled by motors or sleds are brought into violent contact with their environment. More commonly though, such injuries occur when there is violent conta

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mitters. These could include such compounds as acetylcholine, glutamate, and aspartate (Evans, 1992, pp. 815-841). One common misconception with regard to concussion is that the forces involved must be sufficient to produce loss of consciousness. Consequently, the seriousness of less severe concussions is sometimes not fully appreciated. Typically, injured persons will not say, "I have a concussion" (Fick, 1995, pp. 53-60). Rather, they may say that they "saw stars", or complain of a headache (Ryan, 1991, pp. 81-86). Other times, concussed persons may not even know what their problem is; they may only acknowledge that they "just don't feel right" (Fick, 1995, pp. 53-60). For the physician, the first step in the assessment of someone with a concussion is to take a history. It is important to find out whether or not the player lost consciousness and for how long. If the patient cannot provide an adequate history of the event, it is important to question teammates, trainers, and coaches. With alert patients, the physician should ask questions to test memory. Such inquiries might include the following: (1) "Who hit you"?; and (2) "During what inning of the game were you hit" (Fick, 1995, pp. 53-60)? Finally, the physician
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