Clinical neurosurgery
-
In the last 5 years there has been a dramatic decrease in the deaths directly related to football participation. The incidence of serious spinal cord injuries, however, appears to be increasing. The number of quadriplegic athletes varies from an estimated 1 per 7,000 to 1 per 58,000 participants per year in different areas of the country. ⋯ Arbitrarily, most physicians discourage further football participation if an athlete has suffered three cerebral concussions. Strong consideration must be given, however, not only to the number and severity of the concussion, but also to any CAT scan evidence of cerebral edema, contusion, or hemorrhage. With this incredibly sensitive diagnostic tool, one concussion, which is associated with radiographic evidence of structural brain damage, may be enough to strongly discourage or forbid further football participation.
-
Raised intracranial pressure is common in neurosurgical practice, but the clinical effects are variable. The factors which initiate intracranial hypertension are now fairly well established; the extent of the increase of intracranial pressure produced by any combination of these factors is a function of the volume-pressure status of the patient at that particular time and may be expressed in terms of brain clastance. ⋯ Understanding of these principles helps in selection of effective therapy for raised intracranial pressure. Ideal clinical management of raised intracranial pressure should be directed toward the identification of those situations in which intracranial pressure may become increased and should attempt to prevent intracranial hypertension before it actually occurs.