Progress in neurological surgery
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Sport-related concussions affect millions of athletes every year, but they generally present no anatomic alterations when examined using conventional magnetic resonance imaging or a computed tomography scan. Because the damage occurring after a head injury seems to be more functional than structural, these techniques are unable to detect subtle alterations. ⋯ Electrophysiological methods, magnetic resonance spectroscopy, and diffusion tensor imaging are useful techniques that are sensitive to the effects of a brain trauma, which provide complementary information to allow a more complete understanding of the multiple pathophysiological processes involved in concussive events. This report summarizes recent data using neurophysiological and neuroimaging techniques to better understand the acute and chronic effects of sport-related concussions.
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A link between mild traumatic brain injury (mTBI) and neurodegenerative diseases, specifically Alzheimer's disease and chronic traumatic encephalopathy (CTE), has long been suspected. Shared clinical symptomology - most notably the prominent role of central auditory dysfunction and sleep-wake disturbances in both disease states - and similar findings on postmortem pathological examination has further reinforced suspected commonality between these seemingly disparate entities. ⋯ Recent research using diffusion tensor imaging, a novel imaging technique, and focused on patient-reported symptoms has for the first time demonstrated imaging findings in mTBI patients in vivo that are strikingly similar to Alzheimer's dementia and CTE. Moving forward, research will focus on identifying what renders certain patients with mTBI susceptible to developing full-fledged Alzheimer's disease and CTE later in life.
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There is no other sport that has come under greater scrutiny surrounding the incidence and treatment of concussion than football, and there is no other professional sports league that has experienced more intense focus of its handling of concussions than the National Football League (NFL). The NFL has received significant criticism of their management of concussion in players from both the popular press and the medical community. However, those working with active NFL players have changed their assessment and treatment of these injuries as the knowledge of concussions has evolved over time. We review the current approach to the management of concussions in the professional football player.
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Chronic traumatic encephalopathy (CTE) is a progressive neurodegenerative syndrome, which is caused by single, episodic, or repetitive blunt force impacts to the head and transfer of acceleration-deceleration forces to the brain. CTE presents clinically as a composite syndrome of mood disorders and behavioral and cognitive impairment, with or without sensorimotor impairment. Symptoms of CTE may begin with persistent symptoms of acute traumatic brain injury (TBI) following a documented episode of brain trauma or after a latent period that may range from days to weeks to months and years, up to 40 years following a documented episode of brain trauma or cessation of repetitive TBI. ⋯ The brain of a CTE sufferer may appear grossly unremarkable, but shows microscopic evidence of primary and secondary proteinopathies. The primary proteinopathy of CTE is tauopathy, while secondary proteinopathies may include, but are not limited to, amyloidopathy and TDP proteinopathy. Reported prevalence rates of CTE in cohorts exposed to TBI ranges from 3 to 80% across age groups.
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The clinical presentation of concussion can vary widely as patients experience any number of symptoms including headache, dizziness, cognitive symptoms of difficulty with concentration and memory, sleep dysregulation, and mood disturbances. The variability in clinical presentation underscores the importance of thorough history-taking to clearly understand the clinical picture and to allow individualization of the treatment plan. ⋯ For those individuals whose symptoms persist or significantly impair quality of life, pharmacologic intervention may be warranted. Though few studies have investigated the use of pharmacology for treatment of postconcussion syndrome specifically, targeted treatment of medications known to improve selected symptoms can be considered.