Head trauma in sports is fairly common. Approximately 2 million head injuries occur every year in US sports and out of those 300,000 are concussions. American football, ice hockey, boxing, soccer, wrestling, and cheerleading are the sports with the highest incidence of head injuries. It’s estimated that 20% of players in their football careers will experience a head injury! The main mechanism of injury is a direct blow to the head or a very hard impact to another part of the body which results in a “whiplash” type of injury. The latter results in a coup countercoup injury were the brain essentially rates around in our skull causing damage to different lobes.
The lobes of the brain specialize in different functions which is why it’s not uncommon to have multiple lobes injured during a head injury. The frontal lobe contains the centers for intellectual function, eye movement, and motor speech. The temporal lobe is primarily responsible for receptive speech and memory. The parietal lobes contain the association areas where information is processed. The occipital lobes deal primarily with vision. Between the skull and our brain consists of three meninge layers. The dura is a tough outer cover; the arachnoid is a filmy middle layer; and the pia matter is a thin, transparent layer closely adhered to the cortex.
When a traumatic brain injury (TBI) occurs, there can be bleeding into the meninges and bruising to the brain. An athlete should be immediately evaluated following a suspected TBI. The gold standard scale to evaluate an athlete that has just suffered a head injury is the Glasgow Coma Scale (GCS). This is done after making sure the athlete is alert and verbal. In short if an athlete scores a 13-15 on the GCS the brain injury is mild, 9-12 moderate, less than 8 severe. It’s been reported that a GCS score of lower than 7 has a 40% mortality rate. After determining the GCS an athlete should be taken either to the ER or to the sidelines for further evaluation and not be allowed to return to play on the same day.
Side line evaluations are more thorough and can consist of neuropsychological tests and recent memory questions. It should also be noted to suspect a cervical spine injury with any TBI and should be evaluated. It’s VERY important to NEVER leave an athlete alone after a suspected TBI. Life threating injuries can take several minutes to develop where as previously the athlete seemed fine. Changes in personality, loss of coordination, vomiting, unsteady gait, changed in pupil sizes, slurred speech, and bruising can occur well after an athlete has left the field. If any of these symptoms occur the athlete should be transported to the closest ER for immediate evaluation and imaging to rule out life threating injuries.
Regardless of the severity of the head injury, an athlete should not return to play until being thoroughly evaluated by a trained medical professional. Rushing an athlete back from a concussion too soon can result in second impact syndrome, which is rare, but when it does occur is often fatal.
Hyde, T. E., & Gengenbach, M. S. (2007). Conservative management of sports injuries. Jones and Bartlett Publishers.
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