Summary
This article explains the various stresses (tensile, compressive, and shearing) that can affect the brain, and how they may produce the different types of brain injury. The biomechanical forces and dynamics that produce coup versus contra coup injury are covered, as are the common intracranial athletic head injuries, i.e. concussion and the various intracranial haematomas (epidural, subdural, subarachnoid and intracerebral). Though less common in occurrence, because their outcome is so catastrophic, space is also devoted to the recognition, the treatment and (especially in the latter case) the prevention of the malignant brain oedema syndrome of the adolescent and the second impact syndrome of the adult. A major emphasis of this paper is the recognition of the 3 grades of cerebral concussion and the delineation of clear guidelines as to when it is safe to return to collision sports after sustaining such injuries, for the first, second or third time during a given season. Clear guidelines are also presented as to when to discontinue collision sport competition for the remainder of the season after multiple concussions. Because of the concern for the second impact syndrome, the requirement to never allow an athlete with postconcussion syndrome symptoms to return to competition is emphasised. Also covered is the prevention of head injuries, which sports are at greatest risk, and the need for additional research on the cumulative effects of concussion.
Similar content being viewed by others
References
Adams H, Graham DI. Pathology of blunt head injuries. In Critchley et al. Scientific foundations of neurology, pp. 478–491, FA Davis, Philadelphia, 1972
Albright JP, McAuley E, Martin RK, et al. Head and neck injuries in college football: an eight year analysis. American Journal of Sports Medicine 13: 147–152, 1985
Barber HM. Horse-play: survey of accidents with horses. British Medical Journal 3: 532–534, 1973
Barclay WR. Equestian sports. Journal of the American Medical Association 240: 1892–1893, 1978
Bodnar LM. Sports medicine with reference to back and neck injuries. Current Practice Orthopaedic Surgery 7: 116–153, 1977
Cantu RC. Head and spine injuries in the young athlete. Clinics in Sports Medicine 7: 459–472, 1988
Cantu RC. Head injury in sports. Advanced Sports Medicine Fitness 2: 137–150, 1989
Cantu R. Minor head injuries in sports. in Dyment (Ed.) Sports and the adolescent. Adolescent medicine: state of the art reviews, pp. 141–154, Hanley & Belfus, Philadelphia, 1991
Cantu RC, Mueller F. Catastrophic spine injury in football 1977–1989. Journal of Spinal Disease 3: 227–231, 1990
Clarke K, Braslow A. Football fatalities: actuarial perspective. Medicine and Science in Sports and Exercise 10: 94, 1979
Committee on Head Injury Nomenclature of the Congress of Neurological Surgeons. Glossary of head injury including some definitions of injury to the cervical spine. Clinical Neurosurgery 12: 386–394, 1966
Gennarelli TA, Segawa H, Wald U, et al. Physiological response to angular acceleration of the head. In Grossman & Gildenberg (Eds) Head injury: basic and clinical aspects, pp. 129–140, Raven Press, New York, 1982
Gerberich SG, Priest JD, Boen JR, et al. Concussion incidences and severity in secondary school varsity football plays. American Journal of Public Health 73: 1370–1375, 1983
Gronwall D. Paced auditory serial addition task: a measure of recovery from concussion. Perceptual and Motor Skills 4: 367–373, 1977
Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet 2: 605–609, 1974
Gronwall D, Wrightson P. Cumulative effect of concussion. Lancet 2: 995–997, 1975
Gronwall D, Wrightson P. Memory and information processing capacity after closed head injury. Journal of Neurology, Neurosurgery and Psychiatry 44: 889–895, 1981
Gronwall D, Wrightson P. Duration of post-traumatic amnesia after mild head injury. Journal of Clinical Neuropsychology 2: 51–60, 1985
Guthkeich AN. Post-traumatic amnesia, post-concussional symptoms and accident neurosis. European Neurology 19: 91–102, 1980
Hugen Holtz H, Richard MT. Return to athletic competition following concussion. Canadian Medical Association Journal 127: 827–829, 1982
Krel FW. Parachuting for sport — study of 100 deaths. Journal of the American Medical Association 194: 264–268, 1965
Langfitt TW, Kassell NF. Cerebral vasodilations produced by brainstem stimulation: neurogenic control vs autoregulation. American Journal of Physiology 215: 90–97, 1978
Langfitt TW, Tannenbaum HM, Kassell NF. The etiology of acute brain swelling following experimental head injury. Journal of Neurosurgery 24: 47–56, 1966
Lindsay KW, McLatchie G, Jennett B. Serious head injuries in sports. British Medical Journal 281: 789–791, 1980
Maroon JC, Steele PB, Berlin R. Football head and neck injuries: an update. Clinical Neurosurgery 27: 414–429, 1980
McCoy GF, Piggot J, Macafee AL, et al. Injuries of the cervical spine in schoolboy rugby football. Journal of Bone and Joint Surgery 66B: 500–503, 1984
McLatchie GR, Davies JE, Caulley JH. Injuries in karate, a case for medical control. Journal of Trauma 2: 956–958, 1980
Meggyesy D. Out of their league, p. 125, Ramparts, Berkeley, 1970
Mueller FO, Cantu RC. Catastrophic injuries and fatalities in highschool and college sports, fall 1982 — spring 1988. Medicine and Science in Sports and Exercise 22: 737–741, 1990
Peerless SJ, Rewcastle NB. Shear injuries of the brain. Canadian Medical Association Journal 96: 577–582, 1967
Petras AF, Hoffman EP. Roentgenographic skeletal injury patterns in parachute jumping. American Journal of Sports Medicine 11: 325–328, 1983
Pickles W. Acute general edema of the brain in children with head injuries. New England Journal of Medicine 241: 607–611, 1950
Putnam P. Going-going-gone. Sports Illustrated (June 6) 23–46, 1983
Saunders RL, Harbaugh RE. The second impact in catastrophic contact-sports head trauma. Journal of the American Medical Association 252: 538–539, 1984
Schneider RC. Head and neck injuries in football, Williams & Wilkins, Baltimore, 1973
Schneider RC, Charlie G, Pantek H. The syndrome of acute central cervical spinal cord injury. Journal of Neurosurgery 11: 546–577, 1954
Schneider RC, Gosch HH, Norrell H. Vascular insufficiency and differential-distortion of brain and cord caused by cervicomedullary football injuries. Journal of Neurosurgery 33: 363–374, 1970
Schneider RC, Kennedy JC, Plant ML. Sports injuries, Williams & Wilkins, Baltamore, 1985
Schneider RC, Reifel E, Crislor HO, Osterban B. Serious and fatal football injuries involving the head and spinal cord. Journal of the American Medical Association 177: 106–367, 1961
Schnitker MT. A syndrome of cerebral concussion in children. Journal of Pediatrics 35: 557–560, 1949
Strick, SJ. Shearing of nerve fibers as a cause of brain damage due to head injury. Lancet 2: 443–448, 1961
Symonds C. Concussion and its sequelae. Lancet 1: 1–5, 1962
Yarnell PR, Lynch S. The ‘ding’ amnestic states in football trauma. Neurology 23: 196–197, 1973
Author information
Authors and Affiliations
Additional information
Portions of this article are reproduced with permission from Cantu (1991).
Rights and permissions
About this article
Cite this article
Cantu, R.C. Cerebral Concussion in Sport. Sports Medicine 14, 64–74 (1992). https://doi.org/10.2165/00007256-199214010-00005
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-199214010-00005