Skip to main content

Advertisement

Log in

Cerebral Concussion in Sport

Management and Prevention

  • Injury Clinic
  • Published:
Sports Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

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

    Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Barber HM. Horse-play: survey of accidents with horses. British Medical Journal 3: 532–534, 1973

    Article  PubMed  CAS  Google Scholar 

  • Barclay WR. Equestian sports. Journal of the American Medical Association 240: 1892–1893, 1978

    Article  PubMed  CAS  Google Scholar 

  • Bodnar LM. Sports medicine with reference to back and neck injuries. Current Practice Orthopaedic Surgery 7: 116–153, 1977

    CAS  Google Scholar 

  • Cantu RC. Head and spine injuries in the young athlete. Clinics in Sports Medicine 7: 459–472, 1988

    PubMed  CAS  Google Scholar 

  • Cantu RC. Head injury in sports. Advanced Sports Medicine Fitness 2: 137–150, 1989

    Google Scholar 

  • 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

    Google Scholar 

  • Cantu RC, Mueller F. Catastrophic spine injury in football 1977–1989. Journal of Spinal Disease 3: 227–231, 1990

    CAS  Google Scholar 

  • Clarke K, Braslow A. Football fatalities: actuarial perspective. Medicine and Science in Sports and Exercise 10: 94, 1979

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Gronwall D. Paced auditory serial addition task: a measure of recovery from concussion. Perceptual and Motor Skills 4: 367–373, 1977

    Article  Google Scholar 

  • Gronwall D, Wrightson P. Delayed recovery of intellectual function after minor head injury. Lancet 2: 605–609, 1974

    Article  PubMed  CAS  Google Scholar 

  • Gronwall D, Wrightson P. Cumulative effect of concussion. Lancet 2: 995–997, 1975

    Article  PubMed  CAS  Google Scholar 

  • Gronwall D, Wrightson P. Memory and information processing capacity after closed head injury. Journal of Neurology, Neurosurgery and Psychiatry 44: 889–895, 1981

    Article  CAS  Google Scholar 

  • Gronwall D, Wrightson P. Duration of post-traumatic amnesia after mild head injury. Journal of Clinical Neuropsychology 2: 51–60, 1985

    Article  Google Scholar 

  • Guthkeich AN. Post-traumatic amnesia, post-concussional symptoms and accident neurosis. European Neurology 19: 91–102, 1980

    Article  Google Scholar 

  • Hugen Holtz H, Richard MT. Return to athletic competition following concussion. Canadian Medical Association Journal 127: 827–829, 1982

    Google Scholar 

  • Krel FW. Parachuting for sport — study of 100 deaths. Journal of the American Medical Association 194: 264–268, 1965

    Article  Google Scholar 

  • Langfitt TW, Kassell NF. Cerebral vasodilations produced by brainstem stimulation: neurogenic control vs autoregulation. American Journal of Physiology 215: 90–97, 1978

    Google Scholar 

  • Langfitt TW, Tannenbaum HM, Kassell NF. The etiology of acute brain swelling following experimental head injury. Journal of Neurosurgery 24: 47–56, 1966

    Article  PubMed  CAS  Google Scholar 

  • Lindsay KW, McLatchie G, Jennett B. Serious head injuries in sports. British Medical Journal 281: 789–791, 1980

    Article  PubMed  CAS  Google Scholar 

  • Maroon JC, Steele PB, Berlin R. Football head and neck injuries: an update. Clinical Neurosurgery 27: 414–429, 1980

    PubMed  CAS  Google Scholar 

  • 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

    Google Scholar 

  • McLatchie GR, Davies JE, Caulley JH. Injuries in karate, a case for medical control. Journal of Trauma 2: 956–958, 1980

    Article  Google Scholar 

  • Meggyesy D. Out of their league, p. 125, Ramparts, Berkeley, 1970

    Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Peerless SJ, Rewcastle NB. Shear injuries of the brain. Canadian Medical Association Journal 96: 577–582, 1967

    PubMed  CAS  Google Scholar 

  • Petras AF, Hoffman EP. Roentgenographic skeletal injury patterns in parachute jumping. American Journal of Sports Medicine 11: 325–328, 1983

    Article  PubMed  CAS  Google Scholar 

  • Pickles W. Acute general edema of the brain in children with head injuries. New England Journal of Medicine 241: 607–611, 1950

    Article  Google Scholar 

  • Putnam P. Going-going-gone. Sports Illustrated (June 6) 23–46, 1983

    Google Scholar 

  • Saunders RL, Harbaugh RE. The second impact in catastrophic contact-sports head trauma. Journal of the American Medical Association 252: 538–539, 1984

    Article  PubMed  CAS  Google Scholar 

  • Schneider RC. Head and neck injuries in football, Williams & Wilkins, Baltimore, 1973

    Google Scholar 

  • Schneider RC, Charlie G, Pantek H. The syndrome of acute central cervical spinal cord injury. Journal of Neurosurgery 11: 546–577, 1954

    Article  PubMed  CAS  Google Scholar 

  • 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

    Article  PubMed  CAS  Google Scholar 

  • Schneider RC, Kennedy JC, Plant ML. Sports injuries, Williams & Wilkins, Baltamore, 1985

    Google Scholar 

  • 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

    Article  Google Scholar 

  • Schnitker MT. A syndrome of cerebral concussion in children. Journal of Pediatrics 35: 557–560, 1949

    Article  PubMed  CAS  Google Scholar 

  • Strick, SJ. Shearing of nerve fibers as a cause of brain damage due to head injury. Lancet 2: 443–448, 1961

    Article  Google Scholar 

  • Symonds C. Concussion and its sequelae. Lancet 1: 1–5, 1962

    Article  Google Scholar 

  • Yarnell PR, Lynch S. The ‘ding’ amnestic states in football trauma. Neurology 23: 196–197, 1973

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Additional information

Portions of this article are reproduced with permission from Cantu (1991).

Rights and permissions

Reprints 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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00007256-199214010-00005

Keywords

Navigation