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9 Cards in this Set

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  • Back
Presentation of Postconcussion syndrome
Characterized by persistent headaches, irritability, confusion, and difficulty concentrating and can occur with grades 2 and 3 mild concussions. Classic concussion includes a period of loss of consciousness. If it lasts more than 5 minutes, head CT should be obtained.
Evaluation of Postconcussion syndrome
Can be made with the standard assessment of concussion (SAC), neuropsychological testing, memory testing, and the balance error scoring system (BESS).
Return to Play
The athlete can return to play 1 week to 1 month after the first episode; after a second episode, the athlete should be out for the entire season. Diffuse axonal injury occurs with loss of consciousness lasting over 6 hours; athletes who suffer this injury should consider total avoidance of future contact sports. Return to play should be prohibited if there is loss of consciousness, symptoms lasting more than 15 minutes, recurrence of symptoms with exertion, amnesia, and a history of prior concussion.
Second-impact syndrome
—May occur with a second minor blow before initial symptoms have resolved. Leads to loss of autoregulation of the brain's blood supply and potential herniation. Second-impact syndrome is associated with a 50% mortality rate.
Focal brain syndromes
—Include contusions, intracranial hematomas, epidural hematomas, and subdural hematomas. CT scanning is helpful for distinguishing these entities (Fig. 4–63). Although epidural hematomas are classically said to be characterized by a period of lucidity followed by loss of consciousness, this sequence may not occur. Neurosurgical consultation and monitoring in an intensive care unit are necessary. Surgical treatment of intracranial hematomas may be indicated and are followed by seizure prophylaxis.
GRADES OF MILD CONCUSSIONS
Grade Symptoms Duration Recommended RTP
1 Confusion, no amnesia Minutes When symptoms resolve
2 Retrograde amnesia Hours to days 1 wk
3 Amnesia after impact Days 1 mo
“spear tackler's spine,”
Football players who repeatedly use poor tackling techniques can develop a condition known as “spear tackler's spine,” which includes developmental cervical stenosis, loss of lordosis, and other radiographic abnormalities.
On-field management of Suspected Cervical Spine Injury during athletics
—As with any trauma victim, careful handling of the patient and immobilization are critical. The mechanism of injury usually involves an axial load with flexion and compression of the spine. In football, the helmet and shoulder pads should not be removed. However, the facemask should be removed in the event that an emergent airway is needed. The sequence for proper cervical spine stabilization includes the following:
1. Stabilize the head
2. Log-roll the individual to the supine position
3. Take off the facemask (not helmet)
4. Administer cardiopulmonary resuscitation (CPR) if necessary
5. Apply a backboard
6. Transport the individual
Sports related Spondylolysis/spondylolisthesis
Diagnosis—This condition is common in football interior line positions and gymnasts owing to the repetitive hyperextension of the spine involved in these sports. Oblique radiographs (only 32% sensitive), bone scanning with single-photon emission computed tomography (SPECT) (the most sensitive and effective in the acute setting), and CT (useful in assessing healing) are all helpful for establishing the diagnosis.

Treatment—Treatment includes activity modification, bracing, and fusion for high-grade slips. Individuals with grade I or II injuries may play if they are asymptomatic. For those with grades III, IV, or V injuries who are experiencing intractable pain and/or a progressive slip, a posterolateral fusion should be considered.