Adolescent concussions.

Pediatric Healthcare Associates, Southport, USA.
Connecticut medicine 03/2010; 74(3):149-56.
Source: PubMed

ABSTRACT BACKGROUND: The amount of literature dealing with the diagnosis and treatment of adolescent concussions is considerable. Most articles focus on the athlete. This study examines both sports-related and nonsports-related concussions in adolescents, their etiology, mechanisms of injury (categorized by sport), symptoms exhibited, physical findings, computerized tomography scan results and the problem of prolonged recovery (persistent postconcussion syndrome used in this article to mean symptoms lasting over four weeks.) OBJECTIVE: The purpose of this study is to present the data, their significance and a new method of management that has successfully allowed the author's concussed patients to recover more rapidly. METHOD: A retrospective review of 863 adolescent concussions, in 11-year-old to 19-year-old patients, from July 2004 through December 31, 2008. Subjects were seen as a result of referrals largely from the author's practice (Pediatric Healthcare Associates), other physicians, athletic trainers or patients previously treated. All concussions, including nonsports-related concussions, were included in the study. Some patients had multiple concussions; 774 individuals accounted for the 863 concussions. The number of patients by age and the number of concussions they sustained are listed below.

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    ABSTRACT: The pathophysiology of sports-related concussion (SRC) is incompletely understood. Human adult and experimental animal investigations have revealed structural axonal injuries, decreases in the neuronal metabolite N-acetyl aspartate, and reduced cerebral blood flow (CBF) after SRC and minor traumatic brain injury. The authors of this investigation explore these possibilities after pediatric SRC. Twelve children, ages 11 to 15 years, who experienced SRC were evaluated by ImPACT neurocognitive testing, T1 and susceptibility weighted MRI, diffusion tensor imaging, proton magnetic resonance spectroscopy, and phase contrast angiography at <72 hours, 14 days, and 30 days or greater after concussion. A similar number of age- and gender-matched controls were evaluated at a single time point. ImPACT results confirmed statistically significant differences in initial total symptom score and reaction time between the SRC and control groups, resolving by 14 days for total symptom score and 30 days for reaction time. No evidence of structural injury was found on qualitative review of MRI. No decreases in neuronal metabolite N-acetyl aspartate or elevation of lactic acid were detected by proton magnetic resonance spectroscopy. Statistically significant alterations in CBF were documented in the SRC group, with reduction in CBF predominating (38 vs 48 mL/100 g per minute; P = .027). Improvement toward control values occurred in only 27% of the participants at 14 days and 64% at >30 days after SRC. Pediatric SRC is primarily a physiologic injury, affecting CBF significantly without evidence of measurable structural, metabolic neuronal or axonal injury. Further study of CBF mechanisms is needed to explain patterns of recovery.
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