Handbook of neurological sports medicine

416 Pages·2015·15.685 MB·English

by  Anthony L Petraglia, Julian E Bailes, Arthur L Day

H a n d b o o k o f
Neurological
SportS MediciNe
concussion and other
Nervous System injuries in the athlete
anthony l. petraglia, Md
Julian e. Bailes, Md
arthur l. day, Md
Human Kinetics
Library of Congress Cataloging-in-Publication Data
Petraglia, Anthony L., 1980- author.
Handbook of neurological sports medicine: concussion and other nervous system injuries in the athlete /
Anthony L. Petraglia, Julian E. Bailes, Arthur L. Day.
p. ; cm.
Includes bibliographical references and index.
I. Bailes, Julian E., author. II. Day, Arthur L., author. III. Title.
[DNLM: 1. Athletic Injuries. 2. Brain Injuries. 3. Trauma, Nervous System. QT 261]
RD97.P4816 2015
617.1'027--dc23
2014009602
ISBN: 978-1-4504-4181-0 (print)
Copyright © 2015 by Anthony L. Petraglia, Julian E. Bailes, and Arthur L. Day
All rights reserved. Except for use in a review, the reproduction or utilization of this work in any
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xerography, photocopying, and recording, and in any information storage and retrieval system, is
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contents
Contributors ix
Preface xi
Acknowledgments xiii
part i geNeral coNceptS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
chapter 1 athletes and Neurological injuries: a View From 10,000 Feet . . . . . .3
The Present 4
Spectrum of Neurological Injury in Sport 4
Concluding Thoughts 32
References 32
chapter 2 Medicolegal considerations in Neurological Sports Medicine. . . . .43
With Increased Awareness Comes Increased Scrutiny 43
The King of Concussions 44
Negligence 44
Duty and Breach 45
Violation of a Statutory Duty 45
Standard of Care Defined by Experts 46
Standard of Care Established Through Literature, Rules, Protocols,
and Textbooks 47
Good Samaritan Laws 48
Proximate Cause 48
Assumption of the Risk 48
Theories of Negligence 49
Cases of Interest 49
NFL and NCAA Concussion Litigation 52
Concluding Thoughts 54
References 55
• iii •
iv ••• Contents
chapter 3 Having a game plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59
Developing an Emergency Action Plan 59
Caring for Athletic Injuries 64
Responsibilities of Host and Visiting Medical Staff 71
Concluding Thoughts 73
References 73
part ii SportS-related Head iNJurieS . . . . . . . . . . . . . . . . . . . .75
chapter 4 Biomechanics, pathophysiology,
and classification of concussion. . . . . . . . . . . . . . . . . . . . . . . . . . . .77
Biomechanics and Basic Concepts 77
Lessons Learned From Football 80
Lessons Learned From Other Sports 84
Pathophysiology of Concussion 89
Classification of Concussion and Grading Systems 94
Concluding Thoughts 96
References 96
chapter 5 in the trenches: acute evaluation and Management of concussion. . .103
Presentation 105
Acute Evaluation 110
Concluding Thoughts 114
References 115
chapter 6 Neuroimaging and Neurophysiological Studies
in the Head-injured athlete . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121
Standard Neuroimaging 121
Advanced Structural Techniques 125
Advanced Functional Techniques 129
Neurophysiological Techniques 133
Concluding Thoughts 135
References 135
chapter 7 Neuropsychological assessment in concussion. . . . . . . . . . . . . . .141
Use of Symptom Checklists 142
Value of Neuropsychological Assessment of Concussion 143
Contents ••• v
Issues With Computerized Assessments 147
Other Considerations 150
Other Issues Addressed by Neuropsychologists in Assessing Concussed
Patients 151
Concluding Thoughts 155
References 155
chapter 8 role of Balance testing
and other adjunct Measures in concussion . . . . . . . . . . . . . . . . . .163
Balance Assessment in Concussion 163
Emerging Technology and Future Directions for Adjunct Measures of Assessment
in Concussion 169
Concluding Thoughts 173
References 173
chapter 9 postconcussion Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .179
What’s In a Definition 179
Scope of the Problem 181
A Neuroanatomical Substrate for Prolonged Symptoms 181
Psychogenesis of PCS and PPCS 182
A Modern Conceptual Framework for PCS and PPCS 183
Concluding Thoughts 184
References 184
chapter 10 Neuropathology of chronic traumatic encephalopathy . . . . . . . . .189
Definition of Chronic Traumatic Encephalopathy 189
Posttraumatic Encephalopathy Versus Chronic Traumatic Encephalopathy 192
Gross Morphology and Histomorphology of Chronic Traumatic
Encephalopathy 194
Concluding Thoughts 202
References 202
chapter 11 the emerging role of Subconcussion. . . . . . . . . . . . . . . . . . . . . . .209
A Working Definition 209
Laboratory Evidence of Subconcussive Effects 210
Clinical Evidence of Subconcussion 211
Concluding Thoughts 214
References 216
vi ••• Contents
chapter 12 Severe Head injury and Second impact Syndrome . . . . . . . . . . . .219
Cerebral Contusions and Intraparenchymal Hemorrhage 219
Traumatic Subarachnoid Hemorrhage 220
Subdural Hematoma 221
Skull Fractures 222
Epidural Hematoma 223
Diffuse Axonal Injury 224
Arterial Dissection and Stroke 225
Fatalities 227
Other Posttraumatic Sequelae 228
Second Impact Syndrome 229
Concluding Thoughts 231
References 231
chapter 13 Neurological considerations in return to Sport participation . . . .235
History of Return to Play 235
Symptom Complex and Identification 239
Return to Play and Brain Abnormalities 240
Addressing and Resolving Return-to-Play Issues 244
Concluding Thoughts 249
References 249
chapter 14 the role of pharmacologic therapy and rehabilitation in concussion..251
The Decision to Treat Pharmacologically 251
Somatic Symptoms 252
Sleep Disturbance Symptoms 257
Emotional Symptoms 258
Cognitive Symptoms 260
The Role of Rehabilitation in Concussion Management 262
Concluding Thoughts 264
References 264
chapter 15 the research Behind Natural Neuroprotective
approaches to concussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271
Eicosapentaenoic Acid and Docosahexaenoic Acid 271
Curcumin 272
Resveratrol 275
Creatine 276
Green Tea 278
Contents ••• vii
Caffeine 278
Vitamins E and C 280
Vitamin D 281
Scutellaria baicalensis 282
Examples of Other Neuroprotective Nutraceuticals 283
Another Natural Approach: Hyperbaric Oxygen Therapy 283
Concluding Thoughts 284
Acknowledgment 285
References 285
part iii Sport-related iNJurieS oF tHe SpiNe
aNd peripHeral NerVouS SySteM . . . . . . . . . . . . . . . . .297
chapter 16 cervical, thoracic, and lumbar Spine injuries:
types, causal Mechanisms, and clinical Features . . . . . . . . . . . . .299
Background and Epidemiology 299
Normal Anatomy 300
Types of Tissue Injuries and Neurologic Syndromes 300
Common Cervical Injuries and Conditions 307
Common Thoracic Injuries 313
Common Lumbar Injuries 313
Concluding Thoughts 318
References 318
chapter 17 Management of Spine injuries, including rehabilitation,
Surgical considerations, and return to play. . . . . . . . . . . . . . . . . .321
On-the-Field Assessment 321
Radiological Assessment 324
Treatment and Rehabilitation 325
Surgical Considerations 330
Cervical Spine Injuries and Their Management and Treatment 331
Thoracic and Lumbar Spine Injuries and Their Management 334
Concluding Thoughts 336
References 337
chapter 18 peripheral Nerve injuries in athletes. . . . . . . . . . . . . . . . . . . . . . . .341
Epidemiology 341
Pathogenesis 341
Clinical Evaluation 345
viii ••• Contents
Additional Testing 346
Management Rationale 347
Surgical Options: Primary Nerve Surgery 349
Surgical Options: Secondary Surgery (Soft Tissue or Bony Reconstruction) 350
Postoperative Management and Return to Play 351
Legal Implications 351
Concluding Thoughts 351
References 352
part iV otHer SportS-related Neurological iSSueS. . . . . . .353
chapter 19 Headaches in athletics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .355
Clinical Approach and Assessment 355
Commonly Recognized Headache Syndromes Coincidental
to Sporting Activity 357
Prolonged Sporting Activity as a Trigger for Commonly Recognized
Headache Syndromes 359
Primary Exertional Headache 360
Headaches Attributed to Head or Neck Trauma 361
Headaches Attributed to Sport-Specific Mechanisms 362
Concluding Thoughts 363
References 363
chapter 20 Heat illness in Sport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .365
Background 365
Contributory Factors in Heat Illness 365
Prevention 367
The Spectrum of Heat Illness and Management 368
Return to Play 370
Concluding Thoughts 370
References 370
Appendix A American Spinal Injury Association (ASIA) Standard Neurological
Classification of Spinal Cord Injury 373
Appendix B Sample Concussion Symptom Checklist 375
Appendix C.1 Sport Concussion Assessment Tool (SCAT3) 377
Appendix C.2 Sport Concussion Assessment Tool for Children 383
Appendix D Concussion in Sports Palm Card 389
Index 391
About the Authors 400
contributors
Clayton J. Fitzsimmons, Esq. Elizabeth M. Pieroth, PsyD, ABPP
Fitzsimmons Law Firm Department of Psychiatry
Wheeling, West Virginia NorthShore University HealthSystem
Evanston, Illinois
Robert P. Fitzsimmons, Esq.
Fitzsimmons Law Firm Fabio V. C. Sparapani, MD, PhD
Wheeling, West Virginia Department of Neurological Surgery
Federal University of São Paulo
Jennifer Hammers, DO
São Paulo, Brasil
Department of Forensic Medicine
New York University Robert J. Spinner, MD
New York, New York Department of Neurosurgery
Mayo Clinic
Wesley H. Jones, MD
Rochester, Minnesota
Department of Neurosurgery
University of Texas at Houston Corey T. Walker, MD
Houston, Texas Department of Neurosurgery
Barrow Neurological Institute
Saint-Aaron L. Morris, MD
Phoenix, Arizona
Department of Neurosurgery
University of Texas at Houston Ethan A. Winkler, MD, PhD
Houston, Texas Department of Neurosurgery
University of California, San Francisco
Bennet I. Omalu, MD, MBA, MPH
San Francisco, California
Department of Medical Pathology
and Laboratory Medicine
University of California Davis Medical
Center
Sacramento, California
• ix •