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Key Terms

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Anterograde amnesia

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Balance error scoring system

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Battle’s sign

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Cerebral concussion

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Cerebral contusions

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Cerebral hematomas

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Cerebral infarction

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Cognitive functions

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Consciousness

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Contrecoup injury

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Coup injury

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Diffuse brain injuries

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Focal brain injuries

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Lucid

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Mental status

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Morbidity rate

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Mortality rate

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Neuropsychological testing

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Otorrhea

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Postconcussion syndrome

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Racoon eyes

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Retrograde amnesia

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Romberg test

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Rhinorrhea

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Second impact syndrome

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Traumatic brain injury

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EMERGENCY SITUATION

A high school soccer goalkeeper attempts to make a save and is kicked in the head by an opposing player. The goalkeeper falls to the ground and does not get up. When the athletic trainer arrives on the field, the athlete is bleeding from a laceration on his forehead but is conscious. However, as the athletic trainer begins the evaluation, the athlete begins to become less lucid. The athlete is confused and soon loses consciousness. What actions should the athletic trainer take?

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Introduction

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Cerebral concussion is an injury associated with virtually every sport and with a host of work and recreational activities. Whether on the sideline, athletic training room, or clinical/hospital environment, a thorough and consistent approach to evaluating athletes suspected of a concussion will aid in improving clinical diagnoses and return-to-play decisions. However, when a head injury is suspected, the nature and severity of the injury must first be determined in order to develop an appropriate management plan. An injury that at first appears to be a concussion could actually involve more serious pathology. The athletic trainer should be skilled in the early detection and diagnosis of these injuries and in follow-up evaluation procedures.

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Pathomechanics of Brain Injuries

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Cerebral concussion can be defined as any transient neurological dysfunction resulting from an applied force to the head.1 A forceful blow to the resting movable head usually produces maximum brain injury beneath the point of cranial impact. This is known as a coup injury. A moving head hitting against an unyielding object usually produces maximum brain injury opposite the site of cranial impact (contrecoup injury) as the brain rebounds within the cranium. When the head is accelerated prior to impact, the brain lags toward the trailing surface, thus squeezing away the cerebrospinal fluid (CSF) and allowing for the shearing forces to be maximal at this site (Fig. 5-1). This brain lag actually thickens the layer of CSF under the point of impact, which explains the lack of coup injury in the moving head injury. However, when the head is ...

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