Current concepts in concussion diagnosis and management in sports: A clinical review

protocols. T he word “concussion” derives from the Latin concussus, which means to shake violently. Concussion was initially felt to involve only transient disturbance of brain function without gross structural change. It is now recognized that some concussions do involve structural damage with loss of neurons. Sports concussion is defined as a complex pathophysiological process af fecting the brain, induced by traumatic biomechanical forces.1 A high incidence of concussion in contact sports is well documented in the literature.1-5 There are several common features of a concussive head injury: • Concussion may be caused either by a direct blow to the head, face, or neck, or a by a blow elsewhere on the body that transmits an “impulsive” force to the head. • Concussion typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. • Concussion may result in neuro pathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury. • Concussion results in a graded set of clinical syndromes that may or may not involve loss of consciousness. Resolution of the clinical and cognitive symptoms typically follows a sequential course. • Concussion is typically associated with grossly normal structural neuroimaging studies.6 Recently, the premature retirement of some professional ice hockey players because of concussion-related symptoms has increased awareness of concussion in Canada, but questions remain about whether there is adequate understanding of appropriate concussion management.7 Wennberg recently reported that the National Hockey League (NHL) concussion rate in the Current concepts in concussion diagnosis and management in sports: A clinical review