Head injury in athletes

HEAD INJURIES INCURRED during athletic endeavors have been recorded since g ames were first held. During the last century, our level of understanding o f the types of cerebral insults, their causes, and their treatment has adva nced significantly. Because of the extreme popularity of sports in the Unit ed States and worldwide, the implications of athletic head injury are enorm ous. This is especially true considering the current realization that mild traumatic brain injury (MTBI) or concussion represents a major health consi deration with more Iong-ranging effects than previously thought. When consi dering athletic injuries, people who engage in organized sports, as well as the large number of people who engage in recreational activities, should b e considered. There are 200 million international soccer players, a group i ncreasingly recognized to be at risk for MTBI. The participation in contact sports of a large number of the population, especially youth, requires a c areful and detailed analysis of injury trends and recommended treatment. Th ere are numerous characteristics of this patient population that make manag ement difficult, especially their implicit request to once again be subject ed to potential MTBI by participating in contact sports. Recent research ha s better defined the epidemiological issues related to sports injuries invo lving the central nervous system and has also led to classification and man agement paradigms that help guide decisions regarding athletes' return to p lay. We currently have methods at our disposal that greatly assist us in ma naging this group of patients, including improved recognition of the clinic al syndromes of MTBI, new testing such as neuropsychological assessment, ra diographic evaluations, and a greater appreciation of the pathophysiology o f concussive brain injury. The potential for long-term consequences of repe titive MTBI has been recognized, and we no longer consider the "dinged" sta tes of athletic concussions to have the benign connotations they had in the past. We review the historical developments in the recognition and care of athletes with head injuries, the current theory of the pathophysiology and biomechanics of these insults, and the recommended management strategy, in cluding return-to-play criteria.