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Sports concussions and traumatic brain injury.

In this issue of the Southern Medical Journal, Terrell and colleagues present a two-part review of the current concepts in sports concussions. This topic has significant currency, as academic institutions, medical associations, sports regulatory agencies, schools, coaches, trainers, student athletes and their families, and healthcare providers struggle to evaluate the extent of the head injury problem and to gather what scientific data are available that would, it is hoped, provide guidance for the development of significant preventive measures. The authors provide a comprehensive review of this topic, including the suspected pathophysiology and practical approaches for its address by healthcare professionals. It is likely, in my view, that repeated head trauma/concussions in sports could produce brain injuries not dissimilar to the traumatic brain injuries (TBI) we have seen from current military operations in the Middle East. Mild TBI bears a strong resemblance to sports concussions, although mild military TBI is not as problematic as moderate to severe TBI, owing to the power of the causative explosions, usually from improvised explosive devices, which characterize the latter. Mild TBI, although not always immediately recognized for what it is, can cause chronic headaches, some personality changes, diminished mentation and problem-solving capabilities, vertigo and dizziness, and other symptoms that can be easily overlooked in the larger picture of caring for casualties. Diagnosing mild TBI requires an understanding of its insidious nature and a keen awareness of its presenting symptoms to ensure a high index of suspicion. It is likely there is a continuum of TBIs that may include the mild concussion of a sports injury on one end, with progression along the line of severity to severe TBI. It also is probable that repeated sports concussions during the course of a sports career could move the extent of the injury to the severe side, including the development of chronic traumatic encephalopathy, which has many features of moderate to severe TBI. As the authors point out, new diagnostic tools such as the improved Sports Concussion Assessment Tool are recognized as helpful to the examining physician who will longitudinally study the athlete who experiences one or more concussive episodes. Postconcussive syndrome, as lingering symptoms from a concussion has been identified, is likely representative of a more worrisome TBI than simply a transient event. As the authors describe, knowledge of the cellular and physiologic processes that are disrupted, as well as the pathophysiologies produced by the injuries to the brain and upper cervical spinal cord, is fortunately expanding, which may lead to better diagnostic and therapeutic measures. At this time, the US military and Department of Veterans Affairs healthcare systems have perhaps the most extensive experience with diagnosing, longitudinally evaluating, and treating TBI in our country, owing to the large number of these injuries from the protracted Middle East combat operations. The sports medicine community and the military medicine community would do well to jointly engage in examining this issue from both perspectives, because I believe sports concussions and traumatic brain injuries from battle are located along the same continuum. The age groups overlap a good deal, and there is great importance to be placed in doing whatever can be done to reduce the impact of these injuries on the well-being and future of the young people who sustain them. After all, they are our children, grandchildren, brothers, and sisters. We need to protect them and ensure they are capable of functioning to the best of their abilities in the future.