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EDITORIAL IT ’ S JUST A HEAD KNOCK AND PART OF THE GAME. CONCUSSION: WHAT ’ S ALL THE FUSS ABOUT? By Dr Tony Schneiders
Concussion has been around since the beginning of
Chronic Traumatic Encephalopathy (CTE), formerly
civilisation but it has recently come to the forefront of
known as athletica pugilistica (punch-drunk syndrome).
societal debate via the media for all the right, and maybe the wrong, reasons. While as a health-conscious society we see participation in activity and exercise as synonymous with health and well-being, it must be accepted that sport and recreational pursuits also expose participants to significant risks, with one of them being the possibility of head injury, particularly in contact and collision sports.
This condition has been in the media ever since former Chicago Bears NFL player Dave Duerson tragically committed suicide in 2011 and donated his brain to Boston University who confirmed CTE on autopsy. The Sports Legacy Institute at Boston University accepts donations of brain tissue from deceased sporting and military personal and cites that the brain tissue of 18 of 19 deceased former NFL players have tested positive
Sport-related concussion is a transient functional injury
for CTE. Since this revelation, there has been a proces-
to the brain and considered a sub-category of mild trau-
sion of ex-football stars lining up to report to their attor-
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matic brain injury (mTBI) . Concussion is considered to
neys a long list of neurological mediated signs and
be among the more difficult injuries in sports medicine
symptoms that include forgetfulness, short temper, apa-
to diagnose and manage, with a myriad of mechanisms,
thy and depression which has resulted in multiple class-
presentations, manifestations, and resolutions which
action lawsuits being filed against the NFL. The cynics
are most often individualized to the specific athlete.
amongst you, especially those that have been married
There is no doubt that the science behind concussion
to men in their 5th decade, might suggest a likely cause
assessment continues to evolve and that management
for these symptoms as being the medical condition an-
principles should be based on sound clinical judgement
dropause, colloquially known as Irritable Male Syn-
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underpinned by an evidence based approach. There is
drome (IMS) or grumpy man syndrome. This alternate
currently no single “gold standard” for diagnosing con-
view may also hold some credence given last year’s
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cussion and multiple assessment domains are utilised
tragic suicide by ex-San Diego Charger Junior Seau
by health professionals in order to make a diagnosis
(also a claimant in the NFL law suit) who apparently
which is fundamentally clinical in nature.
had no reported medical history of sustaining a concus-
While the majority of sports concussions resolve within
sion during his entire football career.
7-10 days, symptoms can become chronic in some
Additionally, at this point in time we must consider the
people especially those with anxiety or other mental
best evidence available to determine whether CTE ac-
health comorbidities, and repeated concussions are
tually occurs as a result of repeated concussions in
also now considered to put the athlete at risk of long
sport. It was recently agreed by the Concussion in
term consequences.
Sport Group in the latest Consensus Statement on
One recently identified medical condition considered to be associated with repeated exposure to concussion is
Concussion in Sport4 that CTE was not related to concussions alone, or simple exposure to “contact sports”,
CONTINUED ON NEXT PAGE.