Sports-related concussions: diagnosis, complications, and current management strategies
Sports-related concussions: diagnosis, complications, and current management strategies
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DOI：
10.3171/2016.1.focus15617
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发表时间：
2016-04-01
影响因子：
4.1
通讯作者：
Bailes, Julian E.
中科院分区：
文献类型：
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作者：
Hobbs, Jonathan G.;Young, Jacob S.;Bailes, Julian E.
运动相关脑震荡 (SRC) 是一种创伤性事件，每年影响多达 380 万名运动员。最初的诊断和管理通常是由教练、运动训练师和队医在赛场上进行的。 SRC 通常是创伤性影响后神经功能障碍的短暂发作，大多数症状在 7-10 天内消失；然而，一小部分患者会在事件发生后数年遭受长期症状，并可能发展为慢性神经退行性疾病。很少情况下，SRC 与并发症相关，例如颅骨骨折、硬膜外或硬膜下血肿以及需要神经外科评估的水肿。目前的护理标准基于休息和逐渐恢复比赛的模式，并根据详细病史和体检收集的主观和客观信息做出决定。功能性 MRI 等先进的成像技术，以及对 SRC 背后复杂的病理生理过程的详细了解以及它们如何对运动员产生急性和长期的影响，可能会改变医生治疗脑震荡运动员的方式。希望这些进步能够更准确地评估运动员何时真正安全地返回比赛，降低继发性冲击损伤的风险，并为针对大脑创伤性损伤引起的复杂生化级联反应的治疗策略提供途径。
Sports-related concussions (SRCs) are traumatic events that affect up to 3.8 million athletes per year. The initial diagnosis and management is often instituted on the field of play by coaches, athletic trainers, and team physicians. SRCs are usually transient episodes of neurological dysfunction following a traumatic impact, with most symptoms resolving in 7-10 days; however, a small percentage of patients will suffer protracted symptoms for years after the event and may develop chronic neurodegenerative disease. Rarely, SRCs are associated with complications, such as skull fractures, epidural or subdural hematomas, and edema requiring neurosurgical evaluation. Current standards of care are based on a paradigm of rest and gradual return to play, with decisions driven by subjective and objective information gleaned from a detailed history and physical examination. Advanced imaging techniques such as functional MRI, and detailed understanding of the complex pathophysiological process underlying SRCs and how they affect the athletes acutely and long-term, may change the way physicians treat athletes who suffer a concussion. It is hoped that these advances will allow a more accurate assessment of when an athlete is truly safe to return to play, decreasing the risk of secondary impact injuries, and provide avenues for therapeutic strategies targeting the complex biochemical cascade that results from a traumatic injury to the brain.