Diagnosis and Sideline Management of Sport-Related Concussion

Return to Play Following Concussion: Role for Imaging?

This review surveys concussion management, focusing on the use of neuroimaging techniques in return to play (RTP) decisions. Clinical assessments traditionally were the foundation of concussion diagnoses. However, their subjective nature prompted an exploration of neuroimaging modalities to enhance diagnosis and management. Magnetic resonance spectroscopy provides information about metabolic changes and alterations in the absence of structural abnormalities. Diffusion tensor imaging uncovers microstructural changes in white matter. Functional magnetic resonance imaging assesses neuronal activity to reveal changes in cognitive and sensorimotor functions. Positron emission tomography can assess metabolic disturbances using radiotracers, offering insight into the long-term effects of concussions. Vestibulo-ocular dysfunction screening and eye tracking assess vestibular and oculomotor function. Although these neuroimaging techniques demonstrate promise, continued research and standardization are needed before they can be integrated into the clinical setting. This review emphasizes the potential for neuroimaging in enhancing the accuracy of concussion diagnosis and guiding RTP decisions.

Concussion in Head Trauma

Concussion in the setting of facial trauma is an entity that can be overlooked. Having a high index of suspicion is critical in initial management and prompt treatment. Clinical signs can be common manifestations of a concussion. Serial examinations are important as these clinical manifestations can occur later in the hospitalization. Cognitive assessment tools can also give a baseline of a patient and can be used to assess recovery from a concussion. Assessment of the vestibular and oculomotor system can play a critical role in treatment. Prompt recognition and immediate treatment can help shorten the symptomatology and course of treatment.