Traumatic Brain Injury — Football, Warfare, and Long-Term Effects (New Eng Jour Med)

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Traumatic Brain Injury — Football, Warfare, and Long-Term Effects

Steven T. DeKosky, M.D., Milos D. Ikonomovic, M.D., and Sam Gandy, M.D., Ph.D.
N Engl J Med 2010; 363:1293-1296September 30, 2010


In late July, the National Football League introduced a new poster to be hung in league locker rooms, warning players of possible long-term health effects of concussions. Public awareness of the pathological consequences of traumatic brain injury has been elevated not only by the recognition of the potential clinical significance of repetitive head injuries in such high-contact sports as American football and boxing, but also by the prevalence of vehicular crashes and efforts to improve passenger safety features, and by modern warfare, especially blast injuries. Each year, more than 1.5 million Americans sustain mild traumatic brain injuries with no loss of consciousness and no need for hospitalization; an equal number sustain injuries sufficient to impair consciousness but insufficiently severe to necessitate long-term institutionalization.

The skull provides the brain with a protective thick, bony encasement, yet its irregular interior presents opportunities for damage to the fragile tissues it has evolved to protect. Direct mechanical trauma injures cortical tissue; traumatic hematomas damage subcortical structures and precipitate vasospasm and ischemia; and sudden movement of the skull on its vertebral axis produces rotational, acceleration, or deceleration injury, damaging the long axons interconnecting brain regions. Research regarding traumatic brain injury has long been challenged by the range of these lesions and clinical manifestations, several of which are frequently present concurrently.

Many complications of traumatic brain injury are evident immediately or soon after injury. Acute post-traumatic sensory, motor, and neurocognitive syndromes are presumed to occur as a result of contusions and axonal disruption. Seemingly mild closed-head injuries (i.e., those without skull fracture) may lead to diverse and sometimes disabling symptoms, such as chronic headaches, dizziness and vertigo, difficulty concentrating, word-finding problems, depression, irritability, and impulsiveness. The duration of such symptoms varies but can be months. Post-traumatic stress disorder frequently accompanies traumatic brain injury, though the relationship is poorly understood.

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http://www.nejm.org/doi/full/10.1056/NEJMp1007051?query=TOC

Source Information
From the Office of the Dean and the Department of Neurology, University of Virginia School of Medicine, Charlottesville (S.T.D.); the Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, and the Geriatric Research Educational and Clinical Center, VA Pittsburgh Healthcare System — both in Pittsburgh (M.D.I.); and the Departments of Neurology and Psychiatry and the Alzheimer's Disease Research Center, Mount Sinai School of Medicine and the James J. Peters VA Medical Center — both in New York (S.G.).

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