Concussion historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Historical Perspective
The Hippocratic Corpus, collection of medical works from ancient Greece, mentions concussion, later translated to commotio cerebri, and discusses loss of speech, hearing and sight that can result from "commotion of the brain".[1] This idea of disruption of mental function by 'shaking of the brain' remained the widely accepted understanding of concussion until the 19th century.[1] The Persian physician Muhammad ibn Zakarīya Rāzi was the first to write about concussion as distinct from other types of head injury in the 10th century AD.[2] He may have been the first to use the term "cerebral concussion", and his definition of the condition, a transient loss of function with no physical damage, set the stage for the medical understanding of the condition for centuries.[3] In the 13th century, the physician Lanfranc of Milan's Chiurgia Magna described concussion as brain "commotion", also recognizing a difference between concussion and other types of traumatic brain injury (though many of his contemporaries did not), and discussing the transience of post-concussion symptoms as a result of temporary loss of function from the injury.[2]
In the 14th century, the surgeon Guy de Chauliac pointed out the relatively good prognosis of concussion as compared to more severe types of head trauma such as skull fractures and penetrating head trauma.[2] In the 16th century, the term "concussion" came into use, and symptoms such as confusion, lethargy, and memory problems were described.[2] The 16th century physician Ambroise Paré used the term commotio cerebri,[3] as well as "shaking of the brain", "commotion", and "concussion".
Until the 17th century, concussion was usually described by its clinical features, but after the invention of the microscope, more physicians began exploring underlying physical and structural mechanisms.[2] However, the prevailing view in the 17th century was that the injury did not result from physical damage, and this view continued to be widely held throughout the 18th century.[2]
The word "concussion" was used at the time to describe the state of unconsciousness and other functional problems that resulted from the impact, rather than a physiological condition.[2]
In 1839, Guillaume Dupuytren described brain contusions, which involve many small hemorrhages, as contusio cerebri and showed the difference between unconsciousness associated with damage to the brain parenchyma and that due to concussion, without such injury. In 1941, animal experiments showed that no macroscopic damage occurs in concussion.[4]
The debate over whether concussion is a functional or structural phenomenon is ongoing.[2] Structural damage has been found in the mildly traumatically injured brains of animals, but it is not clear whether these changes would be applicable to humans.[5] Such changes in brain structure could be responsible for certain symptoms such as visual disturbances, but other sets of symptoms, especially those of a psychological nature, are more likely to be caused by reversible pathophysiological changes in cellular function that occur after concussion, such as alterations in neurons' biochemistry.
These reversible changes could also explain why dysfunction is frequently temporary.[2] A task force of head injury experts called the Concussion In Sport Group met in 2001 and decided that "concussion may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural injury.
Definition
No single definition of concussion, mild head injury,[6] or mild traumatic brain injury is universally accepted, though a variety of definitions have been offered.[7] In 2001, the first International Symposium on Concussion in Sport was organized by the International Olympic Committee Medical Commission and other sports federations.[8] A group of experts called the Concussion in Sport Group met there and defined concussion as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces."[9] They agreed that concussion typically involves temporary impairment of neurological function which quickly resolves by itself, and that neuroimaging normally shows no gross structural changes to the brain as the result of the condition.[10]
According to the classic definition, no structural brain damage occurs in concussion;[11] it is a functional state, meaning that symptoms are caused primarily by temporary biochemical changes in neurons, taking place for example at their cell membranes and synapses.[10] However, in recent years researchers have included injuries in which structural damage does occur under the rubric of concussion. According to the National Institute for Health and Clinical Excellence definition, concussion may involve a physiological or physical disruption in the brain's synapses.[12]
Definitions of mild traumatic brain injury (MTBI) have been inconsistent since the 1970s, but the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) described MTBI-related conditions in 1992, providing a consistent, authoritative definition across specialties.[13] In 1993, the American Congress of Rehabilitation Medicine defined MTBI as 30 minutes or fewer of loss of consciousness (LOC), 24 hours or fewer of post-traumatic amnesia (PTA), and a Glasgow Coma Scale (GCS) score of at least 13.[14] In 1994, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defined MTBI using PTA and LOC.[13] Other definitions of MTBI incorporate focal neurological deficit and altered mental status, in addition to PTA and GCS.[7]
Although the term "concussion" is still used in sports literature as interchangeable with "MHI" or "MTBI", the general clinical medical literature now uses "MTBI" instead.[15]
Controversy exists about whether the definition of concussion should include only those injuries in which loss of consciousness occurs.[5] Historically, concussion by definition involved a loss of consciousness, but the definition has changed over time to include a change in consciousness, such as amnesia.[16] The best-known concussion grading scales count head injuries in which loss of consciousness does not occur to be mild concussions and those in which it does to be more severe.[17]
References
- ↑ 1.0 1.1 1.2 1.3 Masferrer R, Masferrer M, Prendergast V, Harrington TR (2000). "Grading scale for cerebral concussions". BNI Quarterly. Barrow Neurological Institute. 16 (1). ISSN 0894-5799.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 McCrory PR, Berkovic SF (2001). "Concussion: The history of clinical and pathophysiological concepts and misconceptions". Neurology. 57 (12): 2283–89. PMID 11756611.
- ↑ 3.0 3.1 Sivák Š, Kurča E, Jančovič D, Petriščák Š, Kučera P (2005). "An outline of the current concepts of mild brain injury with emphasis on the adult population" (PDF). Časopis Lėkařů Českých. 144 (7): 445–450.
- ↑ Denny-Brown D, Russell WR (1940). "Experimental cerebral concussion". Journal of Physiology. 99 (1): 153. PMID 16995229.
- ↑ 5.0 5.1 Invalid
<ref>tag; no text was provided for refs namedPearce - ↑ Satz P, Zaucha K, McCleary C, Light R, Asarnow R, Becker D (1997). "Mild head injury in children and adolescents: A review of studies (1970–1995)". Psychological Bulletin. 122 (2): 107–131. PMID 9283296.
- ↑ 7.0 7.1
Comper P, Bisschop SM, Carnide N, Tricco A (2005). "A systematic review of treatments for mild traumatic brain injury". Brain Injury. 19 (11): 863–880. doi:10.1080-0269050400025042 Check
|doi=value (help). ISSN 0269-9052. PMID 16296570. - ↑ Invalid
<ref>tag; no text was provided for refs namedaubry - ↑ Cantu RC (2006). "An overview of concussion consensus statements since 2000" (PDF). Neurosurgical Focus. 21 (4:E3): 1–6.
- ↑ 10.0 10.1 Invalid
<ref>tag; no text was provided for refs namedAndersonT - ↑ Parkinson D (1999). "Concussion confusion". Critical Reviews in Neurosurgery. 9 (6): 335–339. doi:10.1007/s003290050153. ISSN 1433-0377.
- ↑ "Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults" (PDF). National Institute for Health and Clinical Excellence. September 2007. ISBN 0-9549760-5-3. Retrieved 2008-01-26.
- ↑ 13.0 13.1 Invalid
<ref>tag; no text was provided for refs namedPetchprapai07 - ↑ Kushner D (1998). "Mild Traumatic brain injury: Toward understanding manifestations and treatment". Archives of Internal Medicine. 158 (15): 1617–1624. PMID 9701095.
- ↑ Barth JT, Varney NR, Ruchinskas RA, Francis JP (1999). "Mild head injury: The new frontier in sports medicine". In Varney NR, Roberts RJ. The Evaluation and Treatment of Mild Traumatic Brain Injury. Hillsdale, New Jersey: Lawrence Erlbaum Associates. pp. 85–86. ISBN 0-8058-2394-8. Retrieved 2008-03-06.
- ↑ Ruff RM, Grant I (1999). "Postconcussional disorder: Background to DSM-IV and future considerations". In Varney NR, Roberts RJ. The Evaluation and Treatment of Mild Traumatic Brain Injury. Hillsdale, New Jersey: Lawrence Erlbaum Associates. p. 320. ISBN 0-8058-2394-8.
- ↑ Invalid
<ref>tag; no text was provided for refs namedcobb