Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA.
Am Fam Physician. 2012 Jan 15;85(2):123-32.
Concussion is a disturbance in brain function caused by direct or indirect force to the head. It is a functional rather than structural injury that results from shear stress to brain tissue caused by rotational or angular forces-direct impact to the head is not required. Initial evaluation involves eliminating cervical spine injury and serious traumatic brain injury. Headache is the most common symptom of concussion, although a variety of clinical domains (e.g., somatic, cognitive, affective) can be affected. Signs and symptoms are nonspecific; therefore, a temporal relationship between an appropriate mechanism of injury and symptoms must be determined. There are numerous assessment tools to aid diagnosis, including symptom checklists, neuropsychological tests, postural stability tests, and sideline assessment tools. These tools are also used to monitor recovery. Cognitive and physical rest are the cornerstones of initial management. There are no specific treatments for concussion; therefore, focus is on managing symptoms and return to play. Because concussion recovery is variable, rigid classification systems have mostly been abandoned in favor of an individualized approach. A graded return-to-play protocol can be implemented once a patient has recovered in all affected domains. Children, adolescents, and those with a history of concussions may require a longer recovery period. There is limited research on the management of concussions in children and adolescents, but concern for potential consequences of injury to the developing brain suggests that a more conservative approach to management is appropriate in these patients.
脑震荡是由头部直接或间接受力导致的脑功能障碍。它是一种功能性而非结构性损伤，是由旋转或角力导致的脑组织剪切力引起的，不一定需要头部直接受到撞击。初步评估包括排除颈椎损伤和严重创伤性脑损伤。头痛是脑震荡最常见的症状，尽管各种临床领域（如躯体、认知、情感）都可能受到影响。体征和症状是非特异性的；因此，必须确定适当的损伤机制与症状之间的时间关系。有许多评估工具可以帮助诊断，包括症状检查表、神经心理学测试、姿势稳定性测试和场外评估工具。这些工具也用于监测恢复情况。认知和身体休息是初步管理的基石。目前没有针对脑震荡的特定治疗方法，因此重点是管理症状和恢复运动。由于脑震荡的恢复情况因人而异，因此大多数情况下已不再使用僵化的分类系统，而是采用个体化的方法。一旦患者在所有受影响的领域都已康复，可以实施分级重返赛场的方案。儿童、青少年和有脑震荡病史的患者可能需要更长的恢复期。关于儿童和青少年脑震荡管理的研究有限，但考虑到对发育中大脑受伤的潜在后果，建议对这些患者采取更保守的管理方法。
