Terrell Thomas R, Nobles Timothy, Rader Brianna, Bielak Kenneth, Asif Irfan, Casmus Robert, Yeager Jamie, Hussein Reem
From the University of Tennessee Graduate School of Medicine, Knoxville, the Department of Physical Education and Athletics, Catawba College, Salisbury, North Carolina, and the East Tennessee State University School of Medicine, Johnson City.
South Med J. 2014 Feb;107(2):115-25. doi: 10.1097/SMJ.0000000000000063.
Concussion is a popular clinical topic that has been the subject of unprecedented recent media coverage. As concerns about the potential short- and long-term implications of repetitive head injury in sports such as football continue to mount, the proper clinical management of concussion seems to increase in importance. The days of ignoring the "ding" on the sideline are definitely over. A series of updated clinical evaluation and management recommendations from international experts are highlighted in this review. The clinical presentation of an acute concussion, both the typical and more subtle variations, may be evaluated with new validated sideline evaluation tools (eg, Sports Concussion Assessment Tool 2). In addition, the role of computerized neuropsychological and balance testing in the acute and ongoing evaluation are discussed, along with how they contribute to the return-to-play decision. Same-day return to play is outdated, and the relative insensitivity of current neuroimaging modalities to demonstrate structural damage is highlighted. New therapeutic interventions such as amantadine and cognitive rest may improve recovery time. The appropriate management of concussion typically results in a normal functional and neurocognitive outcome. The recommendations in this article may guide clinicians, with varying degrees of prior experience managing concussion, to increase the likelihood of an excellent outcome.
脑震荡是一个热门的临床话题，近期受到了前所未有的媒体关注。随着人们对足球等运动中反复头部受伤可能产生的短期和长期影响的担忧不断加剧，脑震荡的恰当临床管理显得愈发重要。忽视场边“小伤”的日子肯定一去不复返了。本综述重点介绍了国际专家提出的一系列最新临床评估和管理建议。急性脑震荡的临床表现，包括典型和更细微的变化，可用新的经过验证的场边评估工具（如运动脑震荡评估工具第2版）进行评估。此外，还讨论了计算机化神经心理学和平衡测试在急性和持续评估中的作用，以及它们如何有助于做出重返赛场的决定。当日重返赛场的做法已过时，同时强调了当前神经影像学检查方式在显示结构损伤方面相对不敏感的问题。金刚烷胺和认知休息等新的治疗干预措施可能会缩短恢复时间。脑震荡的恰当管理通常会带来正常的功能和神经认知结果。本文中的建议可指导不同脑震荡管理经验水平的临床医生，提高获得良好结果的可能性。
