Satarasinghe Praveen, Hamilton D Kojo, Buchanan Robert J, Koltz Michael T
Department of Neurosurgery, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA.
J Exp Neurosci. 2019 Jan 9;13:1179069518824125. doi: 10.1177/1179069518824125. eCollection 2019.
There is a plethora of theories about the pathophysiology behind a sport-related concussion. In this review of the literature, the authors evaluated studies on the pathophysiology of sport-related concussion and professional athlete return-to-play guidelines. The goal of this article is to summarize the most common hypotheses for sport-related concussion, evaluate if there are common underlying mechanisms, and determine if correlations are seen between published mechanisms and the most current return-to-play recommendations.
Two authors selected papers from the past 5 years for literature review involving discussion of sport-related concussion and pathophysiology, pathology, or physiology of concussion using mutually agreed-upon search criteria. After the articles were filtered based on search criteria, pathophysiological explanations for concussion were organized into tables. Following analysis of pathophysiology, concussion protocols and return-to-play guidelines were obtained via a Google search for the major professional sports leagues and synthesized into a summary table.
Out of 1112 initially identified publications, 53 met our criteria for qualitative analysis. The 53 studies revealed 5 primary neuropathological explanations for sport-related concussion, regardless of the many theories talked about in the different papers. These 5 explanations, in order of predominance in the articles analyzed, were (1) tauopathy, (2) white matter changes, (3) neural connectivity alterations, (4) reduction in cerebral perfusion, and (5) gray matter atrophy. Pathology may be sport specific: white matter changes are seen in 47% of football reports, tauopathy is seen in 50% of hockey reports, and soccer reports 50% tauopathy as well as 50% neural connectivity alterations. Analysis of the return-to-play guidelines across professional sports indicated commonalities in concussion management despite individual policies.
Current evidence on pathophysiology for sport-related concussion does not yet support one unifying mechanism, but published hypotheses may potentially be simplified into 5 primary groups. The unification of the complex, likely multifactorial mechanisms for sport-related concussion to a few common explanations, combined with unique findings within individual sports presented in this report, may help filter and link concussion pathophysiology in sport. By doing so, the authors hope that this review will help guide future concussion research, treatment, and management.
关于运动相关脑震荡背后的病理生理学存在众多理论。在这篇文献综述中，作者评估了有关运动相关脑震荡病理生理学以及职业运动员重返赛场指南的研究。本文的目的是总结运动相关脑震荡最常见的假说，评估是否存在共同的潜在机制，并确定已发表的机制与最新的重返赛场建议之间是否存在关联。
两位作者从过去5年中挑选论文进行文献综述，这些论文涉及使用共同商定的搜索标准对运动相关脑震荡以及脑震荡的病理生理学、病理学或生理学进行的讨论。根据搜索标准对文章进行筛选后，将脑震荡的病理生理学解释整理成表格。在对病理生理学进行分析之后，通过谷歌搜索主要职业体育联盟获得了脑震荡协议和重返赛场指南，并综合成一个汇总表。
在最初识别出的1112篇出版物中，有53篇符合我们的定性分析标准。这53项研究揭示了运动相关脑震荡的5种主要神经病理学解释，尽管不同论文中讨论了许多理论。按照在分析的文章中的主导顺序，这5种解释分别是：（1）tau蛋白病，（2）白质变化，（3）神经连接改变，（4）脑灌注减少，以及（5）灰质萎缩。病理学可能因运动项目而异：在47%的橄榄球报告中可见白质变化，在50%的曲棍球报告中可见tau蛋白病，在足球报告中50%可见tau蛋白病以及50%可见神经连接改变。对各职业体育项目重返赛场指南的分析表明，尽管各有个别政策，但在脑震荡管理方面存在共性。
目前关于运动相关脑震荡病理生理学的证据尚不支持一种统一的机制，但已发表的假说可能潜在地简化为5个主要类别。将运动相关脑震荡复杂的、可能是多因素的机制统一为一些常见解释，再结合本报告中各单项运动的独特发现，可能有助于筛选和关联运动中的脑震荡病理生理学。通过这样做，作者希望本综述将有助于指导未来的脑震荡研究以及治疗和管理。
