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Mild Head Injury in Young Athletes

Mild head injury is of growing interest because of its underdiagnosed prevalence and underestimated clinical importance. Half of the patients in emergency departments report sport-related head injuries or concussions. Knowledge of symptoms and appropriate management can be improved and is a matter of practical interest for healthcare providers as well as coaches, parents and athletes in order to improve patient care and prevent future injuries. An acute concussion presents with a combination of physical, cognitive, and emotional symptoms, which are usually self-limited and resolve within a week. However, significant sequelae from even mild impacts, such as headaches, prolonged cognitive impairment, or even death, are known. A second impact before full recovery from the first may have deleterious consequences and should be avoided by observing strict rules for «return to play.» Recent research suggests that repetitive minor hits my cause delayed brain damage (dementia pugilistica or the «punch-drunk syndrome»). A link to neurodegenerative diseases such as dementia, Alzheimer’s disease (AD) and parkinsonism (tauopathies) is described by amyloidβ plaques in those brains. A genetic predisposition (apolipoprotein) is discussed.
This review will focus on the impact of mild head injuries in young athletes and present the current «return to play» rules to avoid the second-impact syndrome. We describe in detail standardized guidelines for appropriate diagnosis and treatment and discuss the association between repetitive minor injuries and chronic traumatic encephalopathy and neurodegenerative diseases.

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Burkhard Simma, Department of Pediatrics Academic Teaching Hospital Landeskrankenhaus Feldkirch
Daniela Jonas
Prof. Dr. med. Jürg Lütschg, Universitäts-Kinderklinik beider Basel (UKBB)