Mild traumatic brain injury: neuroimaging of sports-related concussion.

From the Veterans Affairs Mid Atlantic Mental Illness Research, Education, and Clinical Center (C.V.M, R.A.H., K.H.T.); the Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, North Carolina (C.V.M., R.A.H.); the Mental Health Service Line, Salisbury Veterans Affairs Medical Center, Salisbury, North Carolina (R.A.H., K.H.T.); the Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina (R.A.H.); the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College ofMedicine, Houston, Texas (R.A.H.); Centre de Recherche enNeuropsychologie et Cognition, Universite deMontreal,Montreal, Canada (M.L.); Bioengineering Center, Wayne State University, Detroit, Michigan (L.Z.); and the Research and Education Service Line, SalisburyVeterans Affairs Medical Center, Salisbury, North Carolina (K.H.T.). Address correspondence to Dr. Robin Hurley, Hefner VA Medical Center, 1601 Brenner Avenue, Salisbury, NC 28144; Robin.Hurley@ med.va.gov (E-mail). Copyright 2005 American Psychiatric Publishing, Inc. P awareness of sports-related head injuries came to the forefront in the early twentieth century. Between 1869 and 1905, there were 18 deaths and 159 documented serious injuries attributed to the game of football. In response to these alarming numbers, President Theodore Roosevelt convened representatives from the academic institutions governing football to discuss reforming the game. The American Football Rules Committee arose from these conferences. In 1962, the American Medical Association’s Committee on Medical Aspects of Sports organized a conference addressing head protection in athletes and associated matters in sports medicine. A greater understanding of the need to determine patterns of injury in order to reduce morbidity in the professional and recreational athletic arenas resulted. Although football was the main focus on the American front, emphasis was placed on head protection in other sports arenas elsewhere. In Sweden, for example, the use of hockey helmets became mandatory in 1963. This was subsequent to an insurance survey that found over 100 closed head injuries, including 1 death, 22 mild traumatic brain injuries (MTBIs) and 3 facial fractures as a result of hockey participation. Today, multiple sports are associated with concussive events. In excess of 1.5 million people participate in football (i.e. recreational, high school, collegiate, and professional) annually. The estimated annual incidence of MTBI’s in football is 4–20%. A systematic review of the literature from 1985 to 2000 found ice hockey and rugby to have the highest incidence of concussion for high school, college, and amateur athletes, while soccer had the lowest. At the recreational level, female taekwondo participants and male boxers had the highest frequency of concussion. Of the injuries, 6.2% were concussive in a three-year prospective study among intercollegiate athletes. According to a survey of 1,659 children participating in contact sports, 3% suffered concussions. In addition, an epidemiologic study of collegiate and high school football players found that players who sustain one concussion are three times more likely to sustain a second one in the same season.