CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(04): 284-291
DOI: 10.1055/s-0037-1602691
Review article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Brain Concussion: New Classifications and Current Physiopathological Knowledge of the Disease

Concussão cerebral: Novas classificações e conhecimento fisiopatológico atual da doença
1   Programa de Pós-Graduação em Neurociências, Universidade Anhembi Morumbi, São Paulo, SP, Brazil
2   Programa de Pós-Graduação em Urgências e Emergências, Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
,
Durval Damiani
3   Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

09 January 2017

23 February 2017

Publication Date:
20 April 2017 (online)

Abstract

The present review paper aims to update the definition and classification of cerebral concussion, highlighting its pathophysiological mechanisms. The high prevalence of cerebral concussion in emergency rooms around the world makes it necessary to know its proper management to avoid its late sequelae, which traditionally compromise cognitive aspects of behavior. New evidence on potential neuroprotective treatments is being investigated.

Resumo

O presente artigo aborda, por meio de revisão bibliográfica, uma atualização acerca das novas definições e classificações da concussão cerebral, destacando seus mecanismos fisiopatológicos. A elevada prevalência da concussão cerebral nas salas de emergências de todo o mundo torna necessário o conhecimento do seu adequado manejo, a fim de se evitarem suas sequelas tardias, que tradicionalmente comprometem aspectos cognitivos do comportamento. Novas evidências sobre potenciais tratamentos neuroprotetores estão sendo investigadas.

 
  • References

  • 1 Bogousslavsky J, Tatu L. French neuropsychiatry in the Great War: between moral support and electricity. J Hist Neurosci 2013; 22 (02) 144-154
  • 2 Toledo E, Lebel A, Becerra L. , et al. The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Biobehav Rev 2012; 36 (06) 1510-1531
  • 3 McCrory P. Sports concussion and the risk of chronic neurological impairment. Clin J Sport Med 2011; 21 (01) 6-12
  • 4 Sharp DJ, Jenkins PO. Concussion is confusing us all. Pract Neurol 2015; 15 (03) 172-186
  • 5 Kutcher JS, Giza CC. Sports concussion diagnosis and management. Continuum (Minneap Minn) 2014; 20 (6 Sports Neurology): 1552-1569
  • 6 Bazarian JJ, McClung J, Shah MN, Cheng YT, Flesher W, Kraus J. Mild traumatic brain injury in the United States, 1998--2000. Brain Inj 2005; 19 (02) 85-91
  • 7 Koepsell TD, Rivara FP, Vavilala MS. , et al. Incidence and descriptive epidemiologic features of traumatic brain injury in King County, Washington. Pediatrics 2011; 128 (05) 946-954
  • 8 McCrea M, Hammeke T, Olsen G, Leo P, Guskiewicz K. Unreported concussion in high school football players: implications for prevention. Clin J Sport Med 2004; 14 (01) 13-17
  • 9 Clay MB, Glover KL, Lowe DT. Epidemiology of concussion in sport: a literature review. J Chiropr Med 2013; 12 (04) 230-251
  • 10 Ropper AH, Gorson KC. Clinical practice. Concussion. N Engl J Med 2007; 356 (02) 166-172
  • 11 Giza CÇ, Maria NS, Hovda DA. N-methyl-D-aspartate receptor subunit changes after traumatic injury to the developing brain. J Neurotrauma 2006; 23 (06) 950-961
  • 12 Siopi E, Cho AH, Homsi S. , et al. Minocycline restores sAPPα levels and reduces the late histopathological consequences of traumatic brain injury in mice. J Neurotrauma 2011; 28 (10) 2135-2143
  • 13 Chen G, Shi J, Hu Z, Hang C. Inhibitory effect on cerebral inflammatory response following traumatic brain injury in rats: a potential neuroprotective mechanism of N-acetylcysteine. Mediators Inflamm 2008; 2008: 716458
  • 14 Yu F, Wang Z, Tchantchou F, Chiu CT, Zhang Y, Chuang DM. Lithium ameliorates neurodegeneration, suppresses neuroinflammation, and improves behavioral performance in a mouse model of traumatic brain injury. J Neurotrauma 2012; 29 (02) 362-374
  • 15 Koenigs M, Huey ED, Raymont V. , et al. Focal brain damage protects against post-traumatic stress disorder in combat veterans. Nat Neurosci 2008; 11 (02) 232-237
  • 16 Hutson CB, Lazo CR, Mortazavi F, Giza CÇ, Hovda D, Chesselet MF. Traumatic brain injury in adult rats causes progressive nigrostriatal dopaminergic cell loss and enhanced vulnerability to the pesticide paraquat. J Neurotrauma 2011; 28 (09) 1783-1801
  • 17 Giza CÇ, Hovda DA. The new neurometabolic cascade of concussion. Neurosurgery 2014; 75 (04) (Suppl. 04) S24-S33
  • 18 Smith DH, Chen XH, Pierce JES. , et al. Progressive atrophy and neuron death for one year following brain trauma in the rat. J Neurotrauma 1997; 14 (10) 715-727
  • 19 Wan C, Chen J, Hu B. , et al. Downregulation of UBE2Q1 is associated with neuronal apoptosis in rat brain cortex following traumatic brain injury. J Neurosci Res 2014; 92 (01) 1-12
  • 20 Hawkins BE, Krishnamurthy S, Castillo-Carranza DL. , et al. Rapid accumulation of endogenous tau oligomers in a rat model of traumatic brain injury: possible link between traumatic brain injury and sporadic tauopathies. J Biol Chem 2013; 288 (23) 17042-17050
  • 21 Magnoni S, Esparza TJ, Conte V. , et al. Tau elevations in the brain extracellular space correlate with reduced amyloid-β levels and predict adverse clinical outcomes after severe traumatic brain injury. Brain 2012; 135 (Pt 4): 1268-1280
  • 22 Johnson VE, Stewart W, Smith DH. Axonal pathology in traumatic brain injury. Exp Neurol 2013; 246: 35-43
  • 23 Tang-Schomer MD, Johnson VE, Baas PW, Stewart W, Smith DH. Partial interruption of axonal transport due to microtubule breakage accounts for the formation of periodic varicosities after traumatic axonal injury. Exp Neurol 2012; 233 (01) 364-372
  • 24 Prins ML, Hales A, Reger M, Giza CÇ, Hovda DA. Repeat traumatic brain injury in the juvenile rat is associated with increased axonal injury and cognitive impairments. Dev Neurosci 2010; 32 (5-6): 510-518
  • 25 Longhi L, Saatman KE, Fujimoto S. , et al. Temporal window of vulnerability to repetitive experimental concussive brain injury. Neurosurgery 2005; 56 (02) 364-374 , discussion 364–374
  • 26 Stulemeijer M, Vos PE, van der Werf S, van Dijk G, Rijpkema M, Fernández G. How mild traumatic brain injury may affect declarative memory performance in the post-acute stage. J Neurotrauma 2010; 27 (09) 1585-1595
  • 27 Damiani D, Baptistini BÇ, Damiani D. Impacto do traumatismo cranioencefálico nas funções adeno e neuroipofisárias. Pediatr Mod 2008; 44 (05) 186-191
  • 28 Milroy G, Dorris L, McMillan TM. Sleep disturbances following mild traumatic brain injury in childhood. J Pediatr Psychol 2008; 33 (03) 242-247
  • 29 Yılmaz S, Pekdemir M, Sarısoy HT, Yaka E. Post-traumatic cerebral infarction: a rare complication in a pediatric patient after mild head injury. Ulus Travma Acil Cerrahi Derg 2011; 17 (02) 186-188
  • 30 Landi A, Marotta N, Mancarella C, Marruzzo D, Salvati M, Delfini R. Basal ganglia stroke due to mild head trauma in pediatric age - clinical and therapeutic management: a case report and 10 year literature review. Ital J Pediatr 2011; 37: 2
  • 31 Evans RW. Persistent post-traumatic headache, postconcussion syndrome, and whiplash injuries: the evidence for a non-traumatic basis with an historical review. Headache 2010; 50 (04) 716-724
  • 32 Levy D, Strassman AM, Burstein R. A critical view on the role of migraine triggers in the genesis of migraine pain. Headache 2009; 49 (06) 953-957
  • 33 Damiani D, Gonçalves VP, Kuhl L, Aloi PH, Nascimento AM. Aspectos funcionais do cerebelo: o fim de um dogma. Arq Bras Neurocir 2016; 35: 39-44
  • 34 Tator CH. Concussions and their consequences: current diagnosis, management and prevention. CMAJ 2013; 185 (11) 975-979
  • 35 Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBlieux PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343 (02) 100-105
  • 36 Stiell IG, Wells GA, Vandemheen K. , et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001; 357 (9266): 1391-1396
  • 37 Smits M, Dippel DW, de Haan GG. , et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT scanning in patients with minor head injury. JAMA 2005; 294 (12) 1519-1525
  • 38 Echlin PS, Tator CH, Cusimano MD. , et al. A prospective study of physician-observed concussions during junior ice hockey: implications for incidence rates. Neurosurg Focus 2010; 29 (05) E4
  • 39 Wetjen NM, Pichelmann MA, Atkinson JL. Second impact syndrome: concussion and second injury brain complications. J Am Coll Surg 2010; 211 (04) 553-557
  • 40 Blostein P, Jones SJ. Identification and evaluation of patients with mild traumatic brain injury: results of a national survey of level I trauma centers. J Trauma 2003; 55 (03) 450-453
  • 41 Sakas DE, Whitwell HL. Neurological episodes after minor head injury and trigeminovascular activation. Med Hypotheses 1997; 48 (05) 431-435
  • 42 Ryan LM, Warden DL. Post concussion syndrome. Int Rev Psychiatry 2003; 15 (04) 310-316
  • 43 Mittenberg W, Canyock EM, Condit D, Patton C. Treatment of post-concussion syndrome following mild head injury. J Clin Exp Neuropsychol 2001; 23 (06) 829-836
  • 44 Fralick M, Thiruchelvam D, Tien HÇ, Redelmeier DA. Risk of suicide after a concussion. CMAJ 2016; 188 (07) 497-504
  • 45 Giza CÇ, Difiori JP. Pathophysiology of sports-related concussion: an update on basic science and translational research. Sports Health 2011; 3 (01) 46-51
  • 46 Baugh CM, Kroshus E. Concussion management in US college football: progress and pitfalls. Concussion 2016; 1 (01) CNC6
  • 47 Giza CÇ, Kutcher JS, Ashwal S. , et al. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80 (24) 2250-2257
  • 48 Neal MT, Wilson JL, Hsu W, Powers AK. Concussions: What a neurosurgeon should know about current scientific evidence and management strategies. Surg Neurol Int 2012; 3: 16
  • 49 Schouten JW. Neuroprotection in traumatic brain injury: a complex struggle against the biology of nature. Curr Opin Crit Care 2007; 13 (02) 134-142
  • 50 Lulic D, Burns J, Bae EÇ, van Loveren H, Borlongan CV. A review of laboratory and clinical data supporting the safety and efficacy of cyclosporin A in traumatic brain injury. Neurosurgery 2011; 68 (05) 1172-1185 , discussion 1185–1186
  • 51 Hua F, Wang J, Ishrat T. , et al. Genomic profile of Toll-like receptor pathways in traumatically brain-injured mice: effect of exogenous progesterone. J Neuroinflammation 2011; 8: 42