TAKING ONE FOR THE TEAM
(loosely based on a case study from American Academy of Neurology website)
You are the coach of a college-level girls’ soccer team. During a highly contested match with your college’s
main rival, your star player went to “head the ball,” collided with another player, and struck her head. She
immediately fell to the ground. It appeared that she briefly lost consciousness. When you rushed to her aid,
she could speak but seemed dazed and confused. What do you do, and why?
Three days later, the player complains of a persistent headache and dizziness. Her mother describes her as
being easily agitated, and having difficulty concentrating on simple tasks such as reading the paper or watching
television. The overall trajectory of her condition since the event has been toward improvement, but she is not
back to “being herself” yet. She asks whether she can play in the final match of the season in two days’ time.
What do you tell her (and why)?
1
REFERENCE MATERIAL
(modified from http://www.sciencedaily.com/releases/2013/03/130318151409.htm)
With more than one million athletes now experiencing a concussion each year in the United States, the
American Academy of Neurology (AAN) has released an evidence-based guideline for evaluating and managing
athletes with concussion. This new guideline replaces the 1997 AAN guideline on the same topic. The new
guideline is published in the March 18, 2013, online issue of Neurology®, the medical journal of the American
Academy of Neurology, was developed through an objective evidence-based review of the literature by a
multidisciplinary committee of experts and has been endorsed by a broad range of athletic, medical and
patient groups.
The updated guideline recommends athletes with suspected concussion be immediately taken out of the game
and not returned until assessed by a licensed health care professional trained in concussion, return to play
slowly and only after all acute symptoms are gone. Athletes of high school age and younger with a concussion
should be managed more conservatively in regard to return to play, as evidence shows that they take longer to
recover than college athletes.
According to the guideline:
• Among the sports in the studies evaluated, risk of concussion is greatest in football and rugby, followed by
hockey and soccer. The risk of concussion for young women and girls is greatest in soccer and basketball.
• An athlete who has a history of one or more concussions is at greater risk for being diagnosed with another
concussion.
• The first 10 days after a concussion appears to be the period of greatest risk for being diagnosed with
another concussion.
• There is no clear evidence that one type of football helmet can better protect against concussion over
another kind of helmet. Helmets should fit properly and be well maintained.
• Licensed health professionals trained in treating concussion should look for ongoing symptoms (especially
headache and fogginess), history of concussions and younger age in the athlete. Each of these factors has been
linked to a longer recovery after a concussion.
• Risk factors linked to chronic neurobehavioral impairment in professional athletes include prior concussion,
longer exposure to the sport and having the ApoE4 gene.
• Concussion is a clinical diagnosis. Symptom checklists, the Standardized Assessment of Concussion (SAC),
neuropsychological testing (paper-and-pencil and computerized) and the Balance Error Scoring System may be
helpful tools in diagnosing and managing concussions but should not be used alone for making a diagnosis.
Signs and symptoms of a concussion include:
• Headache and sensitivity to light and sound
• Changes to reaction time, balance and coordination
• Changes in memory, judgment, speech and sleep
• Loss of consciousness or a “blackout” (happens in less than 10 percent of cases)
**IF IN DOUBT, SIT IT OUT**
2
Dr. Diaz-Asper
Tissue plasminogen activator (tPA)
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