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Neurophysiology of Concussion: Theoretical Perspectives

  • Nigel A. Shaw

Abstract

Cerebral concussion is both the most common and most puzzling type of traumatic brain injury (TBI). In this review brief historical data and theories of concussion which have been prominent during the past century are summarized. These are the vascular, reticular, centripetal, pontine cholinergic and convulsive hypotheses. It is concluded that only the convulsive theory is readily compatible with the neurophysiological data and can provide a totally viable explanation for concussion. The chief tenet of the convulsive theory is that since the symptoms of concussion bear a strong resemblance to those of a generalized epileptic seizure, then it is a reasonable assumption that similar pathobiological processes underlie them both. According to the present incarnation of the convulsive theory, the energy imparted to the brain by the sudden mechanical loading of the head may generate turbulent rotatory and other movements of the cerebral hemispheres and so increase the chances of a tissue-deforming collision or impact between the cortex and the boney walls of the skull. In this conception, loss of consciousness is not orchestrated by disruption or interference with the function of the brainstem reticular activating system. Rather, it is due to functional deafferentation of the cortex as a consequence of diffuse mechanically-induced depolarization and synchronized discharge of cortical neurons. A convulsive theory can also explain traumatic amnesia, autonomic disturbances and the miscellaneous collection of symptoms of the post-concussion syndrome more adequately than any of its rivals. In addition, the symptoms of minor concussion (i.e., being stunned, dinged, or dazed) are often strikingly similar to minor epilepsy such as petit mal. The relevance of the convulsive theory to a number of associated problems is also discussed.

Keywords

ANS, autonomic nervous system ARAS, ascending reticular activating system BSRF, brainstem reticular formation DAI, diffuse axonal injury MRI magnetic resonance imaging TBI, traumatic brain injury CBF, cerebral blood flow CSF, cerebrospinal fluid GSA, generalized seizure activity ICP, intracranial pressure 

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Nigel A. Shaw
    • 1
  1. 1.Department of Physiology, School of MedicineUniversity of AucklandAuckland 1New Zealand

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