Concussion Mechanisms and Pathophysiology

  • Jack Wilberger
  • Juan Ortega
  • Semyon Slobounov


Concussions are a frequent occurrence in athletic endeavors, its rate exceeding that occurring in the general population by 50 fold. The biomechanics and pathophysiology of concussion are still not well understood and may lead to potential significant sequelae from single or more commonly multiple concussions. Postconcussive symptoms, the second impact syndrome and the cumulative effects of concussions are all topics of interest in current concussion research in athletes and are leading to a more rational approach in determining policy aimed at returning athletes to their sport after a concussion. This chapter reviews current knowledge on the mechanisms, pathophysiology and sequelae of concussion in athletes.


Concussion Metabolic cascade Glucose utilization Ionic changes Epidural hematoma Subdural Hematoma Intracranial Hemorrhage 


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  1. Buckley, W.E. (1988). Concussions in College Football: A Multivariate Analysis. American Journal of Sports Medicine, 16, 51–56.PubMedGoogle Scholar
  2. Gerberich, S.G., Priest, J.D., Boen., J.R., et al. (1983). Concussion Incidences and Severity in Secondary School Varsity Football Players. American Journal of Public Health 73, 1370–1375.PubMedCrossRefGoogle Scholar
  3. Macciochi, S.N., Barth, J.T., Alves, W., et al. (1996). Neuropsychological Recovery and Functioning after Mild Head Injury in Collegiate Athletes. Neurosurgery, 39, 510–514CrossRefGoogle Scholar
  4. Guskiewicz, K., Weaver, N., Padua, D., Garrett, W. (2000). Epidemiology of Concussion in Collegiate and High School Football Players. American Journal of Sports Medicine, 28, 643–650.PubMedGoogle Scholar
  5. Powell, J, Barber-Foss, K. Traumatic Brain Injury in High School Athletes. JAMA 282:958–963, 1999.PubMedCrossRefGoogle Scholar
  6. Pellman, E.J, Powell, J.W, Viano, D.C., et al. (2004). Concussion in Professional Football: Epidemiological Features of Game Injuries and Review of the Literature-Part 3. Neurosurgery, 54, 81–96.PubMedCrossRefGoogle Scholar
  7. Shaw, N. (2002). The neurophysiology of concussion. Progress in Neurobiology, 67, 281–344.PubMedCrossRefGoogle Scholar
  8. Wojtys, E., Hovda, D., Landry, G., Boland, A., Lovell, M., McCrea, M., Minkoff, J. (1999). Concussion in sports: Current Concepts. American Journal of Sport Medicine, 27(5), 676–687.Google Scholar
  9. Barth, J., Freeman, J., Broshek, D., Varney, R. (2001). Acceleration-decelaration sport-related concussion: The gravity of it all. Journal of Athletic Training, 36(3), 253–256.PubMedGoogle Scholar
  10. Viano, D.C., Casson, I.R., Pellman, E.J. (2005). Concussion in Professional Football: Brain Responses by Finite Element Analysis-Part 9. Neurosurgery, 57, 891–916.PubMedCrossRefGoogle Scholar
  11. Hovda, D.A. (1995). Metabolic dysfunction. In: Narayan R.K., Wilberger, J.E., Povlishock J.T. (Eds). Neurotrauma. pp.1459–1478. McGraw Hill, NY.Google Scholar
  12. Doberstein, C., Velarde, F., Babie, H., Vovda, D.A. (1992). Changes in local cerebral blood flow following concussive brain injury. Society for Neuroscience, Abstract 18, 175. Anaheim, CA.Google Scholar
  13. Giza, C., & Hovda, D. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36(3), 228–235.PubMedGoogle Scholar
  14. Pfenninger, E.G., Reith, A., Breitig, D., et al. (1989). Early changes of intracranial pressure, perfusion pressure, and blood flow after acute head injury. Par 1. Journal of Neurosurgery, 70, 774–779.PubMedGoogle Scholar
  15. Yamakashi, I., & McIntosh, T.K. (1989). Effects of traumatic brain injury on regional cerebral blood flow in rats as measured with radiolabeled microspheres. Journal of Cerebral Blood Flow Metabolism, 9, 117–124.Google Scholar
  16. Bergsneider, M., Hovda, D.A., Shalman, E., et al., (1997). Cerebral hyperglucolysis following severe traumatic brain injury in humans: A positron emission tomography study. Journal of Neurosurgery, 86, 241–251.PubMedGoogle Scholar
  17. Ballanyi, K., Grafe, R., ten Bruggencate, G. (1987). Ion activities and potassium uptake mechanisms of glial cells in guinea-pig olfactory cortex slices. Journal of Physiology, 382, 159–174.PubMedGoogle Scholar
  18. Ip, E.Y., Zanier, E.R., Moore, A.H., Lee, S.M., Hovda, D.A. (2003). Metabolic, neurochemical, and histologic responses to vibrissa motor cortex stimulation after traumatic brain injury. Journal of Cerebral Blood Flow Metabolism, 23(8), 900–910.PubMedCrossRefGoogle Scholar
  19. Bergsneider, M., Hovda, D.A., Lee, S.M., et al., (2000). Dissociation of cerebral glucose metabolism and level of consciousness during the period of metabolic depression following human traumatic brain injury. Journal of Neurotrauma, 17, 389–401.PubMedGoogle Scholar
  20. Vespa, P., Bergsneider, M., Hattori, N., Wu, H.M., Huang, S.C., Martin, N.A., Glenn, T.C., McArthur, D.L., Hovda, D.A. (2005). Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. Journal of Cerebral Blood Flow Metabolism, 25(6), 663–774.CrossRefGoogle Scholar
  21. Soustiel, J.F., Glenn, T.C., Shik, V., Bascardin, J., Mahamid, E., Zaaroor, M. (2005). Monitoring of cerebral blood flow and metabolism in traumatic brain injury. Neurotrauma, 22(9), 955–965.CrossRefGoogle Scholar
  22. Viant, M.R., Lyeth, B.C., Miller, M.G., Berman, R.F. (2005). An NMR metabolomic investigation of early metabolic disturbances following traumatic brain injury in a mammalian model. NMR Biomedicine, 18(8), 507–571.CrossRefGoogle Scholar
  23. Parkin M, Hopwood S, Jones DA, Hashemi P, Landolt H, Fabricius M, Lauritzen M, Boutelle MG, Strong AJ. (2005). Dynamic changes in brain glucose and lactate in pericontusional areas of the human cerebral cortex, monitored with rapid sampling online microdialysis: relationship with depolarisation-like events. Journal of Cerebral Blood Flow Metabolism, 25(3), 402–413.PubMedCrossRefGoogle Scholar
  24. Wu, H.M., Huang, S.C., Hattori, N., Glenn, T.C., Vespa, P.M., Hovda, D.A., Bergsneider, M. (2004a). Subcortical white matter metabolic changes remote from focal hemorrhagic lesions suggest diffuse injury after human traumatic brain injury. Neurosurgery, 55(6), 1306–1315.PubMedCrossRefGoogle Scholar
  25. Wu, H.M., Huang, S.C., Hattori, N., Glenn, T.C., Vespa, P.M., Yu, C.L., Hovda, D.A., Phelps, M.E., Bergsneider, M. (2004b). Selective metabolic reduction in gray matter acutely following human traumatic brain injury. Journal of Neurotrauma, 21(2), 149–61.PubMedCrossRefGoogle Scholar
  26. Hattori, N., Huang, S.C., Wu, H.M., Yeh, E., Glenn, T.C., Vespa, P.M., McArthur, D., Phelps, M.E., Hovda, D.A., Bergsneider, M. (2003). Alteration of glucose utilization correlates with glasgow coma scale after traumatic brain injury. Journal of Nuclear Medicine, 44(11), 1709–1716.PubMedGoogle Scholar
  27. Takahashi, et al. 1981. H. Takahashi, H., S. Manaka, S., & S. Keiji, S. (1981). Changes in extracellular potassium concentration in cortex and brainstem during the acute phase of experimental closed head injury. Journal of Neurosurgery, 55, 708–717.PubMedGoogle Scholar
  28. Katayama, Y., Becker., D., Tamura, T., Hovda, D. (1990). Massive Increases in Extracellular Potassium and the Indiscriminate Release of Glutamate Following Concussive Brain Injury. Journal of Neurosurgery, 73, 889–900.PubMedCrossRefGoogle Scholar
  29. Nilsson et al., 1993. P. Nilsson, P., L. Hillered, L., Y. Olsson, Y., M. Sheardown, M., A.J. Hansen, A.J. (1993). Regional changes of interstitial K+ and Ca2+ levels following cortical compression contusion trauma in rats. Journal of Cerebral Blood Flow Metabolism, 13, 183–192.PubMedGoogle Scholar
  30. Samii, A., Badie, H., Fu, K., Lusher, R.R., Hovda, D.A. (1999). Effect of an N-type calcium channel antagonist (SNX 1111 Ziconotide) on calcium-45 accumulation following fluid perfusion injury. Journal of Neurotrauma, 16, 879–892.PubMedGoogle Scholar
  31. Maxwell, W.L, McCreath, B.J., Graham, D.I. Gennarelli, T.A., (1995). Cytochemical evidence for redistribution of membrane pump calcium-ATPase and ecto-Ca-ATPase activity, and calcium influx in myelinated nerve fibres of theoptic nerve after stretch injury. Journal of Neurocytology, 24, 925–942.PubMedCrossRefGoogle Scholar
  32. Saunders, R.L., Harbaugh, R.E. (1984). The second impact in catastrophic contact sports head trauma. JAMA: 252, 538–539.PubMedCrossRefGoogle Scholar
  33. Cantu, R.C. (1992). Second Impact Syndrome: Immediate Management. Physician and Sports Medicine, 20, 55–66.Google Scholar
  34. Cantu, R.C., & Voy, R. (1995). Second Impact Syndrome: A Risk in any Sport. Physician and Sports Medicine 23(6), 91–96.Google Scholar
  35. Junger, E.C., Newell., D.W., Grant., G.A., et al. (1997). Cerebral Autoregulation Following Minor Head Injury. Journal of Neurosurgery, 86, 425–432.PubMedCrossRefGoogle Scholar
  36. Martland, H.S. (192). Punch Drunk. JAMA 91, 1103–1107.Google Scholar
  37. Casson, I.R., Siegel, O., Sharm, R., et al. (1984). Brain Damage in Modern Boxers. JAMA 251, 2663–2667.PubMedCrossRefGoogle Scholar
  38. Casson, I.R., Sharon., R., Campbell., E.A., et al. (1982). Neurological and CT Evaluation of Knocked-Out Boxers. Journal of Neurology, Neurosurgery, 45, 170–174.Google Scholar
  39. Corsellis, J.A.N., Bruton, C.J., Freeman-Brown, D. (1973). The Aftermath of Boxing. Psychological Medicine, 3, 270–273.PubMedCrossRefGoogle Scholar
  40. Jordan, B.D., Relkin., N.R., Ravdin, L.D., et al. (1997). Apolipoprotein E e4 Associated with Chronic Traumatic Brain Injury in Boxing. JAMA 278, 136–140.PubMedCrossRefGoogle Scholar
  41. Matser, J.T., Kessels, A.G., Jordan, B.D., et al. (1998). Chronic Traumatic Brain Injury in Professional Soccer Players. Neurology, 51, 791–796.PubMedGoogle Scholar
  42. Sortland, O., Tysvaer., A.T. (1989). Brain Damage in Former Association Soccer Players. An Evaluation by Cerebral Computed Tomography. Neuroradiology, 31, 44–48.PubMedGoogle Scholar
  43. Tysvaer, A.T., Lochen, E.A. (1991). Soccer Injuries to the Brain: A neuropsychological study of Former Soccer Players. American Journal of Sports Medicine, 19, 56–60.PubMedGoogle Scholar
  44. Guskiewicz, K.M., McCrea, M., Marshall, S, W, et al. (2003). Cumulative Effects Associated with Recurrent Concussion in Collegiate Football Players: The NCAA Concussion Study. JAMA 19, 2604–2605.Google Scholar
  45. Iverson, G.L., Gaetz, ML, Lovell, M.R, Collins, M.W. (2004). Cumulative Effects of Concussion in Amateur Athletes. Brain Injury, 18, 433–443.PubMedCrossRefGoogle Scholar
  46. Wilberger, J.E., Maroon, J.C. (1989). Head Injury in Athletes. Clinical Sports Medicine, 8, 1–9.Google Scholar
  47. Bailes, J., & Hudson, V. (2001). Classification of sport-related head trauma: a spectrum of mild to severe injury. Journal of Athletic Training, 36(3), 236–243.PubMedGoogle Scholar
  48. Yuan, Y., Prough, D., Smith, T., DeWitt, D. (1998). The Effects of Traumatic Brain Injury on Regional l0.Cerebral Blood Flow in Rats. Journal of Neurotrauma 5, 289–301.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Jack Wilberger
    • 1
  • Juan Ortega
    • 2
  • Semyon Slobounov
    • 3
  1. 1.Department of Neurosurgery, Vice Dean Drexel University College of MedicineAllegheny General HospitalPittsburgh
  2. 2.Department of NeurosurgeryAllegheny General HospitalPittsburgh
  3. 3.Department of KinesiologyThe Pennsylvania State UniversityUniversity Park

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