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Clinics in neurology and neurosurgery of sport: traumatic cerebral contusion
  1. G Davis1,
  2. D Marion2,
  3. B George3,
  4. O Hamel4,
  5. M Turner5,
  6. P McCrory6
  1. 1
    Cabrini Medical Centre, Malvern, Victoria, Australia
  2. 2
    Fusion Medical Education, LLC, Wakefield, Massachusetts, USA
  3. 3
    Hopital Lariboisi, University Paris VII, Paris, France
  4. 4
    Department of Neurosurgery, Hopital Lariboisi, University Paris VII, Paris, France
  5. 5
    British Horeseracing Authority, London, UK
  6. 6
    Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia
  1. Associate Professor P McCrory, Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia 3010; p.mccrory{at}unimelb.edu.au

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This case highlights the difficulties encountered in managing a sports player with traumatic brain injury. Fortunately, most head injuries in sport are minor and recover completely. Although the consensus definition1 of sports concussion emphasizes the lack of structural brain injury, this is not the case with more severe injuries.

The presence of acute abnormalities (eg, contusion, haemorrhage) on CT or MRI scans in such patients inherently pushes the nature and consequences of the injury higher up the spectrum of traumatic brain injury and standard sports concussion management guidelines may no longer apply.

The case described is one of mild TBI and not simple concussion. However, many elements of the management are common to both conditions, and for the sake of simplicity, we will accept, as have the faculty, that this is a case of concussion with a cerebral contusion.

CASE STUDIES: FRONTAL CONTUSION

Patient 1

A 26 year-old professional ice hockey player was celebrating his team’s victory at a local nightclub. He was hit over the head with a beer bottle and lost consciousness for 3 minutes. In the emergency department, he had neurologically fully recovered. His scalp laceration was sutured and a CT scan of the brain was performed, revealing a small frontal contusion. There was no associated skull fracture and the CT scan was otherwise unremarkable. He was advised to rest for 6 weeks and then underwent formal neurological and neuropsychological testing, which were normal. Repeat CT scan of the brain showed complete resolution of the contusion (fig 1). What recommendations do you make, based on the following considerations?

Figure 1

Patient 1: repeat axial CT brain scan performed at 6 weeks after injury and reported as normal.

(1) Can he return to ice hockey?

  1. If so, when?

  2. Are there any extra precautions you would take when he returns to competition?

  3. If he sustains a …

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