ABC of Sports Medicine: Head Injury In SportBMJ 1994; 308 doi: http://dx.doi.org/10.1136/bmj.308.6944.1620 (Published 18 June 1994) Cite this as: BMJ 1994;308:1620
- G McLatchie,
- B Jennett
Most sports related injuries are musculoskeletal, affecting limbs or trunk, and related to specific risks associated with particular sports. Head injuries by contrast can occur in many sports and, except those incurred during boxing, are accidental. Unlike other injuries, the effects of which are usually maximal at onset, injury to the head may precipitate a process of intracranial disorder that can convert a mild initial injury into a life threatening condition from secondary complications. Moreover, even mild injuries are often associated with considerable temporary disability, and repeated mild injuries can result in cumulative brian damage. Doctors on sports fields have to decide whether patients with head injury can resume play or, if not, what further immediate management is needed and when they can play again. The answers to these questions depend on a sensible balancing of risks.
Nature of damage to the brain
It is damage to the brain that matters when the head is hit. Injuries to the scalp or skull are important only as indicators of the possibility of underlying impact damage or of the risk of complications that could cause secondary brain damage. Either impact or secondary brain damage may be diffuse or focal, and this will influence the clinical features.
Primary brain damage Impact (or primary) damage can take two forms
(1) Cerebral contusions - Bruising on the brain surface due to the brain's impact with the overlying skull - are the commonest form of impact damage. Contusion may be focal underneath a fracture resulting from a focal impact, blunt or penetrating, or it may be diffuse, resulting from the brain as a whole being thrown against the rough interior surface of the skull and dural dividers. Diffuse contusion results when the head as a whole decelerates, usually by hitting the ground, in which case the contusions are usually bilateral, affecting the tips of both frontal and temporal poles regardless of where the …