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BRAIN HEALTH
BRAIN HEALTH

Sport-Related Concussion: A brief overview

By Eliot Young, MD, FAAFP, CAQ-SM

ports-related concussion (SRC) affects millions of athletes every Diagnosis
year and is increasingly becoming a topic of interest and concern The diagnosis of concussion should consist of a detailed history
Sfor active individuals, parents and medical providers alike. While and a focused examination involving neurologic, vestibular, cervical
many of these injuries spontaneously resolve, some patients may experi- and oculomotor components.
ence prolonged effects. As such, they can be disruptive to work, school, History should be obtained from the patient as well as a close
social life and relationships. Medical providers should be aware of the observer, if possible, to fill in memory gaps if necessary. Loss of con-
typical signs and symptoms to avoid delayed diagnosis. The diagnosis sciousness is infrequent in SRC, while the most common symptoms
and management should be individualized, as each injury is unique in include dizziness, headache, “feeling in a fog” and balance problems.
its presentation and recovery. Most symptoms will be apparent immediately or within a few minutes,
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though occasionally they can be delayed up to 72 hours. Once con-
Definition/Epidemiology cussion is suspected, the person should be removed immediately from
SRCs are considered a form of mild traumatic brain injury occur- any potential secondary insult (e.g., an athlete should be removed from
ring during exercise or sports, which is “caused by a direct blow to the further sport that day). In Texas, UIL rules mandate this approach and
head, neck or body resulting in an impulsive force being transmitted to use the slogan “when in doubt, sit them out.”
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the brain.” It is estimated that 3.8 million concussions occur annually “Red flag” symptoms, if present, should prompt transport to an emer-
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in sport and recreation at all ages in the U.S.,7 of which nearly 50% gency room. These include seizure activity, midline neck tenderness, pro-
occur in those 18 years of age and younger. In fact, by the age of 16, longed loss of consciousness >1-minute, focal neurologic deficit, abnormal
20% of children will have experienced a traumatic brain injury. 22 pupillary exam, vomiting or deteriorating neurological exam.6
There seems to be a higher risk of concussion in girls within There are multiple screening tools and apps that can guide the
comparable sports (soccer, basketball), though the reason for this is evaluation and management of suspected concussion. Screening tools
unknown. The sports with the highest rates of concussion are boys’ such as the BESS (Balance Error Scoring System), King-Devick test
football and girls’ soccer, followed by boys’ lacrosse, boys’ ice hockey, and the SCAT (Sport Concussion Assessment tool) have undergone
boys’ wrestling and girls’ lacrosse. 7 validation and modification over time. The SCAT6 is the most recent
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12 SAN ANTONIO MEDICINE • June 2025