Download PDF
Aktuelle Neurologie 2003; 30(10): 519-524
DOI: 10.1055/s-2003-45014
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Sport und das leichte Schädel-Hirn-Trauma

Sports and Mild Traumatic Brain InjuryM.  Holzgraefe1 , M.  Otto2 , Arbeitsgemeinschaft „Neurologie und Sport” in der Deutschen Gesellschaft für Neurologie
  • 1Kliniken für Neurologische Rehabilitation und Frührehabilitation, Asklepios Kliniken Schildautal, Seesen
  • 2Abteilung für Neurologie der Universität Göttingen
Further Information

Publication History

Publication Date:
01 December 2003 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Die Häufigkeit sportbedingter Schädel-Hirn-Traumen hängt von verschiedenen Faktoren ab: der Sportart, der Beliebtheit der Sportart in der Bevölkerung sowie den Regeln und Regelauslegungen. Schwere Schädel-Hirn-Traumen sind leicht zu diagnostizieren und das diagnostische sowie das therapeutische Vorgehen ist vorgegeben. Schwerer sind die Diagnose und das praktische Umgehen mit den viel häufigeren leichten Schädel-Hirn-Traumen. In der vorliegenden Arbeit wird das leichte Schädel-Hirn-Trauma im Sport bezüglich des klinischen Bildes, der notwendigen Diagnostik sowie der Frage der Wiederaufnahme des Sportes dargestellt. Abschließend wird das Problem der Spätschäden nach leichten, rezidivierenden Schädel-Hirn-Traumen, einem eventuell genetischen Risikoprofil und mögliche biochemische Marker zur Diagnostik und Einschätzung des Risikos für den Sport diskutiert.

Abstract

The frequency of sport-related traumatic brain injuries depends upon various factors: the type of sport and popularity of the sport in the general population, as well as the rules and their interpretation. Severe traumatic brain injuries can easily be diagnosed and guidelines exist for both their diagnosis and therapy. Difficulties arise in the diagnosis and practical management of mild head injuries. The following article deals with clinical presentation, mandatory diagnostic measures and eventual resumption of the sport following head injury. Finally, the problem of residual neurological deficits following repeated mild head injury and the question of genetic risk profiles as well biological markers for the diagnosis and evaluation of sport hazards are discussed.

Literatur

  • 1 Holzgraefe M, Rama B, Spoerri O. Gibt es sportartspezifische Schädel-Hirn-Traumen?.  Neurochirurgia. 1985;  28 161-163
    PubMedSearch in Google Scholar
  • 2 Centers for Disease Control . Sports-related recurrent brain injuries - United States.  JAMA. 1997;  277 1190-1191
    CrossrefPubMedSearch in Google Scholar
  • 3 Frommelt P. Neurologische Erkrankungen. In: Verband Deutscher Rentenversicherungsträger Sozialmedizinische Begutachtung in der gesetzlichen Rentenversicherung. Stuttgart; Fischer 1995: 409-451
    Search in Google Scholar
  • 4 Schürmeyer T, Hidding J, Herter T. Die Bedeutung des Schädel-Hirn-Traumas im Sport.  Dt Zeitschr Sportmed. 1983;  3 86-89
    PubMedSearch in Google Scholar
  • 5 Powell J W, BarberFoss K D. Traumatic brain injuries in high school athletes.  JAMA. 1999;  282 958-963
    CrossrefPubMedSearch in Google Scholar
  • 6 Cherington M. Hazards of bicycling: from handlebars to lightning.  Semin Neurol. 2000;  20 247-253
    Thieme ConnectPubMedSearch in Google Scholar
  • 7 Levy A S, Smith R H. Neurologic injuries in skiers and snowborders.  Semin Neurol. 2000;  20 233-245
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Keidel M, Poremba M. Schädel-Hirn-Trauma. In: Brandt T, Dichgans J, Diener HC (Hrsg) Therapie und Verlauf neurologischer Erkrankungen. Stuttgart, Berlin, Köln; Kohlhammer 1998: 569-586
    Search in Google Scholar
  • 9 Bailes J E, Cantu R C. Head injury in athletes.  Neurosurgery. 2001;  48 26-45; discussion 45 - 46
    PubMedSearch in Google Scholar
  • 10 Matser E J, Kessels A G, Lezak M D. et al . Neuropsychological impairment in amateur soccer players.  JAMA. 1999;  282 971-973
    CrossrefPubMedSearch in Google Scholar
  • 11 Kirkendall D T, Jordan S E, Garret W E. Heading and head injuries in soccer.  Sports Med. 2001;  31 369-386
    PubMedSearch in Google Scholar
  • 12 Aubry M, Cantu R, Dvorak J. et al . Summary and agreement statement of the 1st International Symposium on Concussion in Sport, Vienna 2001.  Clin J Sport Med. 2002;  12 6-11
    CrossrefPubMedSearch in Google Scholar
  • 13 Johnston K M, McCrory P, Mohtadi N G. et al . Evidence-Based review of sport-related concussion: clinical science.  Clin J Sport Med. 2001;  11 150-159
    CrossrefPubMedSearch in Google Scholar
  • 14 McCrory P, Johnston K M, Mohtadi N G. et al . Evidence-based review of sport-related concussion: basic science.  Clin J Sport Med. 2001;  11 160-165
    CrossrefPubMedSearch in Google Scholar
  • 15 Leclerc S, Lassonde M, Delaney J S. et al . Recommendations for grading of concussion in athletes.  Sports Med. 2001;  31 629-636
    PubMedSearch in Google Scholar
  • 16 Collins M W, Grindel S H, Lovell M R. et al . Relationship between concussions and neuropsychological performance in college football players.  JAMA. 1999;  282 964-970
    CrossrefPubMedSearch in Google Scholar
  • 17 Cantu R C. Head injuries in sport.  Br J Sports Med. 1996;  30 289-296
    CrossrefPubMedSearch in Google Scholar
  • 18 Fisher C M. Concussion amnesia.  Neurology. 1966;  16 826-830
    PubMedSearch in Google Scholar
  • 19 Yarnell P R, Lynch S. Retrograde memory immediately after concussion.  Lancet. 1970;  1 863-864
    PubMedSearch in Google Scholar
  • 20 Practice Parameter: The management of concussion in sports (Summary statement). Neurology 1997 48: 581-585
    Search in Google Scholar
  • 21 Tellier A, Della Malva L C, Wimm A C. et al . Mild head injury: a misnomer.  Brain Injury. 1999;  13 463-475
    CrossrefPubMedSearch in Google Scholar
  • 22 Kelly J P. Traumatic brain injury and concussion in sports.  JAMA. 1999;  282 989-991
    CrossrefPubMedSearch in Google Scholar
  • 23 McCrea M, Kelly J P, Randolph C. et al . Immediate neurocognitive effects of concussion.  Neurosurgery. 2002;  50 1032-1040; discussion 1040 - 1042
    PubMedSearch in Google Scholar
  • 24 Downs D S, Abwender D. Neuropsychological impairment in soccer athletes.  J Sports Med Phys Fitness. 2002;  42 103-107
    PubMedSearch in Google Scholar
  • 25 Saunders R L, Harbough R E. The second impact syndrome in catastrophic contact-sports trauma.  JAMA. 1984;  252 538-539
    CrossrefPubMedSearch in Google Scholar
  • 26 Schneider R C, Gosch H H, Norrell H. et al . Vascular insufficiency and differential distortion of brain and cord caused by caricomedullary football injuries.  J Neurosurg. 1970;  33 363-375
    PubMedSearch in Google Scholar
  • 27 Ettlin T M, Kischaka U, Reidman S. et al . Cerebral symptoms after whiplash injury of the neck: A prospective clinical and neuropsychological study of whiplash injury.  J Neurol Neurosurg Psychiatry. 1992;  55 943-948
    CrossrefPubMedSearch in Google Scholar
  • 28 Kelly J P, Nichols J S, Filley C M. et al . Concussion in sports: Guidelines for the prevention of catastrophic outcome.  JAMA. 1991;  266 2867-2869
    CrossrefPubMedSearch in Google Scholar
  • 29 Cantu R C, Mueller F O. Catastrophic football injuries: 1977 - 1998.  Neurosurgery. 2000;  47 673-677
    PubMedSearch in Google Scholar
  • 30 Kelly J P. Concussions in sports and recreation.  Semin Neurol. 2000;  20 165-171
    Thieme ConnectPubMedSearch in Google Scholar
  • 31 Kelly J P, Rosenberg J H. The diagnosis and management of concussion in sports.  Neurology. 1997;  48 575-579
    CrossrefPubMedSearch in Google Scholar
  • 32 McCrea M, Kelly J P, Randolph C. et al . Standardized assessment of concussion (SAC): onsite mental status evalutation of the athlete.  J Head Trauma Rehabil. 1998;  13 27-35
    CrossrefPubMedSearch in Google Scholar
  • 33 Holzgraefe M. Sportmedizinische Beratung nach Schädel-Hirn-Trauma.  Dt Zeitschr f Sportmed. 1996;  47 97-98
    PubMedSearch in Google Scholar
  • 34 Lovell M R, Collins M W. Neuropsychological assessment of college football players.  J Head Trauma Rehabil. 1998;  13 9-26
    CrossrefPubMedSearch in Google Scholar
  • 35 Bleiberg J, Halpern E L, Reeves D. et al . Future directions for the neuropsychological assessment of sports concussion.  J Head Trauma Rehabil. 1998;  13 36-44
    PubMedSearch in Google Scholar
  • 36 Lovell M R, Iverson G L, Collin M W. et al . Does loss of consciousness predict neurological decrements of the concussion?.  Clin J Sport Med. 1999;  9 193-198
    PubMedSearch in Google Scholar
  • 37 Maroon J C, Lowell M R, Norwig J. et al . Cerebral concussion in athletes: Evaluation and neuropsychological testing.  Neurosurgery. 2000;  47 659-669
    PubMedSearch in Google Scholar
  • 38 Johnston K M, Ptito A, Chankowsky J, Chen J K. New frontiers in diagnostic imaging in concussive head injury.  Clin J Sport Med. 2001b;  11 166-175
    CrossrefPubMedSearch in Google Scholar
  • 39 Bohnen N, Twijnstra A, Jolles J. Posttraumatic and emotional symptoms in different subgroups of patients with mild head injury.  Brain Inj. 1992;  6 481-487
    PubMedSearch in Google Scholar
  • 40 Dikmen S S, McLean A, Temkin N. et al . Neuropsychological and psychosocial consequences of minor head injury.  J Neurol Neurosurg Psychiatry. 1992;  49 1227-1232
    PubMedSearch in Google Scholar
  • 41 Holzgraefe M, Lemme W, Funke W. et al . The significance of diagnostic imaging in acute and chronic brain damage in boxing: A prospective study in amateur boxing using magnetic resonance imaging (MRI).  Int J Sports Med. 1992;  13 616-620
    PubMedSearch in Google Scholar
  • 42 Roberts A H. Brain Damage in Boxers. London; Pitman 1969
    Search in Google Scholar
  • 43 Jordan B D. Chronic traumatic brain injury associated with boxing.  Semin Neurol. 2000;  20 179-185
    Thieme ConnectPubMedSearch in Google Scholar
  • 44 Unterharnscheidt F. A neurologists's reflection on Boxing. IV. Late and permanent brain damage.  Rev Neur. 1995;  23 1013-1026
    PubMedSearch in Google Scholar
  • 45 Martland H S. Punch drunk.  JAMA. 1928;  91 1103-1107
    CrossrefPubMedSearch in Google Scholar
  • 46 Moseley I F. The neuroimaging evidence for chronic brain damage due to boxing.  Neuroradiology. 2000;  42 1-8
    CrossrefPubMedSearch in Google Scholar
  • 47 Jordan B D, Kanik A B, Horwich M S. et al . Apolipoprotein E epsilon 4 and fatal cerebral amyloid angiopathy associated with dementia pugilistica (letter).  Ann Neurol. 1995;  38 698-699
    CrossrefPubMedSearch in Google Scholar
  • 48 Jordan B D, Relkin N R, Ravdin L D. et al . Apolipoprotein E epsilon 4 associated with chronic traumatic brain injury in boxing.  JAMA. 1997;  278 136-140
    CrossrefPubMedSearch in Google Scholar
  • 49 Selkoe D J. Alzheimer's disease: genes, proteins, and therapy.  Physiol Rev. 2001;  81 741-766
    PubMedSearch in Google Scholar
  • 50 Haglund Y, Edman G, Murelius O. et al . Does Swedish amateur boxing lead to chronic brain damage? 1. A retrospective medical, neurological and personality trait study.  Acta Neurol Scand. 1990;  82 245-252
    PubMedSearch in Google Scholar
  • 51 Otto M, Holthusen S, Bahn E. et al . Boxing and running lead to rise in serum levels of S-100 protein.  Int J Sports Med. 2000;  21 551-555
    Thieme ConnectPubMedSearch in Google Scholar
  • 52 Waterloo K, Ingebrigtsen T, Romner B. Neuropsychological function in patients with inceased serum levels of protein s-100 after minor head injury.  Acta Neurochir (Wien). 1997;  139 26-32
    CrossrefPubMedSearch in Google Scholar
  • 53 Ingebrigtsen T, Waterloo K, Jacobsen E A. et al . Traumatic brain damage in minor head injury: relation of serum S-100 protein measurements to magnetic resonance imaging and neurobehavioral outcome.  Neurosurgery. 1999;  45 468-475; discussion 475 - 476
    PubMedSearch in Google Scholar
  • 54 Boden B P, Kirkendall D T, Garrett W E. Concussion incidence in elite college soccer players.  Am J Sports Med. 1998;  26 238-241
    PubMedSearch in Google Scholar
  • 55 Matser J T, Kessels A G, Jordan B D. et al . Chronic traumatic brain injury in professional soccer players.  Neurology. 1998;  51 791-799
    CrossrefPubMedSearch in Google Scholar
  • 56 Baroff G S. Is heading a soccer ball injurious to brain function?.  J Head. 1998;  13 45-52
    PubMedSearch in Google Scholar
  • 57 Naunheim R S, Ryden A, Standeven J. et al . Does soccer headgear attenuate the impact when heading a soccer ball?.  Acad Emerg Med. 2003;  10 85-90
    CrossrefPubMedSearch in Google Scholar
  • 58 Putukian M, Echemendia R J, Mackin S. The acute neuropsychological effects of heading in soccer: a pilot study.  Clin J Sport Med. 2000;  10 104-110
    PubMedSearch in Google Scholar
  • 59 Kutner K C, Erlanger D M, Tsai J. et al . Lower cognitive performance of Trauma Rehabil older football players possessing apolipoprotein E ε4.  Neurosurgery. 2000;  47 651-658
    PubMedSearch in Google Scholar
  • 60 Heitkamp H C, Horstmann T, Schalinski H. In-line skating: injuries and prevention.  J Sports Med Phys Fitness. 2000;  40 247-253
    PubMedSearch in Google Scholar

Prof. Dr. med. Manfred Holzgraefe

Kliniken für Neurologische Rehabilitation und Frührehabilitation · Asklepios Kliniken Schildautal

Karl-Herold-Straße 1

38273 Seesen

Email: M.Holzgraefe@asklepios.com