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J Intern Med. 2018 Nov 27. doi: 10.1111/joim.12863. [Epub ahead of print]

Head trauma in sports - clinical characteristics, epidemiology and biomarkers.

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Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.
Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.
UK Dementia Research Institute at UCL, London, UK.
Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.
Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Huddinge, Sweden.
Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Sweden.
Neurological Institute, Cleveland Clinic, Las Vegas, NV, USA.
Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia.
Division of Anaesthesia, University of Cambridge, Addenbrookes Hospital, Cambridge, Cambs, UK.
Centre for Functional Brain Imaging, Umeå University, Umeå, Sweden.
Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.
Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.
Department of Neurology, University of Turku, Turku, Finland.


Traumatic brain injury (TBI) is clinically divided into a spectrum of severities, with mild TBI being the least severe form and a frequent occurrence in contact sports, such as ice hockey, American football, rugby, horse riding and boxing. Mild TBI is caused by blunt nonpenetrating head trauma that causes movement of the brain and stretching and tearing of axons, with diffuse axonal injury being a central pathogenic mechanism. Mild TBI is in principle synonymous with concussion; both have similar criteria in which the most important elements are acute alteration or loss of consciousness and/or post-traumatic amnesia following head trauma and no apparent brain changes on standard neuroimaging. Symptoms in mild TBI are highly variable and there are no validated imaging or fluid biomarkers to determine whether or not a patient with a normal computerized tomography scan of the brain has neuronal damage. Mild TBI typically resolves within a few weeks but 10-15% of concussion patients develop postconcussive syndrome. Repetitive mild TBI, which is frequent in contact sports, is a risk factor for a complicated recovery process. This overview paper discusses the relationships between repetitive head impacts in contact sports, mild TBI and chronic neurological symptoms. What are these conditions, how common are they, how are they linked and can they be objectified using imaging or fluid-based biomarkers? It gives an update on the current state of research on these questions with a specific focus on clinical characteristics, epidemiology and biomarkers.


biomarkers; clinical characteristics; epidemiology; head trauma; traumatic brain injury


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