Sports-related concussions are common during athletic events. Prompt recognition and diagnosis at the time of impact are crucial to prevent additional injury. Sideline screening and comprehensive evaluation using multimodal tools, such as the Sport Concussion Assessment Tool, can help identify at-risk athletes. Once a concussed player is identified or when a diagnosis is unclear, the athlete must be removed from further play. Severe cases should be referred to an emergency department or urgent care setting. Providing anticipatory guidance can help reduce the risk of additional brain injury and promote optimal recovery.
Sport-related concussion affects approximately 1.6 to 3.8 million athletes annually in the United States. Management has evolved from historical practices of strict cognitive and physical rest to evidence-based approaches emphasizing early, individualized, active rehabilitation. Most adults recover within approximately 14 days, while children and adolescents may require up to 4 weeks, with initial symptom burden representing the strongest predictor of recovery duration. Early, progressive aerobic activity initiated within 24 to 72 hours postinjury accelerates recovery compared to prolonged rest.
Since the original descriptions by Giza and Hovda of the acute neurometabolic cascade of concussion 25 years ago, there has been a broad evolution in the understanding of concussion and other types of traumatic brain injuries (TBI) to include not only acute, neuro, and metabolic aspects of pathophysiology but also the impact and risk of TBI on numerous molecular and cellular processes, neural networks and physiologic systems. This review summarizes research and clinical advancements in the neurometabolic cascade of TBI, recognizing that evolution beyond this postinjury neuronal perspective is key to unlocking improved therapies and reduction of long-term risk.
Autonomic dysfunction, or dysautonomia, is increasingly being recognized as a complication of concussion. While the symptoms can overlap with other postconcussion sequelae, it is important to distinguish the patient suffering from postconcussion dysautonomia in order to provide proper symptomatic management and aid in recovery. This narrative review will summarize the available, high-quality literature regarding autonomic testing abnormalities in patients with a history of concussion, interpret these findings in the context of the sympathetic and parasympathetic divisions of the autonomic nervous system, and discuss an approach to managing postconcussion dysautonomia.
Peripheral nerve injuries in athletes can occur through a variety of mechanisms both in the acute and chronic setting. Patterns of injuries can be identified based on the specific sport and the stresses that sport places on the body, but the diagnosis depends on a thorough history and physical examination. The history in combination with electrodiagnostics and imaging allows for localization of the injury and assessment of the severity. Many nerve injuries in athletes are mild, but severe injuries can occur. Management depends on the severity of the injury and the clinical course.
Sports-related concussion is a common condition that is managed in the outpatient setting. Here we review screening, diagnosis, tracking recovery, and management in the acute (first 48 hours), subacute (2 days-4 weeks), and persistent symptom (>4 weeks) stages. Management focuses on early incremental return to activities of daily living, light aerobic activity with graded return to full play, and symptom-targeted strategies. We place particular focus on posttraumatic headache, which is the most common symptom to persist in concussion.
Neuropsychological assessment plays a critical role in sport-related concussion management, providing objective data to support diagnosis, monitor recovery, and guide return-to-learn and return-to-play decisions. This review summarizes evidence and expert consensus on baseline and post-injury testing, highlights psychometric and practical limitations of routine baseline programs, and underscores the importance of multimodal assessment, biopsychosocial factors, and neuropsychologist involvement in complex or persistent cases, including concerns about chronic traumatic encephalopathy and traumatic encephalopathy syndrome.
Headache is a common neurologic problem affecting many members of the population, including athletes. In athletes, headache is most likely a primary disorder, such as tension-type headache or migraine; however, athletes can be at a higher risk of secondary causes, such as posttraumatic headache. Thus, based on the headache history, clinical examination, and presence of headache red flags, a focused diagnostic evaluation is recommended, ranging from blood tests to neuroimaging, depending on the headache characteristics. Regardless of the primary or secondary headache disorder diagnosis, treatment options should be carefully considered due to the competitive requirements of athletes.
Combat sports athletes inherently challenge their nervous system and put strain on its reserve. Brain fitness is a growing concept and field of research in neurology but particularly in sports neurology for the purpose of improving athlete performance and longevity. The ways in which we can optimize brain fitness of combat sports athletes involves the categories of safe training/rest schedules, prefight and postfight examinations, nutrition/vitamin supplementation, and hydration. When sports neurologists consider at least these areas, it contributes to safe participation for these neurologically vulnerable athletes.
Vestibular symptoms are common after sports-related concussion and predict slower recovery and delayed return to play. This review provides a practical, clinical profile-guided approach for clinicians. Early screening focuses on Vestibular/Ocular Motor Screen, timed tandem gait, and positional testing for benign paroxysmal positional vertigo. A comprehensive neurovestibular examination and history help distinguish dizziness symptom profiles. Early vestibular rehabilitation, combined with cervical management and graded aerobic exercise, speeds recovery. Medications are adjuncts, particularly for vestibular migraine and persistent postural-perceptual dizziness.
