Return to Play Following Brain Injury

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Abstract
Concussion is derived from the Latin Concussus, which means “to shake violently.” Initially it was thought to produce only a temporary disturbance of brain function due to neuronal, chemical, or neuroelectrical changes without gross structural change. We now know that structural damage with loss of brain cells does occur with some concussions. In the last several years, the neurobiology of cerebral concussion has been advanced, predominantly in animal studies but also in studies in man. It has become clear that in the minutes to days following concussive brain injury, that brain cells that are not irreversibly destroyed, remain alive, but in a vulnerable state. These cells are particularly vulnerable to minor changes in cerebral blood flow and/or increases in intracranial pressure and especially anoxia. Animal studies have shown that during this period of vulnerability, which may last as long as a week, a minor reduction in cerebral blood flow that would normally be well tolerated, now produces extensive neuronal cell loss (Lee, Lifshitz et al., 1955; 480 Lifshitz, Pinanong et al., 1955; Jenkins, Marmarou et al., 1986; Jenkins, Moszynski et al., 1989; Sutton, Hovda et al., 1994).

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