2013 年 36 巻 2 号 p. 119-128
Judo-related severe head injury in children and adolescents is a hot topic in the media and in society. Neurosurgeons are often involved in many other sports-related head injuries. The Committee of Sport Head Injury in the Japan Society of Neurotraumatology has studied to develop guideline for neurosurgeons how to manage the athletes with sports-related concussion or an intracranial structural lesion, and how to allow them to return to play.
Sports-related concussion includes not only transient unconsciousness and amnesia but also various somatic (e.g. headache), cognitive and emotional symptoms. The most concussions typically resolve in a short time, although the recovery may be longer over a week in children and adolescents. The Sports Concussion Assessment Tool (SCAT) is the standard method for evaluation of concussion. Repeated concussions may produce rapid catastrophic deterioration (second impact syndrome) or chronic traumatic encephalopathy presenting with cognitive dysfunction. Second impact syndrome may occur in association with acute subdural hematoma. In concussion patients with prolonged symptoms (e.g. headache), brain CT or MRI should be recommended to exclude an intracranial structural lesion such as thin subdural hematoma. Once concussion is diagnosed, an athlete should not be return to play in the same day. An athlete must be asymptomatic prior to return to play, and should take a graduated return to play protocol lasting around one week. Once an intracranial structural lesion (e.g. subdural hematoma) has been found after sport head injury, the athlete should not be allowed principally to return to play contact sports.