World Cup Soccer; a Major League Soccer Superstar's Career-Ending Injury, Concussion; and WORLD NEUROSURGERY: A Common Thread

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<ul><li><p>Forum</p><p>WCoRo</p><p>Fparlarfes(FISpadis</p><p>FZusetnattioandmepromeaw</p><p>Winda dCosymptoms, including physical signs (e.g., loss of consciousness,amnesia), behavioral changes (e.g., irritability), cognitive impair-ment (e.g., slowed reaction times), sleep disturbances (e.g., drows-</p><p>ine(e.tiotiomabypro</p><p>Cresgoain wbe</p><p>Imeaduascon</p><p>Tcondotheheatial</p><p>Although much is currently understood about concussion, wehave barely begun to fully appreciate the pathophysiology and bio-mechanical forces that produce this condition and possible conse-</p><p>Key C C P S T</p><p>AbbFIF</p><p>22wordshronic Traumatic Encephalopathyoncussionost Concussion Syndromeoccerraumatic Brain Injury</p><p>reviations and AcronymsA: Fdration Internationale de Football Association</p><p>From the Center for the Study of Traumatic Encephalopathy and Department ofNeurosurgery, Boston University School of Medicine, Boston, Massachusetts, USA</p><p>To whom correspondence should be addressed: Robert C. Cantu, M.A., M.D.[E-mail:]</p><p>Citation: World Neurosurg. (2010) 74, 2/3:224-225.DOI: 10.1016/j.wneu.2010.07.023</p><p>Journal homepage:</p><p>Available online:</p><p>1878-8750/$ - see front matter 2010 Published by Elsevier Inc.</p><p>4 WORLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.07.023orld Cup Soccer; a Major League Soccer Sncussion; and WORLD NEUROSURGERY: A Cobert C. Cantu</p><p>or nearly a month in June and July, 2010, we were treated tothe grandest spectacle in participation sport, played on theworld stagebeforeunbelievablemedia coverage aswell as fan</p><p>ticipation coming from all over the world. International sportsgest participation event, soccer, has been played by the best pro-sionals at the Fdration Internationale de Football AssociationFA) World Cup in South Africa. The nal was an epic battle, within winning in electrifying fashion 1-0 over the understandablytraught The Netherlands.IFA, the governing body for this event, is headquartered in</p><p>rich, Switzerland, in a surreally beautiful modern building andting. I cannot think of FIFA without remembering the three Inter-ional Concussion Conferences that FIFA, along with the Interna-nal Ice Hockey Federation, International Olympic Committee,most recently the International Rugby Union, sponsored. These</p><p>etings, held initially in Vienna in 2001, Prague in 2004, and ap-priately at FIFA headquarters in 2008, and the consensus state-nts from these meetings dramatically advanced concussionareness, understanding, and management (1, 4, 5, 11).</p><p>e now recognize that a concussion is a traumatic brain injuryucedby an impulsive force transmitted to thehead resulting fromirect or indirect impact to the head, face, neck, or elsewhere (9).ncussions may present with a wide range of clinical signs andRobert C. Cantu, M.A., M.D.Clinical Professor, Department of Neurosurgery</p><p>Co-Director of the Neurological Sports Injury CenterBrigham &amp; Womens Hospital</p><p>Center for the Study of Traumatic EncephalopathyBoston University School of Medicine</p><p>rstars Career-Ending Injury,on Thread</p><p>ss), somatic symptoms (e.g., headaches), cognitive symptomsg., feeling in a fog), and/or emotional symptoms (e.g., emo-nal lability) (4). Because these impairments in neurologic func-n often present with a rapid onset and resolve spontaneously,ny concussions are neither recognized by athletes nor observedcoaches or athletic trainers (7, 8, 10, 12). As a result, a largeportion of concussions are simply unreported.oncussions inmale and female soccer players typically occur as a</p><p>ult of head collisions in the act of heading the ball (40.5%), andlies are at highest risk (2). The incidence of reported concussionomen is higher than in men, and the rate of recovery appears to</p><p>slower at the high school level as compared to college (7).n soccer, rule changes may be in order because there is a specicchanism of injury associated with concussion, especially inlts. Because concussions typically occur in bothmen andwomen</p><p>a result of contact while heading the ball, limiting this type oftact may be appropriate (4).here are various types of headgear proposed to limit the effect ofcussion in soccer athletes. Although there have been nonran-</p><p>mized studies of the effect of headgear on head injuries in soccer,re have not been analytic studies specically looking at the role ofdgear on concussion rate or severity (3, 6). This remains a poten-area of interest.upemm</p></li><li><p>quences, postconcussion syndrome, and chronic traumatic enceph-alopathy.</p><p>TTwA lleaMaYet2 cpocarent</p><p>fortunately not as a participant but rather as a member of the TVmedia broadcasting events back to the United States.</p><p>RE</p><p>1.</p><p>2.</p><p>3. Cantu R: Consensus Statement on Concussion in</p><p>4.</p><p>5.</p><p>play a role in recovery from sports-related concus-</p><p>9.</p><p>10.</p><p>cussionhistory through thepreparticipation screen-ing and a symptom survey in young athletes. Clin J</p><p>CitaDOI</p><p>Jour</p><p>Ava</p><p>1878Inc.</p><p>FORUM</p><p>ROBERT C. CANTU A COMMON THREAD</p><p>WORLD NEUROSURGERY 74 [2/3]: 224-225, AUGUST/SEPTEMBER 2SportThe 3rd International Conference on Con-cussion, Zurich, November 2008. Neurosurgery 64:786-787, 2009.</p><p>Concussion (mild traumatic brain injury) and theteam physician: a consensus statement. Med SciSports Exerc 38:395-399, 2006.</p><p>Cusimano MD: Canadian minor hockey partici-pants knowledge about concussion. Can J NeurolSci 36:315-320, 2009.sion? A comparison of high school and collegiateathletes. J Pediatr 142:546-553, 2003.</p><p>Gessel LM, Fields SK, Collins CL, Dick RW, Com-stock RD: Concussions among United States highschool and collegiate athletes. J Athl Train 42:495-503, 2007.</p><p>McCrory P, Johnston K et al: Summary and agree-ment statement of the second international confer-010 www.WSport Med 18:235-240, 2008.</p><p>tion: World Neurosurg. (2010) 74, 2/3:224-225.: 10.1016/j.wneu.2010.07.023</p><p>nal homepage:</p><p>ilable online:</p><p>-8750/$ - see front matter 2010 Published by Elsevierwo years ago, the World Cup was a possible stage for Taylorellman, a superstarMajor League Soccer star in theUnited States.ethal scorer, Twellman still is the youngest and fastest player ingue history to reach the 100-goal plateau. At age 28, this formerjor League Soccer Most Valuable Players future seemed brilliant.his ninth concussion (including a grade 1, 3 grade 3, and 3 gradeoncussions) and perhaps a premature return led to a persistentstconcussion syndrome that derailed and then terminated hiseer. Showing himself to be a bright young man of multiple tal-s, Twellman was nonetheless at this summers World Cup, un-</p><p>So what is the connection between the World Cup, TaylorTwellman, concussion, and WORLD NEUROSURGERY? Concus-sion is experienced in and by all people. Just as WORLD NEURO-SURGERY takes neurosurgical knowledge global, so does theWorld Cup for soccer, reported by Twellman. Neurosurgical ex-periences are no longer primarily a U.S. experience, as was Twell-mans soccer, but is now on an international scale. The journal,like concussion, is in its infancy, like Twellmans media career,but with exploding implications for neurosurgical knowledgeand a worldwide audience.</p><p>FERENCES</p><p>Aubry M, Cantu R, Devorak J: Summary and agree-ment statement of the rst international conferenceon concussion in sport, Vienna 2001. PhysicianSportsmedicine 30:57-63, 2002.</p><p>Benson BW, Hamilton GM, Meeuwisse WH, Mc-Crory P, Dvorak J: Is protective equipment useful inpreventing concussion? A systematic review of theliterature. Br J SportsMed 43(Suppl 1):i56-67, 2009.</p><p>6. Delaney JS, Lacroix VJ, Leclerc S, Johnston KM:Concussions among university football and soccerplayers. Clin J Sport Med 12:331-338, 2002.</p><p>7. Delaney JS, Al-Kashmiri A, Drummond R, CorreaJA: The effect of protective headgear on head inju-ries and concussions in adolescent football (soccer)players. Br J Sports Med 42:110-115, discussion 115,2008.</p><p>8. FieldM,CollinsMW,LovellMR,Maroon J:Does age</p><p>ence on concussion in sport, Prague 2004. Br JSports Med 39:196-205, 2005.</p><p>11. McCrory P, Meeuwisse W, Johnston K, et al: Con-sensus statement on concussion in sportthe 3rdInternational Conference on concussion in sport,held in Zurich, November 2008. J Clin Neurosci 16:755-763, 2009.</p><p>12. Valovich McLeod TC, Bay RC, Heil J, McVeigh SD:Identication of sport and recreational activity 225</p><p>World Cup Soccer; a Major League Soccer Superstars Career-Ending Injury, Concussion; and WORLD NEUROSURGERY: A Common ThreadREFERENCES</p></li></ul>