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Abstract
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Mild traumatic brain injury (TBI) or concussion (the terms can be used interchangeably) is defined as a head trauma resulting in brief loss of consciousness and/or alteration of mental state.1 Today, this is a clinical diagnosis based on self-reported symptoms after blunt head trauma, and the condition presents an everyday challenge in emergency care units around the world. Concussion is common in contact sports such as boxing, American football, ice hockey, and rugby, but also highly prevalent in horse-riding.
There are several reasons why the diagnosis should not be neglected. First, 7%-20% of concussion patients presenting to the emergency department have an intra-cranial abnormality (e.g., contusion or hemorrhage) on a day-of-injury CT scan.2 Second, a significant number of concussion patients get incapacitating symptoms for >10 days following the injury.3 Third, repetitive concussions may cause traumatic encephalopathy syndrome (TES), a clinical disorder associated with neuropathologically diagnosed chronic traumatic encephalopathy (CTE), which is a neurodegenerative disease,4 suggesting that care should be taken to minimize the risk of a new concussion before proper recovery from the first one has been secured.
In the current issue of Journal of Neurotrauma, McDonald et al. undertook a longitudinal prospective study of professional flat-track jockeys with and without incident concussion to examine how the recently developed blood biomarkers for neuroaxonal injury (neurofilament light [NfL] and tau) and astrocytic activation/injury (glial fibrillary acidic protein [GFAP]) can be used together with computerized cognitive testing to diagnose the condition and characterize its time course.5
Among 64 professional, flat-track jockeys who donated baseline (non-concussed) blood samples and underwent cognitive testing using a computerized test (CogSport), 15 medically diagnosed concussions occurred during the training and competition season. The concussed jockeys were followed with repeated blood sampling and cognitive testing during a year at time points of high relevance to concussion dynamics (2- and 7-days, and 1- and 12-months post-concussion).
Language: en |