@article{ref1,
title="Sport-related structural brain injury: three cases of subdural hemorrhage in American high school football",
journal="World neurosurgery",
year="2017",
author="Yengo-Kahn, Aaron M. and Gardner, Ryan M. and Kuhn, Andrew W. and Solomon, Gary S. and Bonfield, Christopher M. and Zuckerman, Scott L.",
volume="106",
number="",
pages="1055.e5-1055.e11",
abstract="BACKGROUND: The risk of sport-related concussion (SRC) has emerged as a major public health concern. In rare instances, sport-related head injuries can be even more severe, such as subdural hemorrhage, epidural hemorrhage, or malignant cerebral edema. Unlike SRCs, sport-related structural brain injury (SRSBI) is rare, may require neurosurgical intervention, and can lead to permanent neurologic deficit or death. Data characterizing SRSBI is limited and many have recognized the need to better understand these catastrophic brain injuries. The goal of the current series is to describe, in detail, the presentation, management and outcomes of examples of these rare injuries. CASE DESCRIPTION: During the Fall of 2015, three high school football players presented with acute subdural hemorrhages (SDH) following in-game collisions and were treated at our institution within a span of 2 months. For the two athletes who required surgical intervention, a previous SRC was sustained within four weeks prior to the catastrophic event. One year after injury, two players have returned to school, though with persistent deficits. One patient remains non-verbal and wheelchair-bound. None of the athletes has returned to sports. <br><br>CONCLUSIONS: Acute SDH resultant from an in-game football collision is rare. The temporal proximity of the reported SRSBIs to recent SRCs emphasizes the importance of return to play protocols and raises questions regarding the possibility of second impact syndrome. Although epidemiologic conclusions cannot be drawn from this small sample, these cases provide a unique opportunity to demonstrate the presentation, management, and long-term outcomes of SRSBI in American high school football.  Keywords: American football <br><br>Copyright © 2017 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1878-8750",
doi="10.1016/j.wneu.2017.07.072",
url="http://dx.doi.org/10.1016/j.wneu.2017.07.072"
}