Handbook of Neurological Sports Medicine

Anthony L. Petraglia, MD, graduated from the University of Chicago in 2002 with a BA in neuroscience and earned his medical degree from the University of Rochester School of Medicine and Dentistry in 2007. He completed his residency in neurological surgery at the University of Rochester Medical Center in 2014. Petraglia was the first neurosurgery resident to complete a neurological sports medicine fellowship, and is currently an attending neurosurgeon at Unity Health System in Rochester, New York, where he is also the director of the concussion program. Petraglia has presented nationally and internationally on neurological sports medicine, has published numerous manuscripts and book chapters on various aspects of neurological surgery, and performs editorial duties for several medical journals. His membership in professional organizations includes the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS), and he has served as an assistant to the Sports Medicine Section of the AANS/CNS. He has worked as a physician with several collegiate and high school football teams, as a neurosurgical consultant for the Webster Youth Sports Council, and as a medical director for cyclocross racing. Julian E. Bailes, Jr., MD, earned a BS from from Louisiana State University in 1978, and his MD from Louisiana State University School of Medicine in New Orleans in 1982. He completed a general surgery internship at Northwestern Memorial Hospital in 1983 and a neurological surgery residency at Northwestern University in Chicago in 1987, as well as a fellowship in cerebrovascular surgery at the Barrow Neurological Institute in Phoenix. Bailes was director of cerebrovascular surgery at Allegheny General Hospital in Pittsburgh from 1988 until 1997 and later at Celebration Health Hospital in Orlando, where he also was the director of emergency medical services at both the city and county levels. In 2000, Bailes assumed the position of professor and chair in the department of neurosurgery at West Virginia University School of Medicine in Morgantown. He most recently assumed the position of chair of the department of neurosurgery at NorthShore University Health System in Chicago and is co-director of the Neurological Institute. Bailes is a past chair of the Sports Medicine Section for the American Association of Neurological Surgeons. He has more than 100 publications concerning various aspects of neurological surgery, including three books on neurological sports medicine, and performs editorial duties for numerous medical journals. He is an internationally recognized expert on neurological athletic injuries and has been a team physician at either the National Football League (NFL) or collegiate level for more than 20 years. Since 1992, he has been the neurological consultant to the NFL Players' Association (NFLPA), which has sponsored his research on the effects of head injuries on professional athletes. He is the director of the NFLPA's Second Opinion Network. He is the medical director of the Center for Study of Retired Athletes, which is affiliated with the NFLPA and the University of North Carolina, and is the medical director of Pop Warner Football, the nation's largest youth football association. Arthur L. Day, MD, graduated from Louisiana State University Medical School in 1972. He completed his surgical internship iin Birmingham, Alabama, and subsequently completed his residency in neurological surgery and fellowship in brain tumor immunology at the University of Florida College of Medicine in Gainesville, Florida. Day practiced at the University of Florida for 25 years, ultimately rising to the positions of professor, co-chair, and program director of the department of neurological surgery at the University of Florida. In 2002, he moved to Boston to assume a position as a professor of surgery at Harvard Medical School with a clinical practice at Brigham and Women's Hospital. While there, he served as the associate chair and residency program director of the department of neurological surgery at Brigham and Women's and Children's Hospital in Boston. Subsequently, he was the chair of the department and also the director of the Cerebrovascular Center and the Neurologic Sports Injury Center at Brigham and Women's Hospital. He co-founded and directed an annual meeting at Fenway Park addressing the latest knowledge and treatments of athletic-related neurological injuries. He currently is professor, vice chair, residency program director, and director of clinical education in the department of neurosurgery at the University of Texas Medical School at Houston. Day has held leadership positions in many medical professional societies and has received numerous awards and honors. He has published almost 170 journal articles and book chapters and has co-edited a book about neurological sports injuries. He is an internationally recognized expert in neurological sports medicine. For the past 30 years, he has served as a consulting physician for multiple NCAA and National Football League (NFL) teams.

Part 1: General Concepts Chapter 1. Athletes and Neurological Injuries: A View From 10,000 Feet A Stroll Through History The Present Spectrum of Neurological Injury in Sports Concluding Thoughts References Chapter 2. Medicolegal Considerations in Neurological Sports Medicine With Increased Awareness Comes Increased Scrutiny The King of Concussions Negligence Duty and Breach Violation of a Statutory Duty Standard of Care Defined by Experts Standard of Care Established Through Literature, Rules, Protocols and Textbooks Good Samaritan Laws Proximate Cause Assumption of the Risk Theories of Negligence Cases of Interest NFL and NCAA Concussion Litigation Concluding Thoughts References Chapter 3. Having a Game Plan Developing an Emergency Action Plan Caring for Athletic Injuries Responsibilities of Host and Visiting Medical Staff Concluding Thoughts References Part 2: Sport-Related Head Injuries Chapter 4. Biomechanics, Pathophysiology, and Classification of Concussion Biomechanics and Basic Concepts Lessons Learned From Football Lessons Learned From Other Sports Pathophysiology of Concussion Classification of Concussion and Grading Systems Concluding Thoughts References Chapter 5. In the Trenches: Acute Evaluation and Management of Concussion Presentation Acute Evaluation Concluding Thoughts References Chapter 6. Neuroimaging and Neurophysiological Studies in the Head-Injured Athlete Standard Neuroimaging Advanced Structural Techniques Advanced Functional Techniques Neurophysiological Techniques Concluding Thoughts References Chapter 7. Neuropsychological Assessment in Concussion Use of Symptom Checklists Value of Neuropsychological Assessment of Concussion Issues With Computerized Assessments Other Considerations Other Issues Addressed by Neuropsychologists in the Assessment of Concussed Patients Concluding Thoughts References Chapter 8. Role of Balance Testing and Other Adjunct Measures in Concussion Balance Assessment in Concussion Emerging Technology and Future Directions for Adjunct Measures of Assessment in Concussion Concluding Thoughts References Chapter 9. Postconcussion Syndrome What's in a Definition Scope of the Problem A Neuroanatomical Substrate for Prolonged Symptoms Psychogenesis of PCS and PPCS A Modern Conceptual Framework for PCS and PPCS Concluding Thoughts References Chapter 10. Neuropathology of Chronic Traumatic Encephalopathy Definition of Chronic Traumatic Encephalopathy Posttraumatic Encephalopathy Versus Chronic Traumatic Encephalopathy Gross Morphology and Histomorphology of Chronic Traumatic Encephalopathy Concluding Thoughts References Chapter 11. The Emerging Role of Subconcussion A Working Definition Laboratory Evidence of Subconcussive Effects Clinical Evidence of Subconcussion Concluding Thoughts References Chapter 12. Severe Head Injury and Second Impact Syndrome Cerebral Contusions and Intraparenchymal Hemorrhage Traumatic Subarachnoid Hemorrhage Subdural Hematoma Skull Fractures Epidural Hematoma Diffuse Axonal Injury Arterial Dissection and Stroke Fatalities Other Posttraumatic Sequelae Second Impact Syndrome Concluding Thoughts References Chapter 13. Neurological Considerations in Return to Sport Participation History of Return to Play Symptom Complex and Identification Return to Play and Brain Abnormalities Addressing and Resolving Return to Play Issues Concluding Thoughts References Chapter 14. The Role of Pharmacological Therapy and Rehabilitation in Concussion The Decision to Treat Pharmacologically Somatic Symptoms Sleep Disturbance Symptoms Emotional Symptoms Cognitive Symptoms The Role of Rehabilitation in Concussion Management Concluding Thoughts References Chapter 15. The Research Behind Natural Neuroprotective Approaches to Concussion Eicosapentaenoic Acid and Docosahexaenoic Acid Curcumin Resveratrol Creatine Green Tea Caffeine Vitamins E and C Vitamin D Scutellaria baicalensis Examples of Other Neuroprotective Nutraceuticals Another Natural Approach: Hyperbaric Oxygen Therapy Concluding Thoughts Concluding Thoughts References Part 3: Sport-Related Injuries of the Spine and Peripheral Nervous System Chapter 16. Cervical, Thoracic, and Lumbar Spine Injuries: Types, Causal Mechanisms, and Clinical Features Background and Epidemiology Normal Anatomy Types of Tissue Injuries and Neurologic Syndromes Common Cervical Injuries and Conditions Common Thoracic Injuries Common Lumbar Injuries Concluding Thoughts References Chapter 17. Management of Spine Injuries, Including Rehabilitation, Surgical Considerations, and Return to Play On-the-Field Assessment Radiological Assessment Treatment and Rehabilitation Surgical Considerations Cervical Spine Injuries and Their Management and Treatment Cervical Spine Injury: Return to Play Thoracic and Lumbar Spine Injuries and Their Management Concluding Thoughts Chapter 18. Peripheral Nerve Injuries in Athletes Epidemiology Pathogenesis Clinical Evaluation Additional Testing Management Rationale Surgical Options: Primary Nerve Surgery Surgical Options: Secondary Surgery (Soft Tissue or Bony Reconstruction) Postoperative Management and Return to Play Legal Implications Concluding Thoughts References Part 4: Other Sport-Related Neurological Issues Chapter 19. Headaches in Athletics Clinical Approach and Assessment Commonly Recognized Headache Syndromes Coincidental to Sporting Activity Prolonged Sporting Activity as a Trigger for Commonly Recognized Headache Syndromes Primary Exertional Headache Headaches Attributed to Head or Neck Trauma Headaches Attributed to Sport-Specific Mechanisms Concluding Thoughts References Chapter 20. Heat Illness in Sports Background Contributory Factors in Heat Illness Prevention The Spectrum of Heat Illness and Management Return to Play Concluding Thoughts References

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