The Neurometabolic Cascade of Concussion

Objective: To review the underlying pathophysiologic processes of concussive brain injury and relate these neurometabolic changes to clinical sports-related issues such as injury to the developing brain, overuse injury, and repeated concussion. Data Sources: Over 100 articles from both basic science andclinical medical literature selected for relevance to concussivebrain injury, postinjury pathophysiology, and recovery of function. Data Synthesis: The primary elements of the pathophysiologic cascade following concussive brain injury include abrupt neuronal depolarization, release of excitatory neurotransmitters, ionic shifts, changes in glucose metabolism, altered cerebral blood flow, and impaired axonal function. These alterations can be correlated with periods of postconcussion vulnerability and with neurobehavioral abnormalities. While the time course of these changes is well understood in experimental animal models, it is only beginning to be characterized following human concussion. Conclusions/Recommendations: Following concussion,cerebral pathophysiology can be adversely affected for days inanimals and weeks in humans. Significant changes in cerebral glucose metabolism can exist even in head-injured patients with normal Glasgow Coma Scores, underscoring the need for indepth clinical assessment in an effort to uncover neurocognitive correlates of altered cerebral physiology. Improve