Cerebral concussion in athletes: Evaluation and neuropsychological testing

Joseph C. Maroon, Mark R. Lovell, John Norwig, Kenneth Podell, John W. Powell, Roger Hartl

Research output: Contribution to journalArticlepeer-review

212 Scopus citations


OBJECTIVE: To conduct a topic review of studies related to cerebral concussion in athletes, as an aid to improving decision-making and outcomes. METHODS: We review the literature to provide an historical perspective on the incidence and definition of and the management guidelines for mild traumatic brain injury in sports. In addition, metabolic changes resulting from cerebral concussion and the second-impact syndrome are reviewed, to provide additional principles for decision-making. Neuropsychological testing, as it applies to athletes, is discussed in detail, to delineate baseline assessments, the characteristics of the neuropsychological evaluation, the neuropsychological tests used, and the methods for in-season identification of cerebral concussion. Future directions in the management of concussions are presented. RESULTS: The incidence of cerebral concussions has been reduced from approximately 19 per 100 participants in football per season to approximately 4 per 100, i.e., 40,000 to 50,000 concussions per year in football alone. The most commonly used definitions of concussion are those proposed by Cantu and the American Academy of Neurology. Each has associated management guidelines. Concussion or loss of consciousness occurs when the extracellular potassium concentration increases beyond the upper normal limit of approximately 4 to 5 mmol/L, to levels of 20 to 50 mmol/L, inhibiting the action potential and leading to loss of consciousness. This phenomenon helps to explain the delayed effects of symptoms after trauma. CONCLUSION: Neuropsychological testing seems to be an effective way to obtain useful data on the short-term and long-term effects of mild traumatic brain injury. Moreover, knowledge of the various definitions and management strategies, as well as the utility of neuropsychological testing, is essential for those involved in decision-making with athletes with mild traumatic brain injuries.

Original languageEnglish (US)
Pages (from-to)659-672
Number of pages14
Issue number3
StatePublished - 2000


  • Brain concussion
  • Cerebral metabolism
  • Head injuries
  • Neuropsychological tests
  • Sports medicine

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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