Preventing permanent concussion damage.

New guidelines from the American Academy of neurology (AAN) and the Brain Injury Association are the first attempt to create consensus on the best way to evaluate and manage athletes who suffer a concussion during athletic competition. They are recommended for use by coaches and trainers, enabling them to determine the severity of a concussion and setting forth a guide for when the injured athlete should receive emergency medical treatment and when he or she can return to competition.

"A concussion is an injury in which the brain is shaken inside the skull," explains neurologist James P. Kelly, co-author of the ANN's Practice Parameter on the Management of Concussion in Sports. "People throw around the phrase `minor concussion,' but there is no such thing as a `minor' concusion. Repeated concussions can cause not only permanent damage to the brain, but even death," Immediate symptoms of concusion include headache, dizziness or vertigo, lack of awareness of surroundings, and nausea or vomiting. As time progresses, an individual who suffers a concussion can develop mental dysfunction, sleep disturbance, light-headedness, and ringing in the ears.

The ANN guidelines divide concussion into three levels: Grade 1, which involves no loss of consciousness, with symptoms resolved in less than 15 minutes; Grade 2, with no loss of consciousness and symptoms lasting more than 15 minutes; and Grade 3, causing a loss of consciousness for any period of time. An athlete who suffers a Grade 1 concussion can return to play. However, if another Grade 1 concussion occurs in the same contest, he or she should be taken out of the game.

Someone who suffers a Grade 2 concussion should not be allowed to re-enter the contest and should be monitored to make sure further complications do not arise. He or she should not be allowed to return to practice until symptom-free for a week.

Anyone who...