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      Selective head–neck cooling after concussion shortens return-to-play in ice hockey players

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          Abstract

          We aimed to investigate whether selective head–neck cooling could shorten recovery after sports-related concussions (SRCs). In a nonrandomized study of 15 Swedish professional ice hockey teams, 29 concussed players received immediate head and neck cooling for ≥30 min (initiated at 12.3 ± 9.2 min post-SRC by a portable cooling system), and 52 SRC controls received standard management. Players receiving head–neck cooling had shorter time to return-to-play than controls (7 vs 12.5 days, p < 0.0001), and 7% in the intervention group versus 25% in the control group were out of play for ≥3 weeks (p = 0.07). Immediate selective head–neck cooling is a promising option in the acute management of SRC that should be addressed in larger cohorts.

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          Most cited references53

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          Consensus statement on concussion in sport-the 5(th) international conference on concussion in sport held in Berlin, October 2016.

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            The neuropathology and neurobiology of traumatic brain injury.

            The acute and long-term consequences of traumatic brain injury (TBI) have received increased attention in recent years. In this Review, we discuss the neuropathology and neural mechanisms associated with TBI, drawing on findings from sports-induced TBI in athletes, in whom acute TBI damages axons and elicits both regenerative and degenerative tissue responses in the brain and in whom repeated concussions may initiate a long-term neurodegenerative process called dementia pugilistica or chronic traumatic encephalopathy (CTE). We also consider how the neuropathology and neurobiology of CTE in many ways resembles other neurodegenerative illnesses such as Alzheimer's disease, particularly with respect to mismetabolism and aggregation of tau, β-amyloid, and TDP-43. Finally, we explore how translational research in animal models of acceleration/deceleration types of injury relevant for concussion together with clinical studies employing imaging and biochemical markers may further elucidate the neurobiology of TBI and CTE. Copyright © 2012 Elsevier Inc. All rights reserved.
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              The new neurometabolic cascade of concussion.

              Since the original descriptions of postconcussive pathophysiology, there has been a significant increase in interest and ongoing research to study the biological underpinnings of concussion. The initial ionic flux and glutamate release result in significant energy demands and a period of metabolic crisis for the injured brain. These physiological perturbations can now be linked to clinical characteristics of concussion, including migrainous symptoms, vulnerability to repeat injury, and cognitive impairment. Furthermore, advanced neuroimaging now allows a research window to monitor postconcussion pathophysiology in humans noninvasively. There is also increasing concern about the risk for chronic or even progressive neurobehavioral impairment after concussion/mild traumatic brain injury. Critical studies are underway to better link the acute pathobiology of concussion with potential mechanisms of chronic cell death, dysfunction, and neurodegeneration. This "new and improved" article summarizes in a translational fashion and updates what is known about the acute neurometabolic changes after concussive brain injury. Furthermore, new connections are proposed between this neurobiology and early clinical symptoms as well as to cellular processes that may underlie long-term impairment.
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                Author and article information

                Journal
                Concussion
                Concussion
                CNC
                Concussion
                Future Medicine Ltd (London, UK )
                2056-3299
                15 April 2021
                June 2021
                15 April 2021
                : 6
                : 2
                : CNC90
                Affiliations
                [1 ]Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Neurosurgery, Lund, Sweden
                [2 ]Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
                [3 ]Lund University, Family Medicine & Community Medicine, Lund, Sweden
                [4 ]BrainCool AB, Medicon Village, Lund, Sweden
                Author notes
                [* ]Author for correspondence: Niklas.marklund@ 123456med.lu.se
                Author information
                https://orcid.org/0000-0003-3328-5324
                https://orcid.org/0000-0003-3628-0705
                https://orcid.org/0000-0002-9797-5626
                Article
                10.2217/cnc-2021-0002
                8162197
                34084556
                a785f55a-c0dd-4f8c-8536-0becd47f2eca
                © 2021 Niklas Marklund and co authors

                This work is licensed under the Creative Commons Attribution 4.0 License

                History
                : 08 February 2021
                : 19 March 2021
                : 15 April 2021
                Page count
                Pages: 11
                Funding
                Funded by: Centrum för idrottsforskning, FundRef http://dx.doi.org/10.13039/501100005350;
                Award ID: 2020-0116
                Funded by: Regional funds from the Skåne University Hospital;
                Award ID: 2018-Projekt0081
                Categories
                Research Article

                brain temperature,concussion,hypothermia,ice hockey,return to play,selective head–neck cooling,sports-related concussion,traumatic brain injury

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