Sports-related traumatic brain injury
Rules exist within each sport to help prevent cerebral contusions and traumatic brain injuries. However, individual athletes are the best prevention against their own injuries. In a game, athletes notice when they have the symptoms of a cerebral contusion and should take themselves out of the game. It may be hard for medical personnel or coaches to notice when a player has a traumatic brain injury, so it is in the player’s best interest to be removed from play. In hockey, traumatic brain injuries constitute 10%-15% of all head injuries. With the high percent of injuries being traumatic, extensive design improvements have been made to helmets. These improvements reduce the risk of cerebral contusions by providing more padding around the skull and a chin strap that keeps the helmet snug. In baseball, major improvements to helmets have been made to protect batters from the impact a baseball can have when hitting their head. Helmets, before this major improvement, were designed to withstand a velocity of 70 mph from a pitch or foul ball. Since the company Rawlings’ new design, helmets can withstand a velocity of 100 mph and have further padding around the softer parts on the side of the skull.
Traumatic brain injury
Surgery can be performed on mass lesions or to eliminate objects that have penetrated the brain. Mass lesions such as contusions or hematomas causing a significant mass effect (shift of intracranial structures) are considered emergencies and are removed surgically. For intracranial hematomas, the collected blood may be removed using suction or forceps or it may be floated off with water. Surgeons look for hemorrhaging blood vessels and seek to control bleeding. In penetrating brain injury, damaged tissue is surgically debrided, and craniotomy may be needed. Craniotomy, in which part of the skull is removed, may be needed to remove pieces of fractured skull or objects embedded in the brain. Decompressive craniectomy (DC) is performed routinely in the very short period following TBI during operations to treat hematomas; part of the skull is removed temporarily (primary DC). DC performed hours or days after TBI in order to control high intracranial pressures (secondary DC) has not been shown to improve outcome in some trials and may be associated with severe side-effects.