Data supplement for: ms #200101027
Concussion: The history of clinical & pathophysiological concepts and misconceptions
McCrory & Berkovic
Tables 2 and 3 as referred to in the test of the article.
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Table 2: Historical understanding of concussion
Boirel / 1674 / Concussion / No visible damage present. Could not exclude microscopic damage. / Permanent
Read / 1687 / Commotio cerebri / Post concussive symptoms including: tinnitus, stupor, loss of consciousness, sleepiness, giddiness / Transient
Littre / 1705 / Commotio cerebri / Post traumatic death without evidence of structural brain damage / Fatal
de Petit / 1710 / Embranlement / ‘Vibrations’ of the brain causing symptoms. Differentiated from haemorrhage / Transient
Heister / 1757 / Concussion / Disordered senses after blow / Transient
Petit / 1774 / Concussion / Symptoms due to direct physical force on cells / Variable
Bell / 1786 / Concussion / Concussion is an “…immediate consequence of external violence…no mark of injury…obstructs brain function” / Transient
Hunter / 1791 / Concussion / Distinguished concussion from permanent injury by clinical signs / Transient
Kirkland / 1792 / Concussion / Unconsciousness due to blow / Uncertain
Bell / 1807 / Concussion / Some’ inconceivable derangement ‘of the brain. Distinguished concussion from permanent injury by clinical signs / Transient
Dessault / 1830 / Concussion / Concussion… due to the engorgement or congestion of the brain’ / Uncertain
Gama / 1835 / Concussion / Concussion results in nerve injury / Permanent
Baudens / 1836 / Concussion / ‘molecular vibration’ causes clinical symptoms’ / Variable
Brodie / 1837 / Concussion / Concussion conceivable may produce undetectable pathological changes / Uncertain
Syme / 1856 / Concussion / Concussion symptoms reflect suspension of function for a brief period / Transient
Dupuytren / 1839 / Commotio cerebri / Distinguished commotio from structural injury on the basis of physical signs / Transient
Guthrie / 1862 / Concussion / A ‘certain indefinable something’ due to microscopic disruption of brain tissue / Uncertain
Hilton / 1863 / Concussion / Concussion can produce a ‘long continuance’ of symptoms however over time the physiological integrity is restored’ / Transient
Liddell / 1864 / Concussion / Concussion produces an ‘arrest of function without any visible injury to nerve cells’ / Transient
Le Gros / 1870 / Concussion / Immediate and persistent incapacity / Permanent
Erichsen / 1882 / Concussion / Sub-clinical vibration of nervous tissue causing a variety of clinical symptoms / Permanent
Page / 1883 / Concussion / Concussion results from ‘shock’ to the nervous system causing functional rather than structural damage. / Variable
Walton / 1883 / Concussion / Derangement of the higher centres of the brain / Permanent
Oppenheim / 1889 / Concussion / Functional disturbance produced by molecular changes / Permanent
Table 3: Historical development of concussion
Author / Year / Term / Description / Effects /Trotter / 1924 / Concussion / Represents a transient state due to head injury, is instantaneous and manifests widespread paralytic symptoms without structural injury. He believed the cause was ‘acute compressive anaemia’ / Transient
Symonds / 1937 / concussion / Due to reversible pathological changes / Transient
Greenfield / 1938 / concussion / A clinical term indicating the degree or severity of the clinical symptoms not pathological change / Variable
Denny-Brown & Russell / 1941 / Concussion / Concussion due to reversible molecular reaction within nerve cells / Transient
Symonds / 1942 / Concussion / Concussion results in momentary LOC, mild confusion and automatism with amnesia with complete recovery within a few days / Transient
Windle / 1944 / concussion / A transient state which sets in immediately upon application of an adequate force to the brain. / Transient
Merritt / 1959 / concussion / Only used when there is ‘no structural damage to the brain’ / Transient
Brock / 1960 / Concussion / Traumatic disturbance of consciousness without residual symptoms / Transient
Symonds / 1962 / Concussion / Effects not always reversible. / Permanent
Walshe / 1963 / Concussion / No irreversible structural damage. Transient and minor injury / Transient
Tower / 1966 / Concussion/
commotion / Loss of consciousness and some degree of amnesia due to direct physical injury to neuronal elements / Permanent
Ward / 1966 / Concussion / Loss of consciousness and traumatic amnesia as a consequence of head trauma in the absence of physical damage to the brain. / Transient
Congress of Neurological Surgeons / 1966 / Concussion / “a clinical syndrome…characterised by immediate and transient impairment of neurological function” / Transient
Caveness & Walker / 1969 / Concussion / Immediate and transient disturbance of neurological function due to mechanical forces / Transient
Strich / 1969 / Concussion / Diffuse axonal injury can occur after apparently uncomplicated concussion / Permanent
Russell / 1971 / Concussion / Dazed state…gradual recovery of mental powers / Transient
Ommaya & Gennarelli / 1974 / Concussion / A graded set of clinical syndromes …increasing disturbance in level and content of consciousness…caused by mechanical strains with a centripetal disruptive effect on structure and function / Variable
Bruce / 1984 / Concussion / Minimal or no primary cerebral damage / Transient
Adams & Victor / 1985 / Concussion / Immediate and usually reversible traumatic paralysis of nervous function, the effects of which may last for a variable period of time / Transient
Gennarelli / 1986 / Concussion / Immediate and transient disturbance of neurological function due to mechanical causes / Transient
Cantu / 1986 / Concussion / Immediate and transient disturbance of neurological function due to mechanical causes / Transient
Barth et al / 1989 / Concussion / Change of loss of consciousness < 2 minutes and immediately demonstrating attentional/memory problems / Transient
Gronwall et al / 1989 / Concussion / Diffuse damage affecting information processing capacity / Permanent
Rutherford / 1989 / Concussion / Acceleration/deceleration injury to the head…associated with amnesia followed by a characteristic group of symptoms / Permanent
Joseph / 1990 / Concussion / Immediate and transient disturbance of neurological function / Transient
Alves / 1992 / Concussion/MTBI / Transient disturbance or LOC or other neurological function…resulting in a GCS 13-15 / Variable
Berrol / 1992 / Mild TBI / Disturbance of LOC < 30 mins or memory loss or disorientation or GCS 13-15 or PTA < 24 hours / Permanent
Leninger et al / 1992 / Concussion / Alteration or LOC < 20 mins and GCS 13-15 / Permanent