Sheldon E. Jordan

Acute and Chronic Brain Injury in United States National Team Soccer Players

We designed a study to determine whether chronic encephalopathy occurs in elite, active soccer players resulting from repetitive heading of the soccer ball. Studies have suggested that the cumulative effects of heading a ball can cause a chronic brain syndrome similar to dementia pugilistica, which is seen in profes sional boxers. Twenty of 25 members of the U.S. Mens National Soccer Team training camp (average age, 24.9; average years of soccer, 17.7), who com pleted a questionnaire on head injury symptoms and had magnetic resonance imaging of the brain, were compared with 20 age-matched male elite track ath letes. The soccer players were surveyed about playing position, teams, number of headers, acute head inju ries, and years of playing experience. An exposure index to headers was developed to assess a dose- response effect of chronic heading. The soccer and track groups were questioned regarding alcohol use and history of acute head traumas. Questionnaire anal ysis and magnetic resonance imaging demonstrated no statistical differences between the two groups. Among the soccer players, symptoms and magnetic resonance imaging findings did not correlate with age, years of play, exposure index results, or number of headers. However, reported head injury symptoms, especially in soccer players, correlated with histories of prior acute head injuries (r = 0.63). These findings suggest that any evidence of encephalopathy in soccer players relates more to acute head injuries received playing soccer than from repetitive heading.

Evaluation of stroke using EEG frequency analysis and topographic mapping

Frequency analysis and topographic mapping of EEG were studied in 20 consecutive patients with mild stroke and in 20 age-matched normal subjects. Abnormally large increases in delta and decreases in alpha activity were seen over the scalp in 17 of 20 patients and in no normal subjects. Theta was unreliable by itself. The scalp area so localized appeared correct in each case compared with signs, symptoms, and neuroimaging studies. These computerized EEG analysis techniques were abnormal significantly more often than routine EEGs. The results obtained here with simple techniques agree with past studies done with more complex types of EEG analysis.

ARE BRAIN INJURIES A SIGNIFICANT PROBLEM IN SOCCER

This article examines the types of forces that the brain is subjected to in soccer, secondary to both acute brain injury and repetitive heading of the ball. The incidence of acute brain injury is reviewed, as well as studies documenting the effects of heading the ball. Finally, 10 actions are proposed that would make soccer a safer sport with respect to brain injuries and provide avenues for further study in this area.

Computed electroencephalographic topographic brain mapping: A new and accurate monitor of cerebral circulation and function for patients having carotid endarterectomy

To determine the usefulness of computed electroencephalographic (EEG) topographic (CET) brain mapping to monitor neurologic function during carotid endarterectomy (CEA), 46 consecutive patients having CEA were monitored preoperatively, intraoperatively, and immediately postoperatively by CET brain mapping and simultaneous 16-lead EEG. Preoperative studies revealed that 7 of 16 asymptomatic patients, 5 of 11 patients with amaurosis fugax, and 8 of 12 patients with transient ischemic attacks (TIAs) had abnormal CET brain mapping suggestive of previous subclinical stroke. EEG was abnormal in only 8 of the 20 patients with abnormal CET brain mapping. Intraoperatively during carotid cross-clamping, ischemic changes were seen on CET brain mapping in 23 patients whereas EEG detected these changes in only 13 patients. Ischemic changes detected by intraoperative CET brain mapping were more likely to occur in patients with previous stroke (six of seven) than in patients without previous stroke (17 of 39), p less than 0.05. Patients with changes detected by intraoperative CET brain mapping had an average carotid back-pressure of 38 mm Hg, in contrast to 57 mm Hg for patients without CET brain mapping changes, p less than 0.05. After endarterectomy, CET brain mapping revealed new ischemic changes in one patient who awoke with a mild stroke and in one patient who had TIAs and amaurosis fugax within 6 hours of surgery. We conclude that CET brain mapping is a sensitive, accurate, and useful noninvasive monitor of cerebral circulation and function for patients having CEA.(ABSTRACT TRUNCATED AT 250 WORDS)

The Centrifugal Effect and Other Spatial Artifacts of Topographic Eeg Mapping

Topographic maps of EEG can contain artifacts that are foreign to clinical electroencephalographers trained to read traditional EEG records. Several spatial artifacts are described and discussed here, including the centrifugal effect, ring enhancement, spatial aliasing, electrode hills and holes, color-step effects, and restriction of minima/maxima to electrode sites. Users of quantitated EEG with topographic maps should be aware of these artifacts and should have a high suspicion for other analogous artifactual spatial phenomena when interpreting individual patient records.

Computerized electroencephalography in the evaluation of early dementia

SummaryIn elderly patients presenting to an ambulatory practice with complaints of cognitive disturbance, early dementia must be differentiated from depression. The present paper describes the application of standard electroencephalography and evoked potential testing (EEG/EP) and computerized electroencephalography with evoked potential mapping (CEEG/EPM) in the analysis of 64 elderly patients complaining of cognitive disturbance. Although previous reports have claimed a sensitivity level of up to 80% for EEG in demented patients, it appears that a lower sensitivity (37% for EEG alone and 61% for EEG/EP) may be expected at the time of early presentation according to the present study. No EEG/EP abnormalities were detected in patients with depression. In demented patients, CEEG/EPM was abnormal in 85% (46 of 54) of cases compared to 10% (1 of 10) of cases with depression. Specific information was obtained from EEG/EP studies that helped differentiate the various causes of dementia in three cases. In CEEG/EPM studies, a pattern of relative suppression of alpha activity or suppressed auditory P300 amplitude in the posterior parietal regions was observed in 11 or 23 (48%) patients with Alzheimers disease and 2 of 31 (6%) patients with other forms of dementia. None of the depressed patients demonstrated such changes. Based on the present study, it appears that computerized techniques may hold promise as an adjunct to standard EEG evaluation of patients with mild cognitive change in whom diagnosis of dementia or depression is in doubt. Although standard EEG rarely demonstrates characteristic changes that may help differentiate causes of dementia, CEEG/EPM appears to demonstrate, on occasion, abnormalities in the posterior temporal and parietal regions in patients with a diagnosis of probable Alzheimers disease and rarely in other forms of dementia or depression.

Pain referral patterns of the C1 to C3 nerves: Implications for headache disorders

The cervical nerves may play a significant role in primary headache disorders. We reviewed the patterns of pain evoked by stimulation of the first 3 cervical nerves (C1–C3) in 10 patients with chronic occipital pain, 6 of whom also had migraine. Stimulation at the C1 level evoked periorbital and frontal pain in 6 of 6 patients with migraine but evoked occipital or cervical pain in those without migraine. C2 and C3 stimulation resulted in occipital or cervical pain in all patients. The C1 nerve may have an important sensory function in headache disorders that have orbital and frontal pain as a prominent feature. Ann Neurol 2013;74:145–148

Peroneal Nerve Palsy Induced by Cryotherapy

A group of experts from the University of California, Los Angeles, met to discuss a case from another institution. This case conference is part of a series featuring a variety of sports medicine topics.

EHMTI-0316. Exam findings predict outcome of C1 block for migraine treatment

Previous studies have shown the C1 spinal nerve has sensory neurons. Direct stimulation of the C1 spinal nerve provokes peri-orbital pain in migraine patients. No data exist which can predict a positive outcome for C1 nerve root block. Tenderness over the greater occipital nerve has been shown to predict outcome of GON block. We propose that tenderness over the GON with periorbital referral on exam predicts periorbital referral on direct C1 stimulation and predicts a positive outcome of block.

Pain referral patterns of the C1-C3 nerve roots: implications for headache disorders and the development of new therapies

The upper cervical nerve roots (C1-3) are increasingly viewed as an important target for therapeutic intervention in headache, but their specific roles in the pathophysiology of head pain remain uncertain. An increased understanding of the role of C1-3 in primary and secondary headache disorders is important for progress with diagnostic and therapeutic interventions involving these structures.