Neurological Surgery 脳神経外科49巻5号

2021年09月発行

特集 頭部外傷診療アップデート—ガイドラインを読み解く Ⅲ　さまざまな頭部外傷の病態

スポーツ脳神経外科—脳振盪への対応

著者： 荻野雅宏¹

所属機関： ¹獨協医科大学医学部脳神経外科

ページ範囲：P.1032 - P.1039

Point
・脳振盪はあくまで症状から診断され，背景にある病態生理は単一ではなく，簡便な診断方法も見出されていない．
・段階的に復帰すべきことは広く認識されつつあるが，効果的な治療法やリハビリテーションも今後の課題である．
・反復受傷の結果とされる慢性外傷性脳症（CTE）の病理学的所見は解明されつつあるが，臨床診断や検査法の確立にはさらなる研究が必要である．

参考文献

1）McCrory P, et al：Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med 51：838-847, 2017.

2）荻野雅宏，他：スポーツにおける脳振盪に関する共同声明—第5回スポーツ脳振盪会議（ベルリン，2016）—解説と翻訳．神経外傷 42：1-34, 2019

3）Singh R, et al：Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes. JAMA 311：1883-1888, 2014

4）Tremblay S, et al：Diffuse white matter tract abnormalities in clinically normal ageing retired athletes with a history of sports-related concussions. Brain 137（Pt 11）：2997-3011, 2014

5）Wu YC, et al：Longitudinal white-matter abnormalities in sports-related concussion：a diffusion MRI study. Neurology 95：e781-e792, 2020

6）Nakashima T, et al：Focal brain glucose hypometabolism in patients with neuropsychologic deficits after diffuse axonal injury. AJNR Am J Neuroradiol 28：236-42, 2007

7）Mastandrea P, et al：Systematic review and cumulative meta-analysis of the diagnostic accuracy of glial fibrillary acidic protein vs. S100 calcium binding protein B as blood biomarkers in observational studies of patients with mild or moderate acute traumatic brain injury. Diagnosis（Berl）, 2021［Epub ahead of print］　doi：10.1515/dx-2021-0006

8）Verduyn C, et al：CSF and blood neurofilament levels in athletes participating in physical contact sports：a systematic review. Neurology 96：705-715, 2021

9）Di Pietro V, et al：Unique diagnostic signatures of concussion in the saliva of male athletes：the Study of Concussion in Rugby Union through MicroRNAs（SCRUM）. Br J Sports Med, 2021［Epub ahead of print］　doi：10.1136/bjsports-2020-103274

10）Corbin-Berrigan LA, et al：The use of electroencephalography as an informative tool in assisting early clinical management after sport-related concussion：a systematic review. Neuropsychol Rev, 2020［Epub ahead of print］　doi：10.1007/s11065-020-09442-8

11）Grool AM, et al：Association between early participation in physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents. JAMA 316：2504-2514, 2016

12）Leddy JJ, et al：Exercise is medicine for concussion. Curr Sports Med Rep 17：262-270, 2018

13）Mucha A, et al：A brief vestibular/ocular motor screening（VOMS）assessment to evaluate concussions：preliminary findings. Am J Sports Med 42：2479-2486, 2014

14）Cooksey FS：Rehabilitation in vestibular injuries. Proc R Soc Med 39：273-278, 1946

15）Schneider KJ, et al：Rest and treatment/rehabilitation following sport-related concussion：a systematic review. Br J Sports Med 51：930-934, 2017

16）山田睦雄，他：スポーツによる脳振盪のリハビリテーション 競技復帰のために必要なこと．臨スポーツ医 36：296-305, 2019

17）Stern RA, et al：Tau positron-emission tomography in former National Football League players. N Engl J Med 380：1716-1725, 2019

18）Davis GA, et al：What is the difference in concussion management in children as compared with adults? A systematic review. Br J Sports Med 51：949-957, 2017

19）Emery CA, et al：What strategies can be used to effectively reduce the risk of concussion in sport? A systematic review. Br J Sports Med 51：978-984, 2017

20）日本サッカー協会（JFA）技術委員会，JFA医学委員会：JFA育成年代でのヘディング習得のためのガイドライン（幼児期〜U-15）第一版．2021　https://www.jfa.jp/coach/heading_guidelines.html（2021年7月19日アクセス）

21）Martland HS：Punch drunk. JAMA 91：1103-1107, 1928

22）Maroon JC, et al：Chronic traumatic encephalopathy in contact sports：a systematic review of all reported pathological cases. PLoS One 10：e0117338, 2015

23）Mez J, et al：Clinicopathological evaluation of chronic traumatic encephalopathy in players of American football. JAMA 318：360-370, 2017

24）McKee AC, et al；TBI/CTE group：The first NINDS/NIBIB consensus meeting to define neuropathological criteria for the diagnosis of chronic traumatic encephalopathy. Acta Neuropathol 131：75-86, 2016

25）荻野雅宏：慢性外傷性脳症．臨スポーツ医 36：330-333, 2019

26）Goswami R, et al：Frontotemporal correlates of impulsivity and machine learning in retired professional athletes with a history of multiple concussions. Brain Struct Funct 221：1911-1925, 2016

27）Gardner RC, et al：Cavum septum pellucidum in retired American pro-football players. J Neurotrauma 33：157-161, 2016

28）Omalu B, et al：Postmortem autopsy-confirmation of antemortem［F-18］FDDNP-PET scans in a football player with chronic traumatic encephalopathy. Neurosurgery 82：237-246, 2018

29）Petraglia AL, et al：From the field of play to the field of combat：a review of the pharmacological management of concussion. Neurosurgery 70：1520-1533, 2012

30）Shahim P, et al：Neurochemical aftermath of repetitive mild traumatic brain injury. JAMA Neurol 73：1308-1315, 2016

31）Cherry JD, et al：CCL11 is increased in the CNS in chronic traumatic encephalopathy but not in Alzheimer's disease. PLoS One 12：e0185541, 2017