RESUMO
Objective: To compare validity indices of the King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5) for traumatic events in MMA, and to determine if perfusion events (alterations in consciousness as the result of choke holds) cause similar changes in KD/SCAT5 scores. Design: A prospective cohort study in MMA fighters who completed KD and SCAT5 assessments before and after a match. Outcomes were categorized as non-event, traumatic event, or perfusion event. KD/SCAT5 changes were compared between all athletes. Participants: One hundred forty MMA athletes (7 women, 133 men), mean age=27.1 ± 4.9 years. Intervention: N/A. Main outcome measures: King-Devick (KD) test and Sport Concussion Assessment Tool 5 (SCAT5). Results: Among the 140 athletes, 19 sustained traumatic and 15 perfusion events. Testing provided sensitivities/specificities of 21.05%/93.39% (KD) and 77.78%/52.99% (SCAT5) in detecting a traumatic event. KD and SCAT5 Symptom Severity scores differed between athletes with and without traumatic events (P=.041 and .014). KD and SCAT5 Symptoms Score changes were observed between athletes with and without traumatic events (P=.023 and .042). Neither KD nor SCAT5 differed significantly between athletes with and without perfusion events. Conclusions: The KD test provides high specificity and the SCAT5 demonstrates reasonable sensitivity when detecting a traumatic event. Of the SCAT5, symptoms-related scores may most effectively identify a traumatic event. A traumatic event may cause KD/SCAT5 changes similar to a concussion, while perfusion events did not.
RESUMO
Primary melanocytomas of the central nervous system are rare tumors arising from leptomeningeal melanocytes. Only 29 cases have been reported in the literature. Presenting symptoms may include insidious onset of back pain, slowly progressive neurologic deficits such as weakness and sensory changes, and bowel and bladder dysregulation. Advanced imaging including magnetic resonance imaging can be helpful in lesion localization but does not distinguish between primary and metastatic melanoma. In this case series, we present 3 patients with nontraumatic spinal cord injuries secondary to primary central nervous system malignant melanocytomas who were admitted to a single inpatient rehabilitation facility within a 12-month time frame. These cases highlight the importance of the rehabilitation team in the continuum of care for patients undergoing resection of primary melanocytomas of the spinal cord. The rehabilitation team should be involved in the preoperative counseling setting, immediately postoperatively, and in follow-up care to assess for signs of recurrence. A comprehensive multidisciplinary approach including physical and occupational therapists, rehabilitation nurses, rehabilitation neuropsychologists, and physiatrists is important for optimizing the function of these patients.
