Concussion

A lot of jokes are made about stunning blows that a person may receive, especially in the world of sports. We might say a football player really “got his lights knocked out” or a boxer is “punch-drunk.” Most of the time such injuries are not serious, but it is important to remember that whenever a trauma occurs that alters brain function, even for a few seconds, damage has been sustained, and time must be taken to recover. Concussions are a common injury both on the playing field and off, so let’s take a look at what causes them, how to best recover from them, and most importantly how to protect ourselves and our children from getting them in the first place.

What is a Concussion?

A concussion is any change in mental status that is triggered by a traumatic blow to the head or by any other factor that causes the brain to be jarred against the inside of the skull. There are different degrees of concussion that exhibit different symptoms, and they may or may not be associated with a brief period of unconsciousness. However, all concussions have in common the fact that they temporarily interfere with the way the brain functions. Typical symptoms that may be associated with a concussion include dysfunction in memory, reflexes, balance, coordination, and other motor skills.

The majority of concussions are not accompanied by a loss of consciousness. When a black out does occur, it is usually not for more than a few seconds or several minutes at most. Most concussions do not cause permanent damage, and victims usually recover fully. However, one of the biggest dangers of concussion is a subsequent one before a patient has completely healed from the first. This is known as second impact syndrome, and it has the potential to cause permanent brain damage or even death. This is why it is so critical that concussion victims be given time to fully recover before returning to situations, such as playing sports, that may put them at risk for another concussion.

Statistics gathered by the Centers for Disease Control tell us that over 300,000 reported concussions occur annually due to sports-related injuries, which is one of the major causes of concussions. The majority of these are found in boys and young men from the ages of sixteen to twenty five. The precise number of concussions that occur overall is hard to determine. One of the problems is that many times people with minor concussions will not even realize that they have experienced one.

What Are the Signs and Symptoms of a Concussion?

There are many possible symptoms that a concussion victim may experience, and signs typically occur based on the severity of the concussion. Sometimes a person will be knocked out cold for a brief time, and will know for certain that he has had a concussion. Other times, especially when minor trauma causes the injury, the symptoms may be very mild and can potentially not show up for days, weeks, or even longer. Some of the most common symptoms include:

1. Confusion:  Almost all concussion victims become disoriented to some degree, even if it is just for a few seconds.
2. Amnesia:  This is also very common. The vast majority of concussion patients do not remember the impact that caused the injury. This is true whether they experienced unconsciousness or not.
3. Unconsciousness:  Brief periods of unconsciousness may accompany a concussion, but this is the exception rather than the rule.
4. Headache
5. Slurred speech
6. Dizziness
7. Loss of balance
8. Nausea and / or vomiting
9. Ringing of the ears
10. Vacant stare
11. Double or blurred vision

Other concussion symptoms may not appear immediately, but often appear hours or even days later. When such signs appear, the condition is sometimes referred to as post-concussion syndrome. These might include:

1. Mood swings
2. Irritability
3. Depression
4. Anxiety
5. Prolonged headaches
6. Ongoing memory loss or difficulties
7. Delayed cognitive dysfunction
8. Supersensitivity to light and / or sound
9. Insomnia
10. Diminished sense of smell or taste

Signs of concussion in infants or small children can be more difficult to recognize as they may not be able to communicate them. Watch out for:

1. Unexplained restlessness or irritability
2. Poor balance or walking skills
3. Changes in sleeping or feeding patterns
4. Loss of interest in favorite toys or activities
5. Poor attention span or inability to concentrate

When evaluating a patient for a concussion, health care providers often use a three-point scale to estimate the severity of the condition. These classifications are as follows:

1. Grade 1:  No loss of consciousness; temporary confusion and other symptoms that are resolved within 15 minutes.
2. Grade 2:  The same as grade 1, except recovery from initial symptoms takes more than 15 minutes.
3. Grade 3:  Any concussion involving loss of consciousness, no matter how brief.

What Causes a Concussion to Occur?

Any blow to the head or other trauma that impacts the area of the brain can result in a concussion. Our bodies are designed with excellent defense mechanisms in place to protect vital organs such as the brain. This organ is sheltered from danger by the skull on the outside and cerebrospinal fluid on the inside that acts as a shock absorber. Without these protective barriers in place, our brains, which have a consistency similar to gelatin, would be very susceptible to be damaged easily. Concussions occur when the brain is jolted or traumatized by a direct impact, such as a blow on the head, or if the brain comes into harsh contact with the skull, such as when a car going 60 miles per hour stops suddenly in a collision. In a case like that, the skull stops but the brain keeps going and is damaged by hitting the interior of the skull. A concussion is actually minor brain damage that may consist of bleeding and / or tears in the nervous tissue of the brain.

There are two situations that account for most concussions. These are sports injuries and automobile accidents. Football and boxing are the worst culprits when it comes to concussions. Young athletes, especially high school and younger football players, make up the largest percentage of concussion injuries in the United States. As players get older, their bodies mature more and the risk for concussion goes down.

Boxing is particularly hard on the brain. In fact, it has been said that the main object of boxing is to give your opponent a concussion. Another safety issue with boxing is that participants risk second impact syndrome  by experiencing back to back concussions with no time for recovery in between. This puts boxers at great risk for permanent brain damage (Muhammed Ali, former World Champion boxer is a good example). Beyond that, second impact syndrome can be potentially fatal. Over 20 deaths have been attributed to this syndrome in the last 25 years. For reasons such as this, many neurologists support a ban on boxing.

Are There Complications That Can Occur With a Concussion?

If symptoms are severe and long lasting, there is a good chance that brain injuries beyond the realm of a concussion may have occurred. In fact, this is considered one of the biggest possible complications involving concussions: misdiagnosing them and not seeking further treatment. Brain injuries of this degree can lead to permanent damage or even death if they are not treated promptly. Symptoms that may indicate a more severe injury include:

1. Seizures
2. Bruises on the scalp (especially dangerous are bruises on the side or back of the head)
3. Persistent vomiting
4. Prolonged memory loss
5. Prolonged headaches

Other complications that can occur in conjunction with a concussion include:

1. Cumulative neurological damage from multiple concussions:  Researchers have discovered that people who have numerous (more than one) concussion over the course of their lives may find it more difficult to fully recover. Some studies have even linked an increased risk for Alzheimer’s Disease with repeated concussions. In addition, once a person has had a concussion, it appears that it is easier for them to experience subsequent ones.
2. Increased risk for epilepsy:  Having a concussion, especially more than one, can double some individuals risk for developing epilepsy.

How Can a Concussion Most Effectively be Treated?

There is one word that best describes treatment for a concussion: Rest. Recovery from a concussion takes time. It is best to stay off your feet and limit activity until all symptoms have disappeared for at least 24 hours. In the case of contact sports, be especially careful about returning to the playing field until your body has had adequate time to heal.

For relief of headache associated with a concussion, over the counter analgesics such as acetaminophen or ibuprofen are generally safe for short-term use. However, it is best to avoid the use of aspirin, as this compound may encourage internal bleeding at the site of the concussion.

What About Preventing Concussions?

No one can totally prevent accidents that may cause a concussion, but you can reduce risk by using available safety equipment such as helmets for sporting activities and seat belts while traveling in vehicles. It is also a good idea to use air bags whenever possible.

As far as athletics go, parents must weigh the pros and cons of allowing their children to participate in contact sports. If they are on the team, be sure their protective gear fits properly and insist that they never play with out it. Helmets for such activities as skiing,  biking, and skateboarding are also a must.

Another way you can reduce risk is to choose for your self and teach your children to make wise lifestyle choices that will keep their bodies strong and healthy. Such steps may not eliminate the risk for unforeseen accidents that could lead to concussions, but it will enable people to possibly avoid injuries and will certainly make recovery quicker. For example, a regular exercise program would accomplish several goals, such as keeping the circulatory system strong and contributing to greater flexibility and faster reactions that may help avoid situations such as automobile or sporting collisions. All of these provisions will certainly make for a more healthful life, and hopefully concussions will never be a factor!