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Concussion

A concussion is a common injury to the brain that may result in some swelling, inflammation, or other potential changes. Severity and reoccurrence are often factors in the injury and damage of the brain.

Significant brain trauma is referred to as traumatic brain injury or TBI. A concussion is the type of injury that falls into this category. Other significant injuries may have concussion along with other injuries.

When a TBI occurs in sports it is often referred to as a Mild traumatic brain injury [MTBI].

The brain has a fluid called cerebrospinal fluid, which is intended to protect the brain. During a concussion, the protection the fluid gives may not be adequate. The forces causing the concussion, causing movement of the brain and the resulting injury, may be significantly damaging.

Areas of the brain most commonly affected are the midbrain and diencephalon.

Other areas affected include:

1.)  Brain Stem
2.)  Fornix
3.)  Corpus Callosum
4.)  Temporal Lobe
5.)  Frontal Lobe.

The result of the injury can cause loss of brain function, cognitive and emotional symptoms.

Repeated concussions can cause additional problems including:

1.)  Brain damage
2.)  Dementia
3.)  Second-impact syndrome.
4.)  Memory loss
5.)  Coma
6.)  Death

Additional information of note:

Studies have shown that the typical rate of concussion is around 6 per 1,000 receive concussions every year.  There still needs to be additional research to find the amount of damage or injury placed on the brain after a single concussion.

Severity and reoccurrence are often the gauges in how many injuries will occur. Currently, the classic definition indicates; no structural damage. And that’s the concern – we often don’t know when a concussion may occur.

Therefore, symptoms are caused by a change in the functionality of the brain. Symptoms can, therefore, resolve when treatment is administered properly.

Common modalities of injury:

1.)   Car accidents
2.)   Bicycle accidents
3.)   Sport injuries
4.)   Falls
5.)   Fights
6.)   Soldier injuries including nearby explosions

Most Common Symptoms:

Physical Type Symptoms

–  Headache
–  Dizziness
–  Blurred vision
–  Vomiting
–  Nausea
–  Seizures
–  Ringing of ears
–  The sensitivity of bright lights
–  Loss of coordination
–  Difficulty with balancing

Cognitive and Emotional Type Symptoms

–  Confusion
–  Difficulty with attention
–  Disorientation
–  Loss of Consciousness
–  Post-traumatic Amnesia
–  Lethargy
–  Inappropriate emotions
–  Restlessness – can be in children
–  Irritability

Diagnosis

–  Physical exam
–  Neurological exam
–  Duration of unconsciousness
–  Glasgow Coma Scale
–  CT scan
–  SPECT
–  PET scans

Under-reporting of Concussions

Often concussions are not diagnosed following an injury.  This may be due to a variety of issues include inexperience, unknowing symptoms, delayed symptoms, or trying to hide the severity of injury either due to wanting to continue playing sports or work-related injury.

Under-reporting of symptoms is a huge problem in sports injuries. This increases the risk of additional injuries or permanent symptoms. Again, having reoccurrences of concussion or not completely allowing a concussion to heal can dramatically worsen the symptoms and outcome of the injury.

Grading a Concussion

1.) Cantu guidelines:

Grade 1 – No loss of Consciousness
–  Post-traumatic amnesia less than 30 minutes

Grade 2 –  Loss of Consciousness less than 5 minutes
– Post-traumatic amnesia from 30 minutes to 24 hours

Grade 3 –  Loss of Consciousness greater than 5 minutes
– Post-traumatic amnesia lasting longer than 24 hours

2.)  Colorado Medical Society Guidelines:

Grade 1 –  Confusion
–  No loss of consciousness

Grade 2 – Confusion
–  Post-traumatic amnesia
–  No loss of consciousness

Grade 3 – Any loss of consciousness

3.) American Academy of Neurology Guidelines:

Grade 1 – Confusion
–  Symptoms lasting less than 15 minutes
–  No loss of consciousness

Grade 2 –  Symptoms lasting longer than 15 minutes
– No loss of consciousness

Grade 3 –  Loss of Consciousness
Grade 3a –  Coma lasting for seconds
Grade 3b –  Coma lasting for minutes

Treatment

.  Rest
.  Observation
.  Sleep
.  They usually can go away without treatment
.  A very small number of patients need brain surgery to release the pressure build-up.

.  IBU can be used but Tylenol is often preferred.

.  Do not drink alcohol
.  Do not take drugs unless been approved by your Doctor

*** If minimal to no improvement – you may need to go to the Emergency Room or see a Specialist that deals with Concussions.