Concussion

street, hit his head.

A concussion injury is the result of a violent collision between the brain and the inner surface of the skull. This collision results in damage to brain cells and a temporary interruption to normal brain function. Symptoms include headaches, confusion, difficulties with memory and cognition and many other possible signs. Treatment of a concussion involves allowing the brain to rest and recuperate naturally. This in turn requires the patient to avoid mentally taxing activities, as well as activities that can result in further brain injury, for at least 48 hours. You should then recommence normal activities gradually in order to allow the brain to continue its recovery while avoiding recurrence of the injury.

The most typical causes of these injuries (also known as traumatic brain injuries or T.B.I.s) are blows to the head, a fall or violent shaking of the head or upper body.

Although concussions are generally not life threatening, they should be regarded as serious injuries requiring immediate professional medical attention. If you or someone you know experiences an injury that you think may be a concussion, the correct response is to go to the nearest hospital emergency department for an evaluation.

One of the most widespread misconceptions about a traumatic brain injury (T.B.I.) is that it always results in a loss of consciousness. This is incorrect, as many concussions occur without the patient passing out. In fact, because concussion injuries affect the brain, it is quite possible for someone to have one without any external signs of trauma such as bleeding or bruising.

Causes

As we have mentioned above, concussions are usually the result of one of the following:

Receiving a blow to the head, whether deliberate or accidental;
Falling awkwardly to the ground and landing in an uncontrolled manner;
Violent shaking of your upper body or head.

The brain floats inside the skull in a cerebrospinal fluid that helps to cushion it from forceful impact against the inside of the skull. This fluid is dense enough to prevent violent impacts against the inner skull due to normal head movements.

However, it cannot do this in the face of events such as a blow to the head, an uncontrolled fall or violent shaking. These will all result in sharp accelerations or decelerations of the brain relative to the skull and thus to collisions between the two. Impacts such as these can damage brain cells and result in what is officially known as a concussion.

If the collision is exceptionally violent, the brain may suffer bleeding, either inside or on its surface. This is a more serious type of head injury, which can be life threatening.

Concussion Types

Doctors define three types of traumatic brain injury, depending on the severity of the symptoms they observe:

Grade 1- A mild traumatic brain injury has symptoms that last for 15 minutes or less, with the patient not losing consciousness;
A Grade 2 injury – in a moderate concussion, the patient has symptoms that persist for more than 15 minutes but still does not lose consciousness;
Grade 3 – a severe T.B.I., in which the patient loses consciousness, even if only for a few seconds.

Risk Factors

The risk factors that increase the likelihood of experiencing a T.B.I. are:

Participating in combat sports like boxing or kickboxing;
Participating in contact sports such as football, rugby, hockey or soccer. In these sports, collisions between players that can result in awkward and uncontrolled falls are not uncommon;
Participating in other sports that may not be contact sports, but in which falling awkwardly happens from time to time. This would include activities like snowboarding, skiing or gymnastics;
Motor sports such as car or motorcycle racing frequently involve crashes that can produce traumatic brain injuries;
Traveling in a motor vehicle is another risk factor. This is because many concussions result from road accidents in which the occupant of a vehicle receives a blow to the head. Alternatively, the head or upper body may be violently shaken in a collision;
Being a pedestrian or cyclist who is involved in a road accident (with a vehicle or even a cyclist) can also increase the odds of experiencing a concussion;
Children may experience falls or other accidents while playing that can increase the risk of concussion;
Soldiers, particularly those in combat conditions, are at higher risk of concussions due to high powered explosions in their vicinity. These explosions can result in soldiers being hit by foreign objects or receiving violent shaking of the head or upper body;
Another important risk factor that increased the risk of concussion is having had one before. If you have a history of repeated concussions, the risk is even higher.

Recent Increases In Awareness Of Concussion Risk

Many of the T.B.I.s that occur in practice are sports related concussions. In recent years, there has been increasing awareness of the presence of concussion risk in many sports for which there was not thought to be any risk. As an example, recent studies have pointed out the risk of concussion to soccer players as a result of heading the ball.

Symptoms

Due to the huge number of bodily functions for which the brain is responsible, the signs and symptoms of a T.B.I. may cover a wide range. To make things more complicated, some of the symptoms may not appear immediately after the accident that caused the concussion. Instead, they may appear hours (or even days) afterwards.

Typical symptoms of concussions may include at least some of the following:

Headaches;
Loss of memory, particularly about the incident that caised the concussion;
Confusion;
Blurred vision;
Loss of the taste or smell senses;
Dizziness and/or difficulties with balance;
Sensitivity to light or noise;
Problems with concentration;
Insomnia;
A ringing sound in the ears;
Lack of co-ordination;
Nausea and/or vomiting;
Seizures;
Dilated eye pupils or pupils of unequal size. One way to check for this symptom is using a pen light with a pupil gauge;
Irritability,depression or other unusual mood changes.

Should any of these signs and symptoms be present after an accident that includes a fall or a blow to the head, you should seek immediate medical attention. This is particularly the case if these symptoms continue for more than a few hours or worsen during that time.

Concussion Diagnosis & Treatment

Diagnosis

The good news is that most individuals who suffer concussions will eventually make a full recovery, if given the appropriate treatment. To ensure the patient receives proper treatment, a prompt diagnosis must be performed by a qualified medical professional.

To carry out a diagnosis, a doctor will do some or all of the following:

Ask questions to test the patient’s memory and cognitive state. These may include his/her name, address and date of birth;
Test the patient’s co-ordination & reflexes;
Tests of the patient’s vision & hearing, e.g, holding 3 fingers up and asking the patient to count them.

To determine whether the patient has experienced a skull fracture or other serious physical injury, the doctor may also request a CT scan or an MRI. Since a CT scan uses X Rays, many doctors are reluctant to use them if the patient is a child, due to the risk of exposure to radiation.

Treatment

As treatment for a suspected sports related concussion, doctors may recommend that the patient immediately cease participation in the game. In addition, the patient will need to:

Refrain from athletic activity for a period (at least 48 hours);
Refrain from any mentally taxing activity for a similar period (e.g. watching T.V.);
Avoid any activities that could cause another T.B.I. and add to the damage of the first concussion. Repeated concussions can increase the risk of permanent brain damage such as chronic traumatic encephalopathy (C.T.E.) a progression deterioration of mental capacities also known as dementia pugilistica;
Take pain relieving medication if he/she is experiencing headaches or other severe pain. However, ask the doctor for guidance as to which medication is safe to take, as some can be harmful;
Should there be any increase in severity of symptoms, the patient should revisit the doctor immediately for a new evaluation of his/her condition.
Only return to normal activities once the doctor is certain that the concussion has healed. It may be advisable to return to normal activity only gradually, and to continually monitor for any increase in symptoms (or for the appearance of new ones). If either of these happens, the patient should revisit the doctor immediately.

How To Prevent Or Avoid Concussions

Although most people recover from them, concussions are serious injuries. As a result, it is important to know what you can do to reduce the risk of experiencing them in the first place. Since they are usually the result of sudden unexpected accidents, it is difficult to avoid or prevent them entirely. However, you can take the following steps to reduce the risk:

Wear protective head coverings such as a helmet when playing sports like hockey, football or lacrosse or when riding a motorcycle or participating in a motor racing event;
Also wear a helmet when participating in an activity in which serious falls can take place, e.g. cycling, horseback riding, skiing,snowboarding and rollerblading;
Wear protective head padding if participating in a combat sport like boxing;
Take common sense (and legally required) steps like always fastening your seat belt when traveling in a motor vehicle;
If you play a sport in which there is plenty of running and sharp changes of direction, you can start an exercise program to strengthen your leg muscles. This will help you in those situations when you need to run while you are somewhat off balance. Your risk of falling will be lower;
If you have children in your home, you should consider modifying your stairways to reduce the risk of them falling through the rails. If necessary, consider blocking the side rails to prevent these types of accidents.

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