Medical health experts and related specialists have underscored that in the past two decades, it has become clear that a concussion is often not a benign, self-limited condition as once thought. Rather, it may result in persistent physical, neuropsychiatric and cognitive symptoms that exact substantial impact on life function and quality.
According to the CDC’s National Center for Injury Prevention and Control, it is estimated that at least 1 million U.S. children experience a mild traumatic brain injury each year. The issue has become more pressing as youth sports have grown in popularity and because research has shown that repeated blows to the head, such as from playing football or heading a soccer ball, can lead to long-term memory loss, dementia and other serious health issues.
The CDC underscored the guidelines are based on the “most comprehensive review of the science” over the past 25 years. And, noting in a news release, “Until today, there was no evidence-based guideline in the United States — inclusive of all causes.”
It is important to understand too, concussions can happen at any age, and any brain injury warrants specialized assessment and approaches to intervention. The CDC’s guidelines are for concussions from all causes, including falls, sports and car accidents.
Dr. Nina’s What You Need To Know: About Concussions, Awareness and Treatment
What is a concussion?
A type of traumatic brain injury (TBI) that occurs from the brain being shaken, jarred, bounced or twisted against our hard skull. This can cause damage to brain cells (neurons) or tissue that connects them as well as metabolic changes (shifts in electrolytes, blood flow and neurotransmitters, and an increase in toxins). Consequently, brain function can be affected.
Our brain consists of tens of billions of neurons and is a solid, firm, almost rubber-like organ that is protected by our skull. Additionally, fluid surrounds the brain and serves as a cushion to protect against minor bumps and jolts that would otherwise result in it being slammed against the inside of the skull. However, when a blow, fall, or other injury is forceful or powerful enough, our brain can be injured.
What are the symptoms of a concussion?
Analogous to a snowflake, no two concussions are alike. Symptoms can range from mild to severe. Some common symptoms include temporary loss of consciousness, amnesia surrounding the moment of collision, confusion, nausea or vomiting, headache, slurred speech, fatigue, drowsiness, forgetfulness, inability to concentrate and delayed response to questions. And, while many associate a concussion with passing out, it must be noted that most never lose consciousness.
Should I get medical care?
Because concussions affect our brain’s function, an injured person may lack the clear judgment as to whether or not to seek medical attention, either immediately or in the days following. As a result, family, friends and coaches are critical in urging, encouraging and advocating that they get care when needed.
It is always wise to contact your primary care provider if you believe you have had a concussion, even if you feel fine. Your health care provider may want you to come in for a check-up and can provide instruction on things you should start right away to facilitate recovery, including taking time off from school or work.
In rare cases, a person with a concussion may develop a bleed or a blood clot that is life-threatening. Seek emergent medical care if you witness the following: loss of consciousness; headache that gets worse and does not go away, weakness; numbness or decreased coordination; repeated vomiting or nausea; slurred speech; seizure; unusual behavior; confusion, restlessness, agitation; and, in children, if they will not stop crying or are inconsolable, or will not nurse or eat. And, again, the concussed person often cannot ascertain that they need medical care or attain it (e.g. loss of consciousness, confusion) — it is up to others to help them get it.
Recognizing a concussion in children can be more complicated than in adults, since a child may not be capable of articulating the more subjective symptoms of a concussion, such as feeling “in a fog” or vertigo. Other symptoms, including irritability, may be mistakenly interpreted as a behavioral issue rather than a sign of a brain injury. Some post-concussion symptoms affect higher-level cognitive processes, which a young child may not yet be using.
How is a concussion diagnosed?
At this time, there is no gold standard when diagnosing a concussion — symptoms can vary, and there is no definitive blood test or study. In fact, the new guidelines highlight that a MRI, X-rays or CT scan aren’t effective. Instead, a diagnosis is based, in large part, on the doctor’s clinical judgement and the patient’s or witness’s history of the events. In other words, it is subjective. And, today, based on research and expert advice, neurocognitive testing is being performed more routinely to provide an objective way of diagnosing the severity, establishing a baseline and measuring recovery.
How is a concussion treated?
Fortunately, most can undergo treatment at home and have a quick recovery — however, some may require hospitalization. Research shows that the primary treatment is rather simple: “cognitive rest,” meaning mental rest. The goal is to avoid tasks that require concentration or complicated thinking so that the brain has the opportunity to heal. Experts recommend limiting school or work schedules as well as technology (emails, texting, watching television, social media).
And, too, until the signs of the concussion have resolved, it is critical to avoid:
• Activities that can cause further head injury such as biking, climbing, horseback riding and skateboarding (to mention a few)
• Bright lights and loud sounds that can overstimulate the brain
Discuss with your health care provider when you should resume light activity and intellectual and social activities — they are an important part of healing and should be reintroduced gradually. Generally speaking, recovery may be slower among older adults, young children, and teens as well as those who have had a prior concussion.
What is post-concussive syndrome?
The majority of people recover from symptoms experienced at the time of the injury. However, for some, they can last for several days, weeks and months, and possibly even longer. This is known as post-concussive syndrome (PCS).
There is still a lot that is unknown about PCS, even the diagnostic criteria varies. However, what experts do agree on is that PCS is the onset of neuropsychological symptoms typically within seven to 10 days after a head trauma. According to the Centers for Disease Control and Prevention (CDC), symptoms typically include:
• Emotional: anxiety, irritability, labile mood, depression
• Physical or somatic: headaches, visual problems, dizziness, noise/light sensitivity, nausea
• Sleep disturbances
• Thinking or cognitive: difficulty with concentration, memory issues, decreased processing speed, fatigue
The severity of symptoms varies greatly — mild, moderate, severe — and recognizing them may be difficult and even missed. Research suggests that the risk of developing PCS does not appear to be related to the severity of the head injury. However, there does appear to be a greater risk in older adults, when there is a history of prior concussion, and in women. Of note, the gender discrepancy may be because women are more likely than men to attain medical care and receive a diagnosis. Most cases of PCS resolve within three months but there are some where symptoms last longer, known as persistent post-concussive symptoms.
What is Chronic Traumatic Encephalopathy?
A degenerative brain disease that has been associated with repetitive impacts to the head, regardless of whether those impacts cause concussions or not. Chronic Traumatic Encephalopathy (CTE) has been shown to cause a myriad of negative symptoms including depression, memory loss and dementia, confusion, depression, and behavioral and personality changes, including aggression and paranoia. The problems can arise years after the blows to the head have stopped.
Some children and teens think concussions aren’t serious or worry if they report a concussion they will lose their position on the team or look weak.
I am not an anti-football (or impact sport) evangelist, but I join with others in the belief that impact sport’s long-term success hinges on moving more urgently toward safety — for the sake of all age groups and especially at the youth level.
Dr. Nina Radcliff, of Galloway Township, is a physician anesthesiologist, television medical contributor and textbook author. Email questions for Dr. Nina to firstname.lastname@example.org with “Dr. Nina” in the subject line. This article is for general information only and should not be used for the diagnosis or treatment of medical conditions and cannot substitute for the advice from your medical professional.