Wednesday, February 1, 2012

Concussion Management

It's football, soccer and ice-hockey season and that means concussions.  Concussion is a mild traumatic brain injury that is the result of a blow to the head. It is so common that over 1 million visits annually to emergency rooms are for concussions.  And most people don't even go to the emergency room so it is estimated that 3 times as many occur as are reported.  Sports related activities and accidents are the main cause of concussions in children and adolescents.

Concussions can be difficult to recognize and there is no specific definition or test that can diagnose it.  Clinical judgment and specific symptoms after an injury define concussion.  The patient does not need to lose consciousness and the symptoms can come on gradually but usually appear immediately or shortly after the injury.   Headache, dizziness, balance disturbance and disorientation are the most common symptoms.   Cognitive defects can occur like confusion, delayed verbal responses, difficulty concentrating and feeling foggy.

Fortunately there is better understanding of concussion now by coaches and sports professionals and some states even require concussion training for coaches, athletes and parents.   The first evaluation usually begins at the sideline and there are tools the coach can use to assess the severity.  If there is any suggestion that the athlete has a concussion he/she should not return to play.  Most of the time concussions do not require neuro-imaging (CT scans) unless there is suspicion of more serious injury like fracture or cervical spine involvement.  CT scans and MRIs cannot diagnose concussion.

There is no medical treatment for concussion, which is a shearing force that disrupts neural membranes and affects blood flow and brain chemistry.  Recovery may take 7-10 days in adults and even longer in children and adolescents.  The patient should rest and avoid physical activity.  Resting the brain is important too and that means no reading, computers or video games.  Children should be allowed to miss school tests and homework during the recovery period.  It is important that the teachers know a head injury has occurred so school work can be limited.

  Most children will recover fully but concussion is a serious event and little is known about the extent of time recovery will take so it needs to be individualized to the patient.  Prolonged headache would indicate that the student is recovering slowly.

Don't hesitate to see a physician if you or a child has suffered a concussion.


Unknown said...

Thanks For blogging about this. Hot topic and so important the neuro-cognitive baseline testing is such an important part! Wells Fargo started a program called Play it Safe to help raise awareness and get more kids tested.

KM said...

Thanks for the interesting article and diagram of the brain.
I have been around people with concussions when volunteering in the ER. The ones I have talked to keep repeating the same questions and were scared about what was happening to them.

KM said...

I learned something new from the diagram. It states that in severe cases the brain twists. That seems like it would cause much more problems.

Toni Brayer, MD said...

KM, the brain doesn't actually twist but it can ricochet off the side walls of the skull with great force.

Anonymous said...

I'm curious about what you suggest to us parents whose kids do contact sports re: concussions. One of my 13-year-old sons friends has already sustained 2 concussions, and continues to do contact sports, including soccer and flag football. His mom, an ER physician (ahem), has her son put on a soft helmet, and is fully aware that with one more concussion, her son is done with contact sports for the duration. Do you have a recommendation concussion exposure?
Thanks, Barb

Toni Brayer, MD said...

Anon: The studies on helmets protecting from concussion are less than conclusive. Certainly the skull is protected and the new ones can absorb impact but concussions still happen with helmets because there is no real way to protect the brain against a hard blow.

I have sympathy for parents of athletes who want to play. You can never fully prevent head injuries with contact sports. Taking time for complete healing is critical before return to play.