CONCUSSION

DEFINITION

Concussion is a change in mental status caused by trauma (shock). It is accompanied by confusion, loss of memory, and, sometimes, loss of consciousness.

DESCRIPTION

A concussion occurs when the head hits or is hit by an object. A concussion can also occur when the brain is pushed against the skull with a strong force. In such cases, parts of the brain that control mental function may be damaged. The injured person may become disoriented (confused) and may briefly lose consciousness.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that about three hundred thousand people experience mild to moderate concussions each year as a result of sports injuries. Most of these people are men between the ages of sixteen and twenty-five.

A concussion usually gets better without any long-term effect. On rare occasions, it is followed by a more serious injury called second-impact syndrome. Second-impact syndrome occurs when the head receives a second blow before the original concussion totally healed. Brain swelling may increase, resulting in a fatal condition. Since 1984, more than twenty people have died from second-impact syndrome.

CAUSES

Motor vehicle accidents and sports injuries are the major causes of concussion. In motor vehicle accidents, concussion can occur without an actual blow to the head. Instead, concussion occurs when the vehicle starts or stops suddenly. In such a case, the brain is pushed strongly against the skull. Contact sports, especially football, hockey, and boxing, are leading causes of concussion. Other significant causes are falls, collisions, or injuries due to bicycling, horseback riding, skiing, and soccer.

The risk of concussion from football is extremely high, especially at the high school level. Research shows that about 1 in 5 high school football players suffer concussion or more serious brain injury at some point during their high school football career. The comparable rate at the college level is 1 in 20.

Concussion and lasting brain damage is also very common among boxers. After all, the goal of this sport is to knock out an opponent, that is, to give him or her a concussion. For this reason, the American Academy of Neurology (a group of doctors who specialize in problems of the nervous system) has called for a ban on boxing.

Repeated concussions over many months or years can eventually cause more serious brain injury. For example, boxers can develop a form of permanent brain damage called "punch drunk" syndrome or dementia pugilistica (pronounced dih-MEN-sha pyoo-juh-LIS-tuh-kuh). Perhaps the best known example is the great boxer Muhammad Ali. Ali eventually developed Parkinson's disease (see Parkinson' disease entry), believed to be caused by head injuries sustained while he was active as a boxer.

Young children are likely to suffer concussions from falls or bumps on the playground or at home. Child abuse is another common cause of concussion.

SYMPTOMS

Symptoms of concussion include:

• Headache
• Disorientation (confusion) as to time, date, or place
• Dizziness
• Vacant stare or confused expression
• Speech that is difficult to understand
• Lack of coordination or weakness
• Amnesia (loss of memory) about events just preceding the blow
• Nausea or vomiting
• Double vision
• Ringing in the ears

These symptoms may last from several minutes to several hours. More severe or longer-lasting symptoms may indicate more severe brain injury. If a person loses consciousness, it will be for several minutes at the most. If unconsciousness last for a longer period, a more serious form of brain injury may have occurred.

Doctors use a three-point system to determine the seriousness of a concussion. This system helps them to choose the appropriate treatment.

• Grade 1: No loss of consciousness, brief confusion, and other symptoms that clear up within 15 minutes.
• Grade 2: No loss of consciousness, brief confusion, and other symptoms that clear up in more than 15 minutes.
• Grade 3: Loss of consciousness for any period of time.

Days or weeks after the original concussion, certain symptoms may reoccur. These symptoms are called post-concussion syndrome. They include:

• Headache
• Loss of ability to concentrate and pay attention
• Anxiety
• Depression
• Sleep disturbance
• Inability to tolerate light and noise.

DIAGNOSIS

Anyone who receives a concussion must be watched very carefully after the accident. It is important to notice how long unconsciousness lasts and how

Professional basketball player Reggie Miller is helped from the court after sustaining a concussion during a game. (Reproduced by permission of

AP/Wide World Photos

)

serious the symptoms seem to be. These signs are indications of how serious the brain injury was, and are important in deciding how to treat the patient.

A medical professional can decide how serious a concussion is with some simple tests. He or she may examine the pupils of the patient's eyes, test the patient's coordination and sense of feeling, and observe his or her memory, orientation, and concentration. Patients with mild concussions do not require hospitalization or further tests. Those with more serious injuries may need some form of brain test, such as a computer-aided tomographic (CAT) scan.

TREATMENT

The symptoms of concussion usually clear up quickly and without lasting effects. Medical specialists decide how soon a person can return to sports activities based on the severity of his or her injury. All treatment plans are designed to prevent a second blow to the head during recovery. A second blow may cause very serious long-term brain damage.

A Grade 1 concussion is usually treated with rest and continued observation only. The person can return to sports activities the same day if a medical professional approves and all symptoms are gone. If a second concussion occurs on the same day, the person should not be allowed to continue contact sports until he or she is free of symptoms for one week.

A person with a Grade 2 concussion must discontinue sports activities for the day. He or she must be observed by a medical professional and be observed throughout the day until all symptoms have disappeared. If symptoms become worse or continue beyond a week, further brain tests, such as a CAT scan, may be necessary. The person cannot return to contact sports until one week after symptoms have disappeared and a medical professional has given permission.

A person with a Grade 3 concussion should be seen immediately by a medical professional. If symptoms are severe, brain tests and hospitalization may be necessary. Prolonged unconsciousness and worsening symptoms require immediate examination by a neurologist.

A neurologist is a doctor who specializes in problems of the nervous system. The patient should be carefully observed after discharge from medical care. If symptoms reappear or become worse, further neurological tests may be necessary.

A person with a Grade 3 concussion should avoid contact sports for at least a month after all symptoms have disappeared. If brain tests indicate that brain swelling or bleeding has occurred, the athlete should give up contact sports for the season and, if symptoms are bad enough, indefinitely.

PROGNOSIS

There are usually no long-term effects of concussion. However, symptoms of post-concussion syndrome may last for weeks or months. The risk of a second concussion in contact sports is even higher than the risk for a first concussion. For that reason, a person who has received a concussion needs to avoid contact sports until the first concussion has entirely cleared up.

PREVENTION

Many cases of concussion can be prevented by using certain types of protective equipment. These include seat belts and air bags in cars, and helmets in contact sports. Helmets should also be worn when bicycling, skiing, or horseback riding. Soft material, such as sand or matting, should be placed under playground equipment.

Young people should think about the value of high-contact sports, such as boxing, football, and hockey, compared to their risk for head injuries. They may decide to take part in sports activities that are fun to participate in, but less risky to one's health.

FOR MORE INFORMATION

Books

Gronwall, D. M. A., Philip Wrightson, and Peter Waddell. Head Injury—The Facts: A Guide for Families and Care-Givers. New York: Oxford University Press, 1998.

Stoler, Diane Roberts. Coping With Mild Traumatic Brain Injury. Garden City Park, NY: Avery Publishing Group, 1998.

Organizations

American Academy of Neurology. 1080 Montreal Avenue St. Paul, MN 55116–2325. (800) 879–1960.