Concussions: Your Brain at Risk?
It is tempting to take a concussion “lightly”, as something you can “shake off”, but concussions are a serious health problem. The NFL has recently offered to pay $765 million dollars to settle a concussion lawsuit brought about by a few hundred NFL players. But it is not a few hundred Americans who suffer these injuries every year but several million.
A concussion is an injury to the brain, commonly caused by a fall, car accident, or from sports. The likelihood of an athlete sustaining a concussion during the season is as high as 20%. The classic signs of concussion are loss of memory and change in mental status (e.g. confusion, mood or behavioral change). Concussion does not require loss of consciousness and in fact in the majority of concussions this does not occur. Concussion symptoms span 4 major areas: Thinking-Remembering / Physical / Emotional-Mood / Sleep.
In the Thinking/Remembering area, loss of memory, called amnesia, is common and usually extends to the injury itself (e.g. an athlete who may not remember getting hit) but can also extend before or after an injury. People also often complain of difficulties with concentrating, remembering new information, and thinking clearly. In the Physical area, loss of energy, feeling slowed down, balance problems, sensitivity to light and/or noise, dizziness, headache, nausea, and vomiting all occur frequently. In the Emotional/Mood area, irritability, sadness, nervousness or anxiety are all seen. Finally in the sleep area, we see concussion patients common describe difficulty falling asleep or sleeping more than usual. All of these can immediately occur after an injury or can more gradually appear over a few hours to a few days.
Some of the more feared complications of a head injury are fractures of the skull or neck, bleeding in the brain, and seizures. Fractures of the neck or skull can result in significant pain in the neck or skull, spinal cord injuries, paralysis, brain contusions, and intracranial hemorrhage. Bleeding in the brain is often accompanied by worsening headache, confusion, lethargy, though can be preceded by what is called a “lucid interval” where the person is talking and acting normally. Seizures, though uncommon in mild concussions, can occur and are often associated with complications such as bleeding in the brain. Dangerous in and of itself, they seem to increase the risk of epilepsy, a more long standing seizure disorder.
Evaluation of a patient with a suspected concussion includes a thorough neurologic examination, careful history trying to determine symptoms and signs which may suggest concussion or something more serious. One of the most important thing a medical provider can do is to determine if a person who has suffered a concussion needs a radiology study such as a CT Scan (though thankfully these studies, which have risk of radiation exposure, are not needed for the majority of patients). There are some systems and tools which allow an athlete to establish a “baseline” cognitive function, which can be compared to a “post injury” test to see if there are residual problems or issues.
Any athlete who suffers a concussion needs to be excluded from sports until cleared by a professional trained in evaluating concussions. One of the most dreaded complications of a concussion is called “second impact syndrome”, when someone suffers a 2nd concussion before their brain has adequately healed from the 1st one. Permanent disability or even death is quite common in second impact syndrome.
Some warning signs that a head injury is not a simple concussion include: severe or worsening headache, confusion, inability to wake the person up, vision problems, vomiting, fever, stiff neck, weakness, numbness, bowel or bladder incontinence. Any of these signs should warrant an immediate emergency department evaluation, and may require neck immobilization and potential ambulance transfer.
If you are worried that you or a loved one may have suffered a concussion, an evaluation by your primary care provider, the emergency department, or your Piedmont Urgent Care by Wellstreet provider can get you well on your way faster. Our clinicians at Piedmont Urgent Care by WellStreet have completed training and received certification in concussion diagnosis and management.