Concussions, A DSN Exclusive Series – Part 1: What Is A Concussion?

Part 1: What Is A Concussion?

DSN: We use the term concussion a lot. Please describe a concussion. Clarify the definition and what is actually happening in the brain when the injury occurs.

Dr. Lieff: The truth is that there is not a lot known about concussion because the brain changes are very small and usually can’t be seen by brain imaging of any kind. At this point in research, it is considered different from other brain injuries where specific damage can be observed. In the future, more powerful devices will likely be able to see damaged neurons, circuits, blood vessels and inflammation. Some breaks in small axon bundles (bundles of wires between neurons) have been observed with powerful new MRIs that are not used in clinical practice.

When the brain is hit, shaken, jostled, or vibrated from the force of an explosion many different events can occur, all too small to be observed. And they can happen in many different places with different effects.

Because concussions really can’t be measured, they are evaluated based on physical and mental symptoms. Immediate symptoms can include disorientation, “seeing stars”, feeling “dazed”, memory loss of the event, headaches, neck pain, and others. The most prominent physical symptom is often headache but can include dizziness, nausea, light sensitivity, motor incoordination, and ringing in the ears. Longer lasting symptoms can include problems with thinking and memory, and emotional lability.

What is surprising is that each concussion is quite variable and seemingly minor concussions can have lasting and significant effects. The differences might be based on a large number of factors including exactly where and how the head was hit.

DSN: There are some persistent myths about concussions. Can you clarify some of these?

Dr. Sandel: 1) People recover from a concussion in 7– 10 days.

While many sports guidelines use the 7- to 10-day timeline, this idea comes from a study published more than 10 years ago that recommended further research. Experts agree that up to 10% of people with concussion go on to have persistent problems. That’s a high percentage. Beyond recent news about chronic traumatic encephalopathy in athletes with repetitive concussions, recent research from Scandinavia disturbingly shows long-term connections between brain injury, including concussion, and seizures, mental health problems, dementia, and poorer vocational outcomes and disability. People with concussion who suffer difficulties with school or employment or have headaches or vertigo that don’t go away should be fully evaluated in a multidisciplinary clinic specializing in concussions.

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2) Helmets protect against concussions.

There is significant ongoing research to try to mitigate the high risk of concussion in collision sports by changing play rules and improving equipment. Helmets can protect against some severe injuries, such as skull fractures and bleeding or bruises in the brain. But high-risk sports involve more than simple impacts. Biomechanical forces, especially rotational (twisting) forces that cause acceleration and then deceleration of the whole body, including the head, during an impact cause microscopic injury. The helmets in use today do not eliminate these forces.

3) Children have more neuroplasticity than adults and can recover brain function more easily.  

Our children’s brains probably are not fully mature until they reach their mid-20s. So while their brains are developing, we must protect them from injury to the extent we can. There is current brain injury research that supports not having our children play collision sports until they can make an informed decision for themselves. This is a hard pill to swallow, given the huge role sports play in our society.  

Check back tomorrow as we delve more deeply into the specific symptoms and treatment of concussions.

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