What is a concussion?

Concussion is one of those medical terms that gets tossed around like a salad.  I especially appreciate when someone hits his head, is bleeding like he was in a gun fight and the most pressing question is, “Does he have a concussion?”  Best to stop the bleeding and call 911 before we answer that.   Then, when it has been determined that yes, indeed it is a concussion, he is back at practice the next week.  We need to make up our minds – is a concussion serious or isn’t it?  I know what I think.  Perhaps you need some more information before you decide.

1.  A concussion is a traumatic injury to the brain.  (Notice the period after that sentence.)  You do not need loss of consciousness to sustain a concussion.  It does not include more serious injuries that result in bleeding under the skull.  This would be a whole new ballgame where concussion is the least of your worries.

2.  You can sustain trauma to the skull, without suffering trauma to the brain itself.  So, every blow to the head does not qualify as a concussion.  We initially recognize that there has been injury to the brain based on a patient’s symptoms.

3.  Immediate loss of consciousness after trauma to the head is definitely a concussion – unless it tells of something more serious.   More mild symptoms of a concussion are headache, nausea, vomiting, confusion, blurry vision, dizziness, problems with short term memory, and drowsiness.  (More on this tomorrow.)

4.  Why does it matter?  People who have one concussion generally recover well.  They may suffer from postconcussive syndrome but this usually resolves on its own within a couple of weeks.  During this time, they may experience headache, nausea, dizziness and difficulty concentrating.  People who have experienced several concussions in their life are at risk for more severe sequelae.  The effects of multiple concussions are cumulative; that is, they add up.  The more concussions a person sustains, the greater his or her risk for long term memory loss, difficulty with concentration, and neurologic and psychiatric problems.

5.  Second-Impact syndrome – While very rare, this is when a minor head injury can become fatal.  It occurs when a second concussion happens within a short period of time after the first, before the brain has had a chance to fully recover.  This can result in sudden and severe brain swelling that, at the least, results in long-term disability and at the worst, results in death.

More on signs and symptoms tomorrow.  Recognition of brain injury is the crucial first step in its management.

Off the topic a little, in reference to yesterday’s entry, it shocks me that girls are more prone to head injury than boys when playing similar sports.  I have been paying very careful attention to the differences between the genders since I gave birth to two little boy babies.  I would have bet my life that girls would have better skills to avoid head injury.  The boys, it seems to me, go through life trying to see just how much blunt force their heads can take.  They lead with their heads, show no caution whatsoever when approaching a precarious situation and repeatedly, fail to learn from their mistakes. “Maybe it was a fluke that it hurt when I hit my head with this bat.  Maybe it won’t happen again.  O.K.  It hurt again.  Maybe it won’t hurt this time …” Perhaps, when God gave girls superior brains, he gave boys harder skulls?  I’ll look into this a little more and let you know.

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