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TBIs (traumatic brain injuries or concussions) can happen very easily, but can take a lifetime to overcome. Some people sustain a blow to the head and have seemingly no after effects, while others take a mild body blow and are symptomatic for weeks or months. No one understands why men and women respond differently, nor why blows of the same magnitude can impact people differently. What we do know is that they all cause brain damage, and that the damage is cumulative and in some cases, lasts a lifetime.

Concussion may be caused by either a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head. It typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously. You don’t need to lose consciousness in order to have a concussion.

Avoiding blows to the head and body are key to avoiding sustaining a TBI. Here are some specific tips:

  1. Avoid activities that bump, blow or jostle your head. This is typically more of a male risk than female. Men are more likely to die of TBU than women.
  2. Avoid mixing energy drinks and alcohol and binge drinking, as we tend to lose judgement when drunk and take risks we wouldn’t otherwise.
  3. Don’t drink and drive. Car accidents are a major cause of TBI.
  4. Wear a helmet when cycling, skateboarding, rollerblading, and batting in baseball.
  5. Never dive into shallow water, or water that you aren’t familiar with. Many TBI and spine and neck injuries result from people striking a rock or pool bottom when diving in.
  6. If you have a TBI don’t drink or use non-prescribed medication or drugs.
  7. Remember that more men than women suffer TBI, and that youth and young adults are at a much higher risk of getting a TBI.
  8. Always wear your seatbelt when driving.

If you think that you or someone you are playing sports with has suffered a concussion or TBI seek medical attention immediately.

Parachute Canada has put together a good set of physician guidelines about concussion. You will find some of the information very helpful. Check out the page for the full text.

  1. What is a concussion?

Of course, the most important key to managing any condition is to know exactly what you are dealing with. Through the years, a number of definitions of concussion have been proposed, often leading to confusion. The “Consensus Statement on Concussion In Sport” (Zurich 2008)1 – released after the 3rd International Conference on Concussion in Sport, defines concussion as: “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces. Several common features that incorporate clinical, pathological, and biomechanical injury constructs that may be used in defining the nature of a concussive head injury include:

  1.  Concussion may be caused by either a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head.
  2. Concussion typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously.
  3. Concussion may result in neuropathological changes, but the acute clinical symptoms largely reflect a functional disturbance rather than a structural injury.
  4. Concussion results in a graded set of clinical syndromes that may or may not involve a loss of consciousness. Resolution of the clinical and cognitive symptoms typically follow a sequential course; however, it is important to note that, in a small percentage of cases, post-concussive symptoms may be prolonged.
  5. No abnormality on standard structural neuroimaging is seen in concussion.”
     
  1. Do you have to lose consciousness to have a concussion?

Perhaps the most important mistake made when trying to define a concussion is that it involves a loss of consciousness (LOC). In fact, most concussions occur without LOC. LOC is just one symptom of concussion, and, in fact, recent research has suggested that a brief (less than one minute) LOC is not necessarily as significant an indicator of concussion severity as once thought. It is important to realize that many people will report a loss of consciousness because they cannot recall events before, during or after their concussion. Unless this is witnessed as a true loss of consciousness, it may be that the person is experiencing amnesia, which is an important post- concussive symptom. It is also important to note that concussion is not simply caused by a direct blow to the head. Blows to the face and to the jaw (which result in a force being transmitted to the brain) are also common causes of concussion. Even a significant blow elsewhere on the body (for example a hard tackle in football or rugby; being body checked in hockey) can cause concussive symptoms through a rapid movement of the soft brain inside the hard case of the skull. In some head injuries, there may be a structural injury to the brain, such as a bleed. Obviously, it is critical to rule out a bleed, and doing so does not affect early head injury management. However, the more typical sport related concussion does not result in any structural injury, but rather a functional injury to the brain cells. A helpful way to explain this to patients is to imagine the brain as a computer. If the computer is clearly damaged (for example, an axe through the CPU or monitor!) then this Concussions Guidelines for Physicians www.parachutecanada.org would define a structural injury. Obviously the computer would not work well due to this damage. In a concussion, the computer looks normal but is not working well (ie. not processing programs as quickly as possible, running at a slower speed, etc.). This is the same situation as in a concussion. Unfortunately, what exactly happens to cause this functional disturbance is not completely known. Given the lack of structural injury, conventional neuroimaging studies (CT, MRI) will be negative.

  1. Who gets a concussion?

The majority of concussions that a family physician will see are sport or activity related. Sports which involve contact or collision (hockey, football, rugby) are among the most common sports where concussion is seen. Other sports, such as soccer and basketball, also often involve contact and therefore a higher concussion risk than non-contact activities. However, a concussion can occur in virtually any activity, including non-sporting activity where a blow to the head, face or jaw, or other force to the head occurs. You should ask about potential concussion when you have a patient who notes a history of a whiplash injury, or an injury around the neck and shoulder area. For example, someone who fell directly on the shoulder may report mainly shoulder pain at the time, but may also have post concussive symptoms which are critical to deal with.

  1. What are the signs and symptoms?

Post concussive symptoms can be physical, cognitive and emotional. • Physical symptoms include: headache, dizziness, nausea, feeling unsteady, feeling “dinged” or “stunned” or “dazed”, feeling like their “bell was rung”, seeing stars or other visual disturbances, ringing in the ears, double vision, simply “not feeling right”. • Physical signs of concussion include: loss of consciousness or impaired consciousness, poor coordination or balance, easy distractability and poor concentration, slowness answering questions and following directions, vomiting, looking “glassy eyed”, photophobia, slurred speech, personality or behavior changes (including inappropriate playing behavior such as skating or running in the wrong direction) and significantly decreased performance or playing ability. • Cognitive symptoms include: confusion, amnesia, disorientation, poor concentration, and memory disturbance. • Emotional symptoms include: feeling of depression or moodiness. It is important to note that not all concussions will include all of these features. If any one of the aforementioned symptoms (or other similar symptoms) is present, concussion should be suspected. Keep in mind that symptoms and signs may be more pronounced later or the next day after the injury. Again, it is critical to remember that a person does not have to have lost consciousness to have sustained a concussion.

  1. What exactly causes the symptoms?

The pathology behind concussion and its resultant symptoms is, as yet, poorly understood. This is obviously a significant limiting factor in our assessment and management, in that there is no simple “test” which will give all the answers about diagnosis and resolution of the problem. It is, Concussions Guidelines for Physicians www.parachutecanada.org therefore, critical to be aware of the multiple post concussive signs and symptoms, and of appropriate management.

Posted on Tuesday, Jan 30, 2018 - 09:35:00 AM EST
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