January 23, 2010

Saturday, January 23, 2010
The term concussion originates from the Latin concutera, which means to shake violently or the Latin concussus, which refers to the action of striking together. It is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion are often used interchangeably.

The American Academy of Neurology Guidelines ranks the severity of a concussion into 3 grades:

Grade I - Confusion, symptoms last < 15 minutes, no loss of consciousness

Grade II - Symptoms last > 15 minutes, no loss of consciousness

Grade III - Loss of consciousness

Concussion Symptoms:
  • Headache
  • Dizziness
  • Vomiting
  • Nausea
  • Lack of motor coordination
  • Difficulty balancing
  • Light sensitivity
  • Seeing bright lights
  • Blurred vision
  • Double vision
  • Tinnitus
  • Convulsions
  • Confusion
  • Disorientation
  • Difficulty focusing attention
  • Loss of consciousness
  • Post-traumatic amnesia
  • Confusion
  • Slurred or incoherent speech
  • Changes in sleeping patterns
  • Difficulty with reasoning, concentrating, and performing everyday activities
  • Crankiness
  • Loss of interest in favorite activities or items
  • Tearfulness
  • Displays of emotion that are inappropriate to the situation
**Common symptoms in children include restlessness, lethargy, and irritability.

Typically symptoms will go away without treatment. Roughly 1% of treated concussions require surgery for a brain injury. Most often plenty of rest is prescribed with a gradual return to normal activities at a pace that does not cause symptoms to worsen.

Medications may be prescribed to treat symptoms associated with the concussion, such as sleep problems and depression. Analgesics such as ibuprofen can be taken for headaches that frequently occur after a concussion, but acetaminophen is preferred to minimize the risk for complications, such as intracranial hemorrhage. Individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor as they may interfere with the healing process.

Observation to monitor for worsening condition is an important part of treatment. Unconsciousness or altered mental status, convulsions, severe, persistent headache, extremity weakness, vomiting, or new bleeding or deafness in either or both ears suggests that another visit to the doctor is needed. No conclusive evidence suggests that it is necessary to wake a patient up every few hours or not.

Symptoms usually go away entirely within three weeks, though they may persist, or complications may occur. Although the mortality rate is almost zero, repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome.

Certain factors may lengthen recovery time, such as longer periods of amnesia or loss of consciousness, substance abuse, clinical depression, poor health or additional injuries sustained and life stress. For unknown reasons, having had one concussion significantly increases a person's risk of having another. Having previously sustained a concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. The prognosis is likely to differ between adults and children; however little research has been done on concussion in the pediatric population. Concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, victims of concussion exhibited the following effects:

    • A decrease in episodic memory (times, places, associated emotions, and other contextual knowledge)
    • A decrease in response inhibition
    • Delayed P3a/P3b waves recorded via EEG
    • An increase in the cortical silence period
    • Reduced muscle speed otherwise known as bradykinesia (slow movement)
In recent news, Canadian researchers suggest that the term concussion is scraped from medical terminology as doctors and parents quite often underestimate the severity of these types of injuries.

“Carol DeMatteo, an occupational therapist and associate clinical professor in the School of Rehabilitation Science at McMaster University in Hamilton, Ont., says children diagnosed with concussions are treated differently from kids with other mild brain injuries.” These children are often sent home from the hospital and returned to school much sooner than those treated for mild brain injuries.

The term mild brain injury takes on a more negative connotation that concussion, which tends to suggests that the prognosis is obviously good. Concussion should not be taken as lightly as evidence suggests people who have experience multiple concussions risk neurological damage or even Alzheimer's disease and other dementias.

Natasha Richardson’s tragic death is a perfect example of what might happen when brain injuries are not taken seriously enough. On 16 March 2009, Richardson sustained a head injury when she fell while taking a skiing lesson at the Mont Tremblant Resort in Quebec. The injury was followed by a lucid interval, when she appeared to be fine as she was able to talk and act normally. Paramedics were told they were not needed. She returned to her hotel room and about three hours later was taken to a local hospital in Sainte-Agathe-des-Monts after complaining of a headache. About 7 hours following her fall, she was transferred by ambulance to Hôpital du Sacré-Cœur, in Montreal, in critical condition. The following day she was flown to Lenox Hill Hospital in New York City, where she died on 18 March. An autopsy conducted by the New York City Medical Examiners Office on 19 March revealed the cause of death was an "epidural hematoma due to blunt impact to the head", and her death was ruled an accident. There is a lot of controversy surrounding her death as many believe it could have been prevented with proper medical care.

If the term "mild traumatic brain injury" replaced "concussion", it would help people understand that this type of injury is serious and that it is an injury to the brain, not just the head. It could also save lives and prevent more serious complications later in life.

'Concussion' underplays severity of injury: doctors
Natasha Richardson

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