The Anatomy of a Concussion
mvpboxing  |   May 04, 2017, 12:05PM

A concussion, the most common type of Traumatic Brain Injury (TBI), is a disturbance of brain function without measurable change in brain anatomy, which may be caused by sudden trauma and marked by a change in mental status. Concussions may or may not be accompanied by loss of consciousness (LOC), and may cause a variety of physical, cognitive, and emotional symptoms.

A concussion is a minor traumatic brain injury (MTBI) that may occur when the head hits an object, or a moving object strikes the head, which causes the brain to bounce against the rigid bone of the skull. This force may cause a tearing or twisting of the structures and blood vessels of the brain, subsequently results in a breakdown of the normal flow of messages within the brain. The damage to the brain is generally found deep within the brain tissue. Due to this damage, the normal functions of the brain signals are interrupted.

Causes, incidence, and risk factors

A concussion can result from sports activities (Boxing, MMA and Football), car accidents, and falls. Acceleration (g-forces, jarring) can exert rotational forces in the brain in any direction (especially the midbrain and diencephalon), may cause loss of alertness and unconsciousness.

The duration of being unconscious may be a sign of the severity of the concussion. However, concussions don't always involve a loss of consciousness. Most people who have a concussion never pass out, but they may describe seeing all white, black, or stars. You can have a concussion and not realize it.

Symptoms

Physical Symptoms of a concussion can range from mild to severe. They can include:

  • √ Acting confused, feeling spacey, or not thinking straight
  • √ Headache
  • √ Loss of consciousness
  • √ Nausea and vomiting
  • √ See flashing lights
  • √ Balance problems
  • √ Tinnitus (ringing in ears)
  • √ Post traumatic seizures
  • √ Post traumatic epilepsy
  • √ Double vision
  • √ Dizziness
  • √ Fatigue
  • √ Trouble falling asleep
  • √ Sleep more than usual
  • √ Drowsiness
  • √ Sensitivity to light
  • √ Sensitivity to noise
  • √ Numbness or tingling
  • √ Difficulty communicating
  • √ Difficulty concentrating

Cognitive and Emotional Symptoms

  • √ Memory loss (post traumatic amnesia) of events before the injury or right after
  • √ Disorientation

The following are emergency symptoms of a concussion. Seek immediate medical care if there are:

  • √ Changes in alertness and consciousness
  • √ Convulsions (seizures)
  • √ Muscle weakness on one or both sides
  • √ Persistent confusion
  • √ Remaining unconsciousness (coma)
  • √ Repeated vomiting
  • √ Unequal pupils
  • √ Walking problems

Head injuries that cause a concussion often occur with injury to the neck and spine. Take special care when moving people who have had a head injury.While recovering from a concussion, you may:

  • √ Have a hard time with tasks that require remembering or concentrating
  • √ Withdrawn, easily upset, or confused
  • √ Have mild headaches

Tests that may be performed include:

  • √ EEG (brain wave test) may be needed if seizures continue
  • √ Head CT scan
  • √ MRI of the head
Diagnosis

The doctor will perform a physical exam and check your nervous system. There may be changes in your pupil size, thinking ability, coordination, and reflexes. If the doctor thinks that you have a concussion, he or she will ask questions about the injury and may test your ability to pay attention, your learning and memory. Your doctor may also try to find out how quickly you can solve problems. Then the doctor will check your strength, balance, coordination, reflexes, and sensation. Sometimes the doctor will order imaging tests such as a CT scan or a MRI to make sure your brain is not bruised or bleeding.

Grade1: The mild concussion occurs when the person does not lose consciousness (pass out) but may seem dazed.

Grade2: The slightly more severe form occurs when the person does not lose consciousness, but has a period of confusion, and does not recall the event. People at higher risk are those who are active in high impact sports and those who are taking blood thinners, such as Coumadin.

Grade3: The classic concussion, which is the most severe form, occurs when the person loses consciousness for a brief period of time and has no memory of the event. Evaluation from a health –care provider should be performed as soon as possible after the injury.

Expectations (prognosis)

Healing or recovering from a concussion takes time. It may take days, weeks, or even months. You may be irritable, have trouble concentrating, unable to remember things, have headaches, dizziness, and blurry vision. These problems will probably go away slowly. You may want to get help from family or friends before making important decisions.

Prevention

A concussion is unexpected, but there are several commonsense precautions you can take to lessen the possibility of traumatic brain injury. In order to prevent head injuries in adults, always wear protective equipment during activities or sports related activities that could cause a head injury .They can help safeguard against traumatic head injuries. Participation in high-contact, high-risk sports such as football, hockey, boxing, MMA and soccer can increase the possibility of a concussion. Skateboarding, snowboarding, horseback riding, and rollerblading are also a threat to your brain's health. Wearing a bike helmet can lower the risk of traumatic head injury by 85%. Ensure that the equipment is properly fitted, well maintained, and worn consistently. Drive and ride smartly. Always wear a seatbelt, obey posted speed limits, and don't use drugs or alcohol because they may impair reaction time. Concussions may be sustained during an assault (fighting), and more males than females report traumatic head injuries.

Wear a helmet and safety equipment when you:

  • √ Play sports, such as baseball, hockey, and football. Drive or ride on a motorcycle and scooter.
  • √ Wear headgear and/or helmet when training in boxing and MMA, skiing, skateboarding and horse riding
  • √ Make your home safer to prevent falls.

Reduce your child's chances of getting a concussion:

  • √ Use child car seats and booster seats correctly.
  • √ Each your child bicycle safety.
  • √ Teach your child how to be safe around streets and cars.
  • √ Keep your child safe from falls.
  • √ Teach your child playground safety.

Order and display the concussion poster: CDC and the NFL encourage parents, coaches, and school professionals to display this poster in team locker rooms, competition and tournament sites, gymnasiums, ice rinks, and schools nationwide.

Treatment

A more serious brain injury that involves bleeding or brain damage must be treated in a hospital. Any person who may have had a concussion needs to see a doctor. Some people have to stay in the hospital to be watched. Others can go home safely. People who go home still need to be watched closely for warning signs or changes in behavior. Call a doctor or seek emergency care immediately if you are watching a person after a concussion and have these symptoms:

  • √ Headache that gets worse or does not go away.
  • √ Weakness, numbness or decreased coordination.
  • √ Repeated vomiting or nausea.
  • √ Slurred speech.
  • √ Extreme drowsiness or you cannot wake them.
  • √ One pupil that is larger than the other.
  • √ Convulsions or seizures.
  • √ Problem recognizing people or places.
  • √ Increasing confusion, restlessness, or agitation.
  • √ Loss of consciousness.

Warning signs in children are the same as those listed above for adults. Take your child to the emergency department if he or she has any of the warnings signs listed above or:

  • √ Will not stop crying.
  • √ Will not nurse or eat.

A person who might have a concussion needs to immediately stop any kind of activity or sport. Being active again too soon increases the person's risk of having a more serious brain injury. Be sure to see a doctor before returning to play. Rest is the best way to recover from a concussion. Here are some tips to help you get better:

  • √ Get plenty of sleep at night, and take it easy during the day.
  • √ Avoid alcohol and illegal drugs.
  • √ Do not take any other medicines unless your doctor says it is okay.

Avoid activities that are physically or mentally demanding (including housework, exercise, schoolwork, video games, or using the computer). Ask your doctor when it's okay for you to resume normal every day activities.

Use ice or a cold pack on any swelling for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin in order to prevent frostbite.

Use pain medicine as directed. Your doctor may give you a prescription for pain medicine or recommend you use a pain medicine that you can buy without a prescription, such as acetaminophen (for example, Tylenol) or ibuprofen (for example, Advil or Motrin).

Some people feel normal again in a few hours while others have symptoms for weeks or months. It is very important to allow yourself time to get better and to slowly return to your regular activities. If your symptoms come back when you are doing an activity, stop and rest for a day. This is a sign that you are pushing yourself too hard. It is also important to call your doctor if you are not improving as expected or if you think that you are getting worse instead of better.

After checking for signs of neck injury, the patient should be watched for several hours. Taking the patient to the emergency room is warranted for any of the following: repeated vomiting, worsening headache, dizziness, seizure activity, excessive drowsiness, double vision, slurred speech, unsteady walk, or weakness or numbness in arms or legs, or signs of basilar skull fracture. After this initial danger period has passed, there is debate whether it is necessary to awaken the patient several times during the first night as has traditionally been done, or whether the patient would benefit more from uninterrupted sleep.

The 2008 Zurich Consensus Statement on Concussion in Sport states, "The cornerstone of concussion management is physical and cognitive rest until symptoms resolve." Most (80–90%) concussions resolve within seven to ten days, although the recovery time may be longer in children and adolescents.

Concussion sufferers are generally prescribed rest, including plenty of sleep at night plus rest during the day. Rest includes both physical and cognitive rest until symptoms clear. Health care providers recommend a gradual return to normal activities at a pace that does not cause symptoms to worsen. Education about symptoms, how to manage them, and their normal time course can lead to an improved outcome.

For persons participating in athletics, the 2008 Zurich Consensus Statement on Concussion in Sport recommends persons be symptom free before restarting and then, not all at once, but rather through a series of graded steps. These steps include: complete physical and cognitive rest, light aerobic activity (less than 70% of maximum heart rate), sport-specific activities such as running drills and skating drills, non-contact training drills (exercise, coordination, and cognitive load), full-contact practice, and full-contact games. Only if a person is symptom free for 24 hours, should he or she proceed to the next step. If symptoms occur, the person should drop back to the previous asymptomatic level for at least another 24 hours. This is not a race. The person should go easy and take his or her time. The emphasis is on remaining symptom free and taking it in medium steps, not on the steps themselves.

Concussion Self-Care at Home

Bleeding under the scalp, but outside the skull, creates a "goose egg" or large bruise (hematoma) at the site of the head injury. A hematoma is common and will go away on its own with time. The use of ice immediately after the trauma may help decrease its size.

Do not apply ice directly to the skin which can cause frostbite–instead insert ice and cold water into a plastic zip lock bag. You may also use a bag of frozen vegetables wrapped in cloth, as this conforms nicely to the shape of the head. Apply ice for 20-30 minutes at a time and repeat about every two to four hours. There is little benefit after 48 hours. Rest is important to allow the brain to heal. In 2010, the American Academy of Neurology called for any athlete suspected of having a concussion to be removed from play until the athlete is evaluated by a physician. If a concussion is suspected due to a sports injury, the Centers for Disease Control recommend implementing a 4-step plan:

  • √ Remove the athlete from play. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the severity of the injury yourself.
  • √ Inform athlete's parents or guardians about the possible concussion and give them the fact sheet on concussion.
  • √ Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it's OK to return to play.
  • √ A repeat concussion that occurs before the brain recovers from the first - usually within a short period of time (hours, days, or weeks) - can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.
Concussion Medical Treatment
  • √ Bed rest, fluids, and a mild pain reliever such as acetaminophen (Tylenol) may be prescribed.
  • √ Ice may be applied to bumps to relieve pain and decrease swelling.
  • √ Cuts are numbed with medication such as lidocaine, by injection or topical application. The cut is then cleansed thoroughly with a saline solution and possibly an iodine solution. The doctor will explore the injury to look for foreign matter and hidden injuries. The wound usually is closed with skin staples, stitches (sutures), and occasionally a skin glue named cyanoacrylate (Dermabond).
Concussion Follow-up

After initial treatment, the patient will be referred for follow-up care to their primary care doctor or a specialist, such as a neurologist. It is important to keep these appointments, particularly because some of the more subtle problems of concussion (memory deficits, personality changes, and changes in cognition) may not be apparent at the time of the initial injury.

Outlook (Prognosis)

People who have had a concussion seem more susceptible to another one, particularly if the new injury occurs before symptoms from the previous concussion have completely gone away. It’s also a negative process if smaller impacts cause the same symptom severity. Repeated concussions may increase a person's risk later life for dementia, Parkison’s disease and depression.

MTBI has a mortality rate of almost zero. The symptoms of most concussions resolve within weeks, but problems may persist. Problems are seldom permanent, and outcome is usually excellent. People over age 55 may take longer to heal from MTBI or may heal incompletely. Similarly, factors such as a previous head injury or a coexisting medical condition have been found to predict longer-lasting post-concussion symptoms. Other factors that may lengthen recovery time after MTBI include psychological problems such as substance abuse or clinical depression, poor health before the injury or additional injuries sustained during it, and life stress. Longer periods of amnesia or loss of consciousness immediately after the injury may indicate longer recovery times from residual symptoms. For unknown reasons, having had one concussion significantly increases a person's risk of having another. Having previously sustained sports concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. Other strong factors include participation in a contact sports coupled with the acceleration of body mass size making impact. The prognosis may differ between concussed adults and children; little research has been done on concussion in the pediatric population, but 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, sufferers of concussion exhibited effects including loss of episodic memory and reduced muscle speed.

Post-concussion syndrome

In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent. Symptoms may include headaches, dizziness, fatigue, anxiety, memory and attention problems, sleep problems, and irritability. There is no scientifically established treatment, and rest, a recommended recovery technique, has limited effectiveness. Symptoms usually go away on their own within months. The question of whether the syndrome is due to structural damage or other factors such as psychological ones, or a combination of these, has long been the subject of debate.

Cumulative effects

Cumulative effects of concussions are poorly understood. The severity of concussions and their symptoms may worsen with successive injuries, even if a subsequent injury occurs months or years after an initial one. Symptoms may be more severe and changes in neurophysiology can occur with the third and subsequent concussions. Studies have had conflicting findings on whether athletes have longer recovery times after repeat concussions and whether cumulative effects such as impairment in cognition and memory occur.

Cumulative effects may include psychiatric disorders and loss of long-term memory. For example, the risk of developing clinical depression has been found to be significantly greater for retired American football players with a history of three or more concussions than for those with no concussion history. Three or more concussions also are associated with a fivefold greater probability of developing Alzheimer's disease earlier and a threefold greater chance of developing memory deficits.

Second-impact syndrome

Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases. The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away. No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain's arterioles lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow. As the brain swells, intracranial pressure rapidly rises. The brain may be herniated and the brain stem can fail within five minutes. Except in boxing, all cases have occurred in athletes under age 20. Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.

Complications

Long-term problems are rare but may include

  • √ Brain swelling (which can be life threatening), if you have a second concussion while still recovering from the first one.
  • √ Long-term changes in the brain (if you have future brain injuries).
  • √ Symptoms of the concussion stay for a long period of time (in a small group of patients)

If symptoms do not go away or are not improving after 2 or 3 weeks, call the doctor if the following symptoms occur:

  • √ Changes in behavior or unusual behavior
  • √ Changes in alertness or produces any other worrisome symptoms
  • √ Changes in speech (slurred, difficult to understand, does not make sense)
  • √ Confusion
  • √ Difficulty waking up or becoming more sleepy
  • √ Double vision or blurred vision
  • √ Fever
  • √ Fluid or blood leaking from the nose or ears
  • √ Headache that is getting worse, lasts a long time, or does not get better with the counter pain relievers
  • √ Problems walking or talking
  • √ Seizures (jerking your arms or legs without control)
  • √ Vomit more than three times

Health care providers examine head trauma survivors to ensure that the injury is not a more severe medical emergency such as an intracranial hemorrhage. As with all head and neck injuries, assessment includes the "ABCs" (airway, breathing, circulation) and stabilization of the cervical spine. Cervical spine injury should be assumed in any athlete who is found to be unconscious after head or neck injury. Maintaining adequate cervical stabilization is critical until neurologic function in all four limbs is found to be intact and the athlete has no reported neck pain or cervical tenderness on palpation. If qualified medical personnel are not available on the field, the athlete should be transported to an emergency facility. Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting, increasing disorientation or a deteriorating level of consciousness, seizures, and unequal pupil size. People with such symptoms, or who are at higher risk for a more serious brain injury, are CT scanned to detect brain lesions and are frequently observed for 24 – 48 hours.

Concussions may be under-diagnosed. The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead clinicians to miss the injury, and athletes may cover up their injuries to remain in competition. A retrospective survey in 2005 found that more than 88% of concussions go unrecognized. Diagnosis of concussion can be complicated because it shares symptoms with other conditions. For example, post-concussion symptoms such as cognitive problems may be misattributed to brain injury when they are in fact due to post-traumatic stress disorder (PTSD).

Article by: Wikipedia, Reference University of Boston; Published by: mvpboxing.com