This morning my teenage daughter (who is never overly enthusiastic when it comes to helping out with chores around the house), went out to put the garbage at the end of the driveway for pickup.
She took two steps with the barrel, slipped and fell backward on the ice. Alarmed, and (being the child of a neurologist), worried about head injury, she came back in the house and informed me conditions were too treacherous for garbage this week. Perhaps she was wise. I have seen a lot of patients with concussions this month. One man did fall on the ice in his driveway and had no memory of what happened or of crawling back to the house subsequently. Another patient slipped on a step, fractured her skull, and again, had no memory of how it happened but had a black eye, blurred vision and headaches for weeks after.
A concussion is a head injury with an alteration in level of awareness. One need not be struck unconscious to have suffered a concussion, being dazed is sufficient. Other signs may be headache, vomiting, dizziness and a poor memory for that last step on the ice. The force of a concussion may cause a tearing or twisting of the structures and blood vessels of the brain, which results in a breakdown of the normal flow of chemical messages within the brain. Levels of concussion are as follows:
Grade 1: Occurs when the person does not pass out, but may seem dazed.
Grade 2: Occurs when the person does not lose consciousness, but has a period where they do not recall the event.
Grade 3: Occurs when the person loses consciousness and has no memory of the event. Evaluation from a health care provider should be performed as soon as possible after the injury.
The most common causes of concussion occur in motor vehicle injuries and in people who fall often (i.e. the elderly). The complications of concussion become more serious if a person is also on a blood thinner like coumadin. There are approximately 600,000 cases of known concussions per year in the U.S.
It is estimated that, in high school football alone, as many as 250,000 concussions occur each year, and that up to 20 percent of players sustain a concussion.
Other sports in which players are also at risk for concussion or head injury include boxing, ice hockey, wrestling, gymnastics, lacrosse, soccer and basketball. Once a concussion has occurred, the player becomes as much as four to six times more likely to sustain a second concussion. Most of these head injuries are mild and resolve without further complications.
Signs of life-threatening injury after a concussion may include severe headache, restlessness, agitation and an increased size of a pupil. As the brain tissue swells, the person may pass out or become difficult to awaken. When these signs are present, neurosurgical intervention may be necessary. Most symptoms of concussion resolve spontaneously within weeks or months.
The damage caused by a concussion may be cumulative and after several concussions, brain function may be permanently damaged, resulting in a form of dementia.
The management of concussion, especially when it occurs in sports where repeat concussions are likely to occur, remains controversial, but there is now a consensus of opinion that it is better to give up the sport that to ruin the brain.
The “punch-drunk” syndrome seen in old time boxers who have taken too many blows to the head can and does occur after repeated concussions. Cognitive assessment with neuropsychological testing is now available in many centers to screen for this after a head injury. Fatigue, headache, difficulties in coordination or disturbances in balance may be early signs of a “punch-drunk” or post-concussion syndrome and should alert a person to the need for further evaluation.
So, the next time your teenager refuses to put out the trash, treat her with the respect she deserves, she may just be trying to preserve her brain power for her homework!
Dr. Deborah Gelinas is the neurologist at Nashoba Valley Medical Center. She comes from a 20-year practice in San Francisco where she was the clinical director of an internationally recognized ALS/MDA center and a Memory Center. She has published books for newly diagnosed patients with neurological disease as well as a host of articles and book chapters. Dr. Gelinas moved back to Massachusetts to be near her mother and five sisters.