The Oxford dictionary defines a concussion as “temporary unconsciousness or confusion caused by a blow to the head.” It demonstrates its use in a sentence by referencing something no “more serious than a mild concussion.”
Many who frequently deal with concussions, also called mild traumatic brain injuries, and their complications will likely reject that casual and cavalier attitude. Treat even the mildest mild concussion with caution. Instead of belittling the injury, TBI professionals will issue the following warning:
Even seemingly mild brain trauma can result in potentially fatal complications, as the mild TBI designation relates only to the initial presentation of symptoms and not to the overall prognosis. TBIs that medical professionals deem mild can still be severe injuries resulting in serious and lasting effects and complications. If you are diagnosed with any type of TBI, you should remain on watch for any symptoms of complications or lingering effects.
For some time now, there have been more and more conversations about concussions and their long-term risks. We started listening when we discovered that even a mild concussion can have long-term cognitive consequences. We listened even closer as we found out that boxers and football players, especially, were suffering life-altering injuries as a result of suffering repeated concussions throughout their athletic careers. We listened even harder when they began telling us it can be affecting our Little League footballers and baseballers.
A little more information is clearly in order.
Mild Traumatic Brain Injury or Concussion
A “mild” traumatic brain injury (MTBI) or concussion results from an impact on the human head by outside forces or from a sudden change in the direction of movement of the head. Essentially, when an outside force impacts the head or causes the body to jolt suddenly or sharply, the brain is driven against the interior of the skull. The unexpected movement damages the brain through stretching and tearing some tissues while bruising and abrading others. The injured tissues result in more or less serious and more or less permanent damage to the brain itself.
A concussion brings about an immediate, temporary loss of some brain functions. It does not, however, always result in a loss of consciousness. In fact, the majority of persons who suffer concussions do not pass out at all. However, the concussion may cause harm to the victim’s memory, balance, coordination, reflexes, judgment, and even speech. The injury to the memory is such that the victim may have little recall of the actual injury itself. The victim who does not recall the injury may well never do so.
Most concussions do not cause long-term damage to the brain, but repeated concussions can cause severe cumulative damage.
Moderate to Severe Traumatic Brain Injury or Concussion
A severe traumatic brain injury (TBI) is still a concussion. It’s just a bad concussion. A severe TBI will virtually always include an episode of unconsciousness. The potential states of unconsciousness resulting from a concussion range from a coma to a minimally conscious state to a post-traumatic concussion state, which may also include post-traumatic amnesia.
Severe TBI may require medical or surgical intervention to prevent swelling from further damaging the brain. Doctors might conduct repeated CAT scans and EEGs to monitor changes in the brain’s functioning, and can surgically insert pressure monitors to monitor swelling. Informal bedside exams will allow physicians to make some judgments as to the extent of the damage.
Many doctors consider severe TBI to be a diagnosis without hope. However, some individuals with severe TBI, even those who have been unresponsive for some time, do recover. The process is, unfortunately, long, difficult, and completely uncertain.
Diagnosis of a Concussion
Concussions are often not diagnosed at all because of the minor appearance of the injuries that cause them and because the resulting symptoms may not seem particularly severe. However, early detection of a concussion is essential to prevent further injury or long-term damage to the brain. An appropriate diagnostic process requires looking at both the immediate and the longer-term symptoms.
Common Immediate Symptoms
After you hit your head, you should keep an eye out for the following symptoms, among many others:
- Dizziness or problems with balance
- Loss of memory of the events surrounding the injury
- Confusion or mental fogginess
- Brief loss of consciousness in some cases
- Slurred speech
- Nausea or vomiting
- Heightened light or sound sensitivity
- Fatigue or sleep disturbances
Common Delayed Symptoms
- Increased difficulty concentrating loss of executive function
- More pronounced memory loss not just relating to the injury
- Disruption in other senses, including hearing, taste, and smell
- Difficulty sleeping and waking
- Personality shifts or increased irritability
- Changes in eating or sleeping patterns
- Worsening headaches that don’t go away
Questions to Ask Your Doctor
If you or your child has had a concussion, there are questions you should be sure to discuss with your doctor.
- What are the risks of future concussions? Your doctor is likely to explain to you the cumulative risks of multiple concussions. People who have had one concussion have very high odds of having another. Repeat concussions cause higher risks of edema, permanent brain damage, and even death. It can also cause the types of dementia discussed below, CTA.
- When is it safe to compete again? It may never be safe for this victim to compete again, but in any event, no concussed athlete should return to the playing field until expressly authorized by medical personnel. The known risks of multiple concussions, particularly when close together, are simply too high. You should also be aware that healing time is generally longer in younger patients.
- When is it safe to exercise again? Once again, you may not exercise again right away, although exercise is rather less risky than competitive sports. Ask your doctor and follow the instructions you receive. It is critical to avoid another concussion so close to the first.
- Is it safe to return to school or work? Your physician will want to be sure that you have recovered from the temporary conditions that can make it risky for you to be out and about. Dizziness and blurred vision should be completely gone before you or your child return to the normal environment. Headaches and light sensitivity should also resolve before returning.
- Can I operate a car or heavy equipment? This question essentially answers itself. When you have healed well enough that you no longer have symptoms interfering with your ability to operate a car or heavy equipment, then you can operate a car or heavy equipment. Ask your doctor and follow the limitations set.
Multiple Concussions Matter A Lot
As we said at the beginning of this blog, repeated concussions became a live topic of conversation around the experiences of professional boxers and football players. Most of us who experienced a concussion as a child or young person only had one concussion, and we quickly healed and returned to normal life. This is not the case with boxers and footballers.
As a result of this growing awareness, many schools and sports organizations have imposed limitations on the ability of very young people to engage in full-contact sports. They have also required parental consent for such participation and have imposed requirements for more and better safety equipment.
Somewhere between two and four million sports and recreation-related concussions occur in the United States annually. The injuries are most common in sports like football which, as a high school sport, accounts for nearly 60 percent of such concussions. Boys are most likely to be injured in playing football while girls get injured in soccer. Other causes among children include bicycling, basketball, and playground accidents. Though not recognized by all as a sport, cheerleading is a growing source of injuries with its increasingly high-risk stunts.
Many athletic governing bodies have been developing policies to prevent or limit repeat concussions because of the risks involved in competitive contact sports, whether amateur or professional.
Some of the policies include:
- Policies for reacting immediately to concussion in the field
- Policies for determining when an athlete can return to competition (generally medical staff, not coaches)
- Policies requiring student-athletes to be removed from the field of play immediately
- Policies requiring written medical authorization for the student to return to play
- Policies requiring a minimum 24-hour wait before returning to the field
- Policies requiring safety training and planning
- Policies requiring more and better safety equipment
Dementia Pugilistica - Punch Drunk Syndrome
Dementia pugilistica (DP) is also called punch-drunk syndrome or fighter’s madness. But whatever name you choose, it refers to the progressive and cumulative damage inflicted on the brain of a boxer through repeated blows to the head leading to multiple concussions, often close together. Although its name recognizes its prevalence in boxing, DP can occur in anyone who has suffered multiple concussions. It commonly presents as a form of dementia or declining cognitive functions. It frequently comes with memory problems and symptoms similar to Parkinson’s.
Boxers who develop DP will often have tremors, slowed or delayed movement, speech problems, and frequent confusion. There is often no diagnosis of the DP because its symptoms do not appear for many years. When they do appear, people often attribute them to the onset of age or Alzheimer’s.
Chronic Traumatic Encephalopathy (CTE)
DP is a variant of a brain syndrome known as chronic traumatic encephalopathy (CTE), another type of brain damage resulting from repeated concussions.
Professionals discover CTE among many professional athletes and military personnel. Either a mild traumatic brain injury or a severe one can cause CTE, and the odds of developing the condition increase with each additional impact to the head. CTE can usually be diagnosed only via autopsy. Recently, however, criteria for recognizing the condition in the living are being developed.
Many famous athletes were either diagnosed with CTE or doctors assumed they had it due to the growing awareness of the risk. Among these are Muhammad Ali (boxer), Frank Gifford (football player), and Brett Favre (football player). Indeed, a study of 111 NFL football player brains found that all but one of them had CTE. There is now an officially recognized link between CTE and football.
Criteria for Diagnosis in the Living
Recently, a study has presented the first consensus on diagnosing Traumatic Encephalopathy Syndrome (TES), the clinical disorder that is usually associated with CTE.
For an individual to receive a diagnosis of TES under the new criteria, the individual must have:
- Substantial exposure to repetitive head impacts from contact sports, military service, or other causes
- At least five years of contact sports, two at the high school level or beyond
- Progressive course of cognitive impairment
- Episodic or short-term memory or executive function loss
- Neurobehavioral dysregulation
- Violent outbursts
Moreover, a medical or psychiatric cause for the criteria must be excluded for a TES or CTE diagnosis to be final.
Unfortunately, there is no treatment at present for CTE. The current approach is to encourage avoidance of additional head injuries.
Although concussions mostly result from accidents sports or recreational accidents and motor vehicle accidents there are still steps you can take to reduce the chances that you or your loved ones will suffer a concussion.
Some of these steps include:
- Always use the seatbelts, shoulder harnesses, and child safety seats required in your motor vehicles
- Understand how your airbags work; don’t put children in front of their locations
- Strengthen neck muscles
- Wear a helmet when:
- Riding a bike or motorcycle
- Skiing or snowboarding
- Using skates, scooters, skateboards, and similar sidewalk equipment
- Catching, batting, or running bases in baseball or softball
- Playing any contact sport such as football, hockey, soccer, or boxing
Consult a Brain Injury Attorney Today
If you or a loved one suffered a TBI and someone else was likely to blame, the best course of action is to get the proper diagnosis and initial treatment, then reach out to a brain injury lawyer who can assess your legal rights.