In this post I shall dwell on the important issue of concussion. A concussion usually refers to loss of consciousness following a closed head injury. By closed head injury I mean that nothing penetrates into the brain. The skull is usually intact. The duration of loss of consciousness is frequently used to grade the severity of closed head injury/ concussion into mild, moderate and severe. However this grading is quite arbitary and other factors have to be borne in mind such as the age of the patient, the mechanism of injury, the force of injury, presence of pre-existing neurological disease such as dementia and whether protective head gear was worn by the person (such as a helmet).
Concussions are common and can occur in many common day to day activities contrary to common belief that concussions only occur in the setting of a motor vehicle accident (MVA) in the case of civilian life or on the battlefield. Concussions are commonly sustained during sports. Indulgence in some sports especially contact sports such as boxing, ultimate fighting (mixed martial arts), American football, rugby, soccer and wrestling to name only a few are more likely to result in a concussion.
So concussions are common and hence the recent heightened concerns about the short term and long term impact of concussions on the brain. Some of you may be well aware of terms such as chronic traumatic encephalopathy (CTE), boxers encephalopathy, dementia pugilistica and “punch drunk syndrome”. They all imply that concussions do have a significant adverse effect on the brain. There is now ample evidence to indicate that multiple concussions (sustained in a person’s lifetime) cause memory and other cognitive problems. They may also predispose to dementia and a secondary Parkinsonian syndrome.
So it is imperative that concussions be recognized early so that the patient can receive adequate medical attention. This is expecially true on the playing field (whether it is a school, college or a professional sport arena). The fear is that many concussions go undetected and the player is allowed to return to play prematurely and risk a second (at times fatal) concussion. For concussions to be recognized in a timely fashion parents, coaches, personal trainers and other team officials need to be trained to identify concussions. A cursory examination is NOT enough and there is a recent thrust to have every player be examined by a physician. The physician after examining the player and considering the mechanism of injury and whether the player has sustained a prior concussion (in that game itself or in the recent past) shall then determine when the player can return back to play.
So not everything is apparent after a closed head injury. If you or any of your loved ones has sustained a concussion, bring them to the attention of a qualified physician. A big onus remains on parents who should demand more close supervision in school during play.
Nitin Sethi, MD