Paging Dr. Frischer – Head trauma & Concussions

Lately, we have seen a renewed focus on head trauma and concussions – especially in high school, college and professional sports. The most recent Center for Disease Control data estimates about 2.5 million cases of traumatic brain injuries annually, contributing to deaths and cases of permanent disability. What is a concussion, how is it treated, and what can we do to prevent it? A concussion is a traumatic brain injury that alters the way the brain functions. Our brain has the consistency of gelatin, and it is cushioned from everyday jolts and bumps by cerebrospinal fluid. A violent blow to the head and neck can cause the brain to slide back and forth forcefully against the inner walls of the skull. Common causes are sudden acceleration or deceleration of the head from a car crash, sports, or being violently struck or shaken.

Interestingly, there isn’t always a loss of consciousness - in fact, this is the case most of the time. Many concussions occur and the victim has no idea that they’ve had one. The signs and symptoms of a concussion can be quite subtle.  They may last for a few days, or for months. Common symptoms include headache, loss of memory, dizziness, and ringing in the ears, temporary loss of consciousness, nausea with or without vomiting, slurred speech, fatigue, and confusion. Less obvious symptoms include trouble with concentration, irritability and other personality changes, sensitivity to light and noise, sleep disturbances, and changes to taste and smell.

Who is at risk for a concussion?  Clearly, anyone who participates in a high-risk contact sport, including football, hockey, soccer, rugby, and boxing.  Also at increased risk are victims of car accidents, soldiers in battle, targets of physical abuse, someone who has fallen, and those who have suffered a concussion in the past.

Every concussion injures the brain, and needs time to heal.  Those who have experienced one are at greater risk for complications, including a doubled risk of developing epilepsy for five years following the injury.  The impact on brain function accumulates with multiple concussions. A second concussion before the first is fully healed may result in even more brain swelling, and far worse outcomes. Therefore, a good coach always follows the rule “When in doubt, take them out.”  An athlete with a suspected concussion should not return to play until he or she has been evaluated by a health care professional trained in concussions, and never returned to play on the same day as the injury.

The diagnosis of concussion is based on the history and examination of a patient. There are no lab tests or x-rays to confirm the diagnosis.  The doctor may, however, order imaging studies of the brain (such as an MRI or CT scan) in order to rule out the danger of an intracranial bleed.

Treatment for a concussion typically consists of going home and being checked regularly for 24 hours (awakened every few hours) to ensure that the symptoms are not getting worse.  Rest and avoiding re-injury are the most important ways to allow the brain to recover. Rest involves limiting both physical and mental exercise.  Acetaminophen (Tylenol) for pain is OK, but some other pain relievers, such as Ibuprofen (Motrin and Advil) thins the blood and could increase the risk of a bleed.

Prevention is key. Wear protective gear when taking part in activities that could cause head trauma, such as contact sports, bicycling, and snowboarding. Use your seat belt, make your home safe from falls, and exercise regularly to keep your core muscles strong and improve balance. Let’s play, exercise, drive our cars, and live our life. But let’s also take extra precautions to keep our most precious organ safe and sound.

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.



Published: July 10, 2014 - Volume 13 - Issue 13