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What Every Parent and Athlete Should Know About Sports Concussion

I. What is Concussion?

Concussion is the most common form of head injury for athletes. It is associated with disorientation, and sometimes with loss of consciousness (LOC) followed by amnesia (forgetting) of what happened both immediately before and after the injury.
However, it is important to note that it is not necessary to lose consciousness to have a concussion.
Mild confusion or disorientation about who or where you are, what the time or date is, or what you were doing when the injury happened can be signs of concussion.  Also note that statistics show that once you sustain a concussion, you are 4 to 6 times more likely to sustain another, even with a mild hit.


II. How do concussions occur?

Our brains are protected inside a hard outer covering of bone, the skull, which is our own natural helmet. Between the skull and the brain is a layer of cerebrospinal fluid (CSF) that suspends the brain inside the skull. The CSF acts as a shock absorber, allowing for some movement of the brain before it bumps into the bone.
There are two common types of injury to the brain in sports: Acceleration-Deceleration and Rotational.
Acceleration-Deceleration Injury usually happens when the athlete's head and body are traveling at a certain speed and then abruptly stop. When this happens, the brain will hit the inside of the skull and brush against bony structures damaging delicate brain tissue.
Rotational Injury happens because the brain is attached at its base where it joins the spinal column. Hits to the head or body may cause rotational motion of the brain within the CSF. This type of injury often leads to shearing of the brain nerve cells.
III. Second Impact Syndrome
A very serious and even fatal brain injury may occur even with a relatively mild hit in contact sports.  A rare disorder, Second Impact Syndrome, occurs when an athlete has a relatively minor blow to the head, with a mild concussion, and then within a short time later (usually within one week) receives a second blow to the head.  In rare cases, it is possible for rapid brain deterioration and even death to occur. This happens because the brain is still affected from the first injury and the second injury results in rapid swelling and pressure within the skull. This intracranial pressure, if uncontrolled, can lead to death.


IV. Post Concussion Syndrome

Following a concussion, especially repeated or successive concussions, the athlete may experience many different kinds of symptoms, which may last for days, weeks, months, or longer. These are generally problems with thinking, sense of well-being, and mood. Headaches are a frequent complaint, as well as difficulty with memory, concentration, attention, fatigue, dizziness, anxiety, depression, and irritability. Sometimes, symptoms are described as "not feeling as quick or clear- thinking" or feeling "more disorganized or forgetful" than usual.
V. Evaluation of the Effects of Concussion
When concussion is suspected, medical evaluation and treatment should be sought from your family physician and consulting neurologist. If there are continued complaints of attention/concentration/memory difficulties, irritability, fatigue, lowered performance in school, headache, dizziness, emotional or other symptoms, it is highly recommended that the athlete receive a neuropsychological examination. A neuropsychological examination can measure brain functioning in ways that a neurological exam, MRI, CT scan cannot. In fact, in cases of mild concussion and post-concussion syndrome, it is very common for results of neurological exams and tests to be normal whereas the neuropsychological evaluation is able to identify the brain dysfunction. The neuropsychologist can also determine a plan of treatment to help remediate the symptoms and to help in return to play decisions.

VI. What can parents and athletes do to prevent the lasting effects of concussion?

It is important that athletes receive preseason baseline cognitive testing before concussions occur.  Then, if an athlete sustains a concussion, his/her progress can be followed by re-testing, comparing post concussion test results to baseline results, to help make the proper decision about when to return to play and when the athlete is healed.  Contact the BMC Brain Injury and Concussion Clinic @ 413-395-7694