Concussion: a stealthy danger

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With football season underway, many parents and coaches are worried about concussions to players.

They can be scary. They don’t show up on medical scans, and, while more than a million people suffer a concussion each year, according to the Centers for Disease Control and Prevention, less than 20 percent of them are knocked unconscious, so they’re not always easily recognized.

A concussion, often called a mild traumatic brain injury, occurs when the brain bumps against the skull.

They are common in high-speed, contact sports. According to the American Academy of Neurology, football, rugby, hockey and soccer pose the greatest risk. For young women and girls, the risk is greatest in soccer and basketball.

If it’s suspected that an athlete has suffered a concussion, he or she should be immediately removed from practice or play.

The signs of concussion are there — and should be acted on — but you need to know what to look for.

“We can pick up the signs and remove the player from harm’s way,” said neurologist Dr. Glenn Kidder, with the NeuroMedical Center in Baton Rouge.

And they shouldn’t return to the field until they’re completely healed.

Concussions are generally suffered by those 15 to 21 years old, and caused by an external force hitting the head or the head hitting something, perhaps in a fall.

“No two concussions are alike,” said Dr. Aaron Karlin, director of the Concussion Management Program at Ochsner Medical Center-North Shore, as well as section head of pediatric physical medicine and rehabilitation there.

To diagnose a concussion, a doctor will look at symptoms, conduct a neurological exam that includes an assessment of reflexes, and a balance test and cognitive test.

“Those are just tools in a toolbox. You still use your medical knowledge” to diagnose, Karlin said.

Symptoms of concussion are:

  • Headaches.
  • Fatigue.
  • Sleep cycle disruptions.
  • Emotional changes, such as excessive irritability or a “flat, robotic” affect.
  • Sensitivity to light and/or noise.
  • Dizziness or imbalance.
  • Disruption of memory, attention and/or concentration.
  • Difficulty with problem-solving or slowed processing speed.
  • Emergency medical care should be sought as soon as possible if a concussion patient experiences seizures, repeated vomiting, slurred speech or declining mental status, such as difficulty in being awakened.

To recover from a concussion takes time and rest.

Patients need physical rest — activities of daily living are allowed, as long as they don’t worsen symptoms, Kidder said — as well as “cognitive rest.”

“When you injure a hamstring, you don’t run on the hamstring,” Karlin said.

In the same way, mental stimulation can be thought of as “flexing your brain ‘muscles.’ You should be relatively inactive,” the physician said.

Someone recovering from a concussion should cut back on activities like watching TV, computer time, texting and playing video games.

“It’s not a lot of fun, but it will help you get better faster,” Kidder said. “We’re doing everything we can to reduce the amount of stimuli, to help the brain heal.”

Sometimes, a student will also need to stay out of school for awhile to get cognitive rest, Kidder said.

Medication doesn’t play a large part in treatment, doctors say.

“If the headache persists, we can try a headache prevention medicine,” Kidder said. “We try to stay away from medicine that masks (symptoms), so we know when the brain is healing.”

If the concussion has disrupted sleep patterns, medicine may be prescribed for sleep, Karlin said.

“Sleep is when the brain is healing,” he said.

Once free of symptoms, which may take up to several weeks, Kidder said, sports activities can be resumed gradually, increasing activity in small steps over several days.

“They have to exercise and remain symptom free because sometimes the symptoms don’t return until they exercise,” Kidder said. “The greatest risk of having another concussion is within 10 days of the first concussion.” And repeat head injuries following an initial concussion, before adequate brain healing, can be serious, Karlin said.

Most concussions, if identified early and treated properly, result in full recovery.

“Eighty to 90 percent of kids treated early ... are symptom-free at rest, within 10 to 14 days,” Karlin said. “By three to four weeks, 80 to 85 percent are back on the field.”

“It takes good communication between coaches, the medical staff, the player and their family to recognize (concussion) and once it’s been recognized, let the brain heal itself,” Kidder said.