Concussions have been creating much fervor in the news recently. Increasingly, high schools, universities and other educational institutions have been implementing policies meant to protect athletes from lifelong brain dysfunction caused by concussions. The NCAA requires that: all student athletes receive information about concussions, all NCAA institutions have a process in place to evaluate athletes for possible concussions, and that athletes exhibiting signs of concussion are removed from play and are not returned until cleared by a physician of physician designee.1 Students are not the only athletes affected by new policies shaped by awareness of the dangers of concussions. Both the NHL and NFL have been making changes to the equipment, policies and evaluation players undergo to avoid serious brain damage that has been associated with multiple concussions.
A concussion is caused by trauma to the brain and is by a loss of consciousness or altered level of consciousness, but people can have concussions and not realize it. Symptoms include headache, memory loss, nausea and vomiting, disorientation and experiencing a loss of time.2 Changes in behavior and mood are also indicators of a concussion. Much of the current discussion has revolved around the long-term effects of multiple concussions, which is also known as chronic traumatic encephalopathy (CTE). Although there are not many confirmed cases of CTE, more than 90% of them were seen in athletes and the symptoms are severe. In the earliest stages patients experience some psychotic symptoms and erratic behavior. Later stages include dementia, gait abnormality and symptoms associated with Parkinson’s Disease.3 what can be done to avoid these problems as an athlete or even just going through day-to-day life.
Your Brain on Concussions
The paper we read this last week described the timetable of events in the brain after experiencing a concussion. When the brain receives a traumatic injury it sets off the neurons, causing excitation in the brain and the movement of many ions, like sodium and potassium, out of balance within brain cells. To get things back on track the brain uses lots of energy to pump the ions back to their proper places. This creates an energy crisis within the brain, which likely is the reason for symptoms such as memory loss, disorientation and unsteadiness. There is also a reduction in the amount of blood flowing to the brain that only further exacerbates the energy crisis. It takes the body a number of hours to recover from the energy crisis and days to repair the damage done to brain cells due to the energy crisis and the trauma itself. Unfortuanatly, other than prevention there isn’t a good way to protect the body from concussions, yet.
So far, the best treatment for concussions is to rest and avoid overstimulation so the brain has time to fully recover. This is because there are a number of problems with treating a concussion with medications. One of the primary problems is with diagnosis. Most of the problems that a concussion causes in the brain happen in less than ten minutes. This leaves a very small window of time to evaluate the trauma, diagnosis the concussion, and administer the treatment. Because there are essentially no medications without side-effects it would likely not be appropriate to administer a concussion treatment every time a person gets knocked-around, “just in case.” A second problem with treating a concussion is finding the problem to treat. Should the excitation be treated, or the lack of blood flow, or the need for energy? Which is the underlying cause of the symptoms, and which if manipulated will cause the fewest side effects? As always, researchers are looking into these questions and any day a great discovery could be made. Until then, play hard, but play safe and protect your noggin.