I Think You Were Dropped On Your Head As A Child.

Concussion "basics"
Concussion “basics”

What is the real meaning behind this common saying? Usually, this saying is used when a person says or does something that isn’t very intelligent. The rationale behind this statement is that the hit to the head of a child is likely to cause brain damage, likely through a concussion. Concussions are becoming increasingly scary to the general public as more research is able to demonstrate their negative long-lasting effects, as demonstrated in the article The Molecular Pathophysiology of Concussive Brain Injury.  

                The problem with concussions is that many times, people are unaware they even had one. There are different intensity levels of concussion, ranging from minor headache and grogginess, to entire loss of consciousness. If someone experiences a minor concussion, it is possible that they won’t realize it could have serious consequences. The other problem facing concussion is that physical contact sports, like football and hockey, are becoming increasingly more intense and rough for both males and females of all ages. Return to play policies seem to be on qualitative evaluation of symptoms rather than quantative measurements of brain health or recovery.  Experiencing multiple concussions in a row greatly increases the chance for long-lasting, severe damage. But if healing occurs between concussions, the risk is much lower.

                Most people understand that a concussion occurs from a hit to the head. The hit could be from a sport, falling, car accident, or really anything that causes the brain to crash into the skull. When this happens, brain cells become damaged. The membranes become permeable to many ions. This causes nonspecific depolarization of the cells, which leads to random action potentials firing. This causes the release of neurotransmitters which excite other molecules. This excitation causes an overabundance of potassium to rush into the cell. This causes the ion pumps in the cell membrane to work extremely hard to restore the cell to its normal condition. This requires an extreme amount of energy in the form of ATP. In order to compensate for the extreme energy need, the brain goes into hyperglycolysis mode. This means the cell is taking glucose through glycolysis, breaking it down into two molecules of pyruvate, and then into lactate and ATP. The ATP is used by the brain, but the lactate builds up in the brain as lactic acid. This is unfortunate because the buildup of acid in the brain is quite detrimental. Next in the process, calcium influx occurs which causes the oxidative metabolism in mitochondria to become impaired. The mitochondria are then unable to produce enough ATP for the brain, which leads to a decrease of available energy. This activated calpain and apoptosis, or cell death.

                The axons of neurons in brain also experience extreme negative side effects as the result of a concussion. The axolemma responds negatively to the previously described calcium influx by disrupting its normal behavior. Its neurofilaments become compacted due to phosphorylation or cleavage of the sidearm chains. This causes the axonal organelles to accumulate as the microtubules of the axon begin to aggregate. All this disruption leads to severe swelling of the axon and eventual death.

                Continuous cell and axon death in the brain can lead to long-term damage. Unfortunately, no real medical or pharmacological treatments for concussions are available. The best, and essentially only, treatment for a concussion is rest and minimizing brain usage. Students shouldn’t attend school or attempt homework until they are symptom-free for at least 24 hours. This is a harsh reality to face since concussive symptoms can last for weeks. For high school students, this might be a huge problem, but to a college science student, missing weeks of school could mean the necessity of repeating classes and potentially not graduating on time and paying for an extra semester, likely without financial aid. This may seem like an extreme consequence, but it is a very real scenario. Missing a month of college science classes would be terribly hard to learn on your own, plus you can’t even keep up with the work while you are out sick because studying causes the brain to work too much during recovery. As for athletes, missing a month of practice could also be career ending. Most coaches wouldn’t allow a person to play after missing a month of practice. Plus, a month of staying in bed as much as possible is likely to lead to loss of muscle mass.

                If concussions can have such serious negative effects, effecting both physiology and life style, what can be done to prevent them? Helmets are an obvious, but they can’t protect everyone at all times. Even state of the art helmets lead to concussions in the NFL and other professional athletic leagues. What about people who experience concussions in everyday life from slipping on ice or falling off a ladder? In that case, education on the essential resting period after a concussion is the best medicine. People need to realize the extreme effects that are consequential of improper concussion treatment. Too early return to play, school, or regular brain function can increase the risk of experiencing an additional concussion. There is a terrible period of brain vulnerability after concussion. It is also nearly impossible to turn off brain function, so the healing process is consequently slowed down.

                The most important things to gain from this specific article are: The mechanism of concussive brain damage, the negative long-lasting effects of concussion (ex. Dementia like symptoms), and the importance of healing and prevention of further concussions. Hopefully, this article leads to thoughts and conversations as to which types of activities that leads to concussions outweigh the possible brain defects that can come from them. Conversations and brainstorming ways to properly deal with concussion are necessary for all people since concussions can happen to anyone.