Concussions

Some common sayings such as “he just got his bell-rung” all point to one thing: the dreaded concussion. While this may seem like a simple injury, a concussion is anything but, with recent research identifying properly diagnosing and treating the injury is vital to preventing lifelong issues. After all, this is the brain we’re talking about. But what is a concussion? It may seem like a straightforward question, but it is important to fully understand it.

What is a concussion?

While commonplace in sports such as football, the saying of a person getting “his bell-rung” is a poor representation of what actually happens. The saying itself is inherently flawed in its wording as the structure of the cranium and brain differ dramatically from a bell.

Think of it this way, the brain is like a blob of jello placed inside of a tupperware (The cranium). When a concussion happens, the brain inside of the cranium is jostled and hits against the walls of its “container.” Similar to how jello fragments when violently shaken in a container, the brain receives some level of punishment (Although not as structurally severe) This sudden movement and subsequent impact creates chemical changes within the brain that give a concussion its characteristic symptoms. While a concussion is also known as a mild traumatic brain injury or MTBI for short, it should be treated seriously and properly evaluated.

Etiology

Concussions are serious head injuries that can result from a variety of methods. They can occur from non-contact incidents such as car accidents or being violently shaken. In these cases, a rapid deceleration or a similar mechanism causes the brain to hit the front of the skull with enough force to induce a concussion. Concussions can also result from direct contact such as in football games when players collide. The amount of force being exerted on the head creates the jostling and subsequent bruising of the brain.

It is especially important to note that just because an athlete does not lose consciousness after a severe hit, it doesn’t mean they aren’t concussed. As stated before, concussions are a result of the brain forcefully hitting the inside of the inside of the cranium. Whether or not the athlete loses consciousness does not factor into whether or not they are concussed. However, a loss of consciousness can be an indicator of a severe concussion which can lead to further complications including intracranial bleeding and severe brain swelling.

Symptoms

Concussions range widely in their severity and thus, their symptoms. Below is a list of concussion symptoms in increasing severity (Generally speaking)

• Headaches

• Sensitivity to light

• Dizziness

• Confusion or feeling in a mental fog/difficulty concentrating

• Fatigue

• Ringing sound in the ears

• Drowsiness/Feeling dazed

• Balance issues

• Blurry vision

• Loss of consciousness

• Nausea/Vomiting

• Seizures

• Retro and anterograde amnesia (Inability to remember things in the short term and the long term)

• Pupils not equal and/or reactive to light (Pupils are not the same size or do not react to when light is shined into them. This is usually indicative of severe intracranial pressure)

• Intracranial bleeding

Diagnosis

Concussions can be diagnosed on the field with the use of 2 tests. The first is an on-field concussion screening test which involves the use of cranial nerve tests. The brain contains 12 primary cranial nerves that perform a variety of functions. They are the olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal nerves. For this test, an athletic trainer or team doctor will evaluate the athlete with tests such as H-patterns (Have the athlete follow the tip of the index finger while moving it

in an H shape), having the athlete balance on one foot, and the famous PEARL test (Pupils Equal and Reactive to Light). The second test would involve the use of the Sport Concussion Assessment Tool 2, or SCAT2 test, which would provide more objective data with the use of questions that tests an athlete’s memory and cognition while also taking into account some of their intangible symptoms such as headaches. These 2 tests used in conjunction with one another can be used to properly diagnose a concussion. In more severe cases such as when an athlete is having seizures, a doctor may order a CT Scan or MRI once the athlete arrives at the hospital to rule out or confirm intracranial bleeding.

Treatment

For concussions, there is no magical treatment that will speed up the recovery process. Rather, the recovery time frame is dictated by the activities of the athlete and whether or not they take the proper steps to ensure they are getting enough rest and not aggravating their brain (i.e. exposure to bright lights and screens, etc). This way, the brain is allowed to fully recuperate and heal.

Athletes should be constantly monitored throughout the recovery process by medical professionals and parents. It is especially important to monitor the athlete’s symptoms and ensure that they continue to progress in the right direction. However, if the athlete does worsen over time, they should be taken to the nearest hospital and evaluated for any intracranial bleeding or brain swelling. Assuming all goes well, athletes can expect to return to their sport anywhere between 2-4 weeks after the initial injury. Before returning to their sports, athletes will need to complete a 6-step concussion protocol, consisting of light/moderate exercise which progresses to more strenuous exercise to definitively rule out any possibility of a concussion.

Complications

Returning to play too early can yield serious consequences including second impact syndrome. Second impact syndrome is a condition caused by a concussion that occurs before the previous concussion fully heals. This triggers a cascading effect within the brain as uncontrollable brain swelling occurs, causing permanent brain damage in all affected athletes and a mortality rate of roughly 50%. Besides this, not taking the time to properly recover from a concussion can result in a prolonged recovery process and being sidelined for a greater amount of time.

Furthermore, Chronic Traumatic Encephalopathy (CTE) is a condition caused by having too many concussions. It typically manifests in football players, boxers, and other athletes participating in contact-heavy sports. This results in a buildup of the tau protein in the brains of athletes which ultimately results in progressive signs of cognitive and neuropsychiatric impairments. Currently, there isn’t a method to test for CTE while the person is still alive.

Athlete Interview

Having a concussion is a miserable experience. I should know because I recently had one myself (And at the time of writing this article I am still suffering through concussion protocol :/). To read more about what happened, check out this link to read my interview with Nathan.

Conclusion

While having a concussion can be a scary thing, it is important to remember that the majority (I’m talking 99.999%) of all athletes make a full recovery and return to play within a few weeks. However, it is important to be honest with doctors and other healthcare professionals. Returning to play before fully recovering from a concussion can have dire, lifelong consequences. This article serves as something to help give you a better idea about what a concussion is and what the treatment process looks like. As always, consult a medical professional before making any treatment decisions.

Sources

“Concussion.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 17 Feb. 2022, mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594.

“Suggested Guidelines for Management of Concussion in Sports - NFHS.” SUGGESTED GUIDELINES FOR MANAGEMENT OF CONCUSSION IN SPORTS, www.nfhs.org/media/1020401/suggested-guidelines-for-management-of-concussion-in-sports-april-2019-final.pdf. Accessed 6 Dec. 2023.

“What Are the 12 Cranial Nerves? Functions and Diagram.” Medical News Today, MediLexicon International, www.medicalnewstoday.com/articles/326621. Accessed 6 Dec. 2023.

“What Is a Concussion?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 12 Feb. 2019, www.cdc.gov/headsup/basics/concussion_whatis.html.