Concussions: An In-Depth Look

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By Christina Lusk-Cáceres, DO

If you follow professional, college, high school, or even recreational sports, it seems as if the topic of concussions is being more widely discussed than ever. The CDC estimates that about 1.6 – 3.8 million concussions occur in sports and recreational activities annually.

Athletes of all ages, abilities, and sports can sustain a concussion, but the chances are significantly increased with collision and contact sports, such as football, ice hockey, and soccer, which are often the top three sports in which the most concussions occur. It is of the utmost importance that ANYONE with a suspected concussion seeks immediate medical treatment and should not return to play that same day and not until they are cleared by a medical professional who is familiar with treating concussions.

In past years, certain people would refer to a concussion as "getting your bell rung" or a "dinger." However, a concussion is actually considered a mild traumatic brain injury (MTBI) and accounts for 80 – 90% of all traumatic brain injuries. This recent change in nomenclature is very important because it highlights the severity of this injury, which can result in temporary loss of normal brain function and have serious, and sometimes long-term, consequences.

As we all know, the brain is a very complex and intricate organ. When the normal function of the brain is disrupted, it can cause serious neurological and vascular changes. The goal of this article is to explain, in layman's terms, the following:

  1. What is a concussion?
  2. How do concussions occur?
  3. What are the symptoms of a concussion?
  4. When should you see a physician?
  5. When can an athlete return to play?

What is a concussion?

The American Medical Society for Sports Medicine defines a concussion as "a traumatically induced transient disturbance of brain function and involves a complex pathophysiologic process."

The American Academy of Neurology defines a concussion as "a clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation, which may involve loss of consciousness (LOC)."

In other words, a concussion is more of a chemical issue, involving potassium, calcium, and some amino acids, than a true structural issue. This means that there is no bleeding or bruising of the brain, which was often thought in the past. When bleeding in the brain occurs, it is considered a traumatic brain injury (TBI) and sometimes requires surgical intervention. Therefore, a concussion cannot be diagnosed or ruled out by imaging of the brain, such as a CT scan or MRI.

Note that loss of consciousness is NOT required to diagnose a concussion.

How do concussions occur?

A concussion occurs most commonly after an external and direct trauma to the head, but it can also occur after a direct trauma to another part of the body where the force of the blow is directed toward the head.  This trauma results in a shearing stress to the brain tissue from rotational and angular forces.

What are the symptoms of a concussion?

Symptoms of a concussion result in deficits of physical, cognitive, emotional, and behavioral aspects of a person's life and usually present immediately after the injury but can be delayed by minutes to hours.  Some of these symptoms include, but are not limited to:

  • Headache
  • Pressure in the head
  • Neck pain
  • Light-headedness/balance problems
  • Dizziness
  • Visual disturbances
  • Light sensitivity
  • Noise sensitivity
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Fatigue
  • Sleep disturbance
  • Sadness
  • Anxiety/nervousness
  • Emotional lability
  • Irritability
  • Difficulty concentrating
  • Difficulty remembering
  • Confusion
  • Memory loss
  • Feeling slowed down
  • Feeling like in a fog
  • Slurred speech

These symptoms typically resolve in 1 – 4 weeks, though some may resolve sooner and some take a little longer.

When should you see a physician?

Anyone who has sustained a head trauma and is suspected to have a concussion should seek immediate medical treatment.

When can an athlete return to play?

First and foremost, an athlete with a suspected concussion should NOT return to play on the same day as the injury.

An athlete with a suspected concussion should not return to activities until they have been evaluated and cleared by a medical professional that is familiar with concussions and the gradual return-to-school and return-to-play progression. All signs and symptoms of the concussion should be resolved prior to returning to sports.

Overall, the most important thing to remember for most injuries, and especially concussions, is that prevention is the key.

For more information about concussions or to schedule an appointment with Dr. Lusk-Cáceres, please call (732) 530-4949.