MILD HEAD INJURY (CONCUSSION)
Concussion, or mild traumatic brain injury (MTBI), is the most common and least serious type of traumatic brain injury. Concussion involves a transient loss of mental function. It can be caused by acceleration or deceleration forces, or by a direct blow. Concussion is generally not associated with penetrating injuries.
Symptoms of mild head injury (Concussion)
Symptoms of concussion can include a period of unconsciousness for less than 30 minutes, vomiting, confusion, and visual disturbances. Amnesia, the hallmark sign of concussion, can be retrograde amnesia (loss of memories that were formed before the injury) or anterograde amnesia (loss of memories formed post-injury). In concussion, amnesia is much more likely to be anterograde (also called Post Traumatic Amnesia or PTA). This type of amnesia is the inability to create and save new memories, much like the process of saving something from the RAM on a computer to its hard drive. Amnesia may not become apparent until the next day or the next week. A common example in sports concussion is the quarterback who was able to conduct all the complicated mental tasks of leading a football team after a concussion, but has no recollection the next day of the part of the game that took place after the concussion.
Patients with concussion may act confused, for example repeatedly asking the same questions, or forgetting where they are. Patients may have focal neurological deficits, signs that a specific part of the brain is not working correctly.
Since concussions may not include damage to the brain's structure, the condition of patients with uncomplicated concussions often either improves or stays the same. But brain damage is a process, and not an event, that may set into motion many different pathological processes. The concussions that result in permanent long term deficits, often do get worse over the first few days. A deteriorating level of consciousness may mean that the patient has another problem such as a worse type of head injury. Similarly, persistent vomiting, worsening headache, ringing in the ears (tinnitus), drowsiness, unequal pupil size, and increasing disorientation are all indicative of a rise in intracranial pressure (ICP). More likely in the typical concussion, the process of axonal injury and damage is progressing. Over the first 72 hours, a stretched or damaged axon, may be further damaged or killed by ionic fluctuations.
The most critical mistake for those suffering from concussion, is not returning for further medical care and evaluation in the time period of 24 to 72 hours after the concussive event, if the symptoms are getting worse. Athletes, especially intercollegiate or professional athletes would typically be followed closely by team trainers during such period. But those injured in accidents may be sent home with no medical person monitoring them unless the situation gets worse. If the person had a concussion yesterday, and they don't have a clear recollection of the time period between the concussion and today, then they are likely suffering from Post Traumatic Amnesia, and are more likely to have a long term or permanent problems.
Another thing: most research on concussions is done on strong and fit male athletes in their late teens or early 20s. People over 40, especially women over 40, are much more likely to have long term problems than these young athletes. Older brains lack the regenerative abilities of younger brains, and older bodies are much more likely to suffer more disabling forces in the same type of accidents. Women generally do worse than men.
Grades of concussion / mild head injury
Concussion is classified into five grades
1. The mildest, grade I, involves only confusion.
2. Grade II involves anterograde amnesia that lasts less than five minutes as well as confusion.
3. Grade III involves the symptoms above, as well as retrograde amnesia and unconsciousness for less than five minutes.
4. Grade IV involves all of the above symptoms, as well as unconsciousness that lasts between 5 and 10 minutes.
5. Grade V is the same as grade IV, with unconsciousness lasting longer than ten minutes.
The American Academy of Neurology (AAN) guidelines make it clear that permanent brain injury can occur with either Grade 2 or Grade 3 concussion. Thus, it is clear that subtle brain injury can have permanent consequences if the acute symptoms of the concussion continue for more than 15 minutes.
What do these grades mean for people who play sports?
- In grade I, the patient may return to contact sports in 20 minutes.
- A patient with a second time grade I concussion may return to play contact sports in 2 weeks after being asymptomatic for a week.
- In grade II, the patient may return to contact sports in 1 week of being asymptomatic.
- A second time grade II may return to play contact sports 1 month after being asymptomatic for a week.
- In grade III, the patient may return to contact sports in 1 month.
- For a patient with a second time grade III concussion, the season is over.
However, if the patient has repeated concussions after contact sports, grade I x 3, grade II x 2, and especially grade III x 2, then it should be recommended that the season is over and a thorough medical evaluation should be considered mandatory.
The symptoms of most concussions are resolved in 48 to 72 hours, but problems may persist.
What is post-concussion syndrome ?
In post-concussion syndrome, symptoms do not resolve for weeks, months, or even years, and the patient may have headaches, light and sound sensitivity, memory and attention problems, dizziness, difficulty with directed movements, depression, and anxiety. Symptoms usually peak 4 to 6 weeks after the concussion, but may go on longer, some even lasting a year or more. Children commonly experience more severe symptoms of post-concussion syndrome than adults. Physical therapy plus rest is the best recovery technique, and symptoms usually go away on their own.
For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg,
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website:http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm,
0 comments:
Post a Comment