CONCUSSIONS

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Concussion has been recognized as a clinical entity for more than 1,000 years. The term “concussion” comes from the Latin “concussus,” which means “to shake violently.” The first recorded description of concussion was by Hippocrates about 2,400 years ago although it was not until the 10th century A.D. that a Persian physician, Rhazes, made the distinction between a concussion and other traumatic brain injuries. In the 13th century, a European physician, Lanfrancus, referred to concussion as “commotio cerebri” in contrast to “contusio cerebri,” indicating the first recognition of a concussion as an altered state of mind rather than a physical brain injury. Concussions have become a frequent topic of conversation in homes, schools, and on TV, and have become a major focus for sports programs in communities, schools, and professional sports.

According to the CDC, each year 1.7 million people are sent to emergency rooms for a traumatic brain injury (TBI) and 1.3 million of them are treated and released. In adults, the leading causes of head injury are falls and motor vehicle accidents (MVAs), but in 15- to 24-year-olds, head injuries from sports rank second only to MVAs. Despite the NCAA’s mandatory sports concussion education programs, surveys of college students indicate that up to 43 percent of students who have suffered a concussion deliberately hide their symptoms. In 2013, the American Academy of Neurology defined concussion as a “clinical syndrome of biomechanically induced alteration of brain function typically affecting memory and orientation, which may involve loss of consciousness.” Concussion occurs as a result of direct head trauma, rapid acceleration-deceleration of the head such as “whiplash” injury, or a blast injury commonly seen in military personnel serving in a war zone. The most common cause of sports concussions is head to head contact. In the mildest form of concussion, the patient is dazed or “sees stars” and may be momentarily confused. Loss of consciousness may occur, although it is only seen in about 10 percent of concussions. A prolonged loss of consciousness indicates a TBI rather than a concussion. Amnesia may occur and may be anterograde (inability to assimilate new memory) or retrograde (failure to recall the injury or events preceding it).

While headache and dizziness are the most common symptoms of concussion, mental “fogginess” and mild cognitive difficulties affecting memory and the ability to concentrate do occur. Post-concussion syndrome occurs in 30 to 80 percent of those with concussion, and in 20 percent of those cases, symptoms may be persistent. On the other hand, in athletes, symptoms usually resolve in one to two weeks. Post-concussion symptoms include those listed above and may also include nausea, vertigo, fatigue, vision or hearing changes, and mood and personality changes. As I mentioned in a previous column, treatment of concussion now includes light aerobic exercise after one to two days of rest following a head injury. Lastly, repeated head injuries are now suspected of causing Chronic Traumatic Encephalopathy (CTE). CTE has caused refocusing on head injuries, especially in football programs. The syndrome, now called CTE, was first described in 1928 by Harrison Martland in an article called “Punch Drunk.” In the last century, the focus on head injuries was on boxing whereas now it is on football and other contact sports.

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