Concussion

Alternative Names :Mild brain injury, Mild traumatic brain injury (MTBI), mild head injury (MHI), minor head trauma

Definition:
A concussion is a traumatic brain injury that is caused by a sudden blow to the head or to the body. The blow shakes the brain inside the skull, which temporarily prevents the brain from working normally.Effects are usually temporary, but can include problems with headache, concentration, memory, judgment, balance and coordination.

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Although concussions usually are caused by a blow to the head, they can also occur when the head and upper body are violently shaken. These injuries can cause a loss of consciousness, but most concussions do not. Because of this, some people have concussions and don’t realize it.

Concussions are common, particularly if you play a contact sport, such as football, boxing etc. But every concussion injures your brain to some extent. This injury needs time and rest to heal properly. Luckily, most concussive traumatic brain injuries are mild, and with rest, most people fully recover from concussions within a few hours to a few weeks.

On rare occasions, concussions cause more serious problems. Repeated concussions or a severe concussion may require surgery or lead to long-lasting problems with movement, learning, or speaking. Because of the small chance of permanent brain problems, it is important to contact a doctor if you or someone you know has symptoms of a concussion.

Symptoms:
It is not always easy to know if someone has a concussion. Not everyone who has a concussion passes out. A person who might have a concussion should immediately stop any kind of activity or sport. Becoming active again before the brain returns to normal functioning increases the person’s risk of having a more serious brain injury.

Symptoms of a concussion range from mild to severe and can last for hours, days, weeks, or even months. If you notice any symptoms of a concussion, contact your doctor.

Symptoms of a concussion include:
*Passing out.
*Not being able to remember what happened after the injury.
*Acting confused, asking the same question over and over, slurring words, or not being able to concentrate.
*Feeling lightheaded, seeing “stars,” having blurry vision, or experiencing ringing in the ears.
*Not being able to stand or walk; or having coordination and balance problems.
*Feeling nauseous or throwing up.

Head trauma is very common in young children. But concussions can be difficult to recognize in infants and toddlers because they can’t readily communicate how they feel. Nonverbal clues of a concussion may include:
*Listlessness, tiring easily
*Irritability, crankiness
*Change in eating or sleeping patterns
*Lack of interest in favorite toys
*Loss of balance, unsteady walking

Occasionally a person who has a more serious concussion develops new symptoms over time and feels worse than he or she did before the injury. This is called post-concussive syndrome. If you have symptoms of post-concussive syndrome, call your doctor. Symptoms of post-concussive syndrome include:

*Changes in your ability to think, concentrate, or remember.
*Headaches or blurry vision.
*Changes in your sleep patterns, such as not being able to sleep or sleeping all the time.
*Changes in your personality such as becoming angry or anxious for no clear reason.
*Lack of interest in your usual activities.
*Changes in your sex drive.
*Dizziness, lightheadedness, or unsteadiness that makes standing or walking difficult.

Causes:
Your brain is a soft organ that is surrounded by spinal fluid and protected by your hard skull. Normally, the fluid around your brain acts like a cushion that keeps your brain from banging into your skull. But if your head or your body is hit unexpectedly hard, your brain can suddenly crash into your skull and temporarily stop working normally.

There are many ways to get a concussion. Some common ways include fights, falls, playground injuries, car crashes, and bike accidents. Concussions can also happen while participating in rough or high-speed sports such as football, boxing, hockey, soccer, skiing, or snowboarding.

Risk Factors:
Factors that may increase your risk of a concussion include:

*Participating in a high risk sport, such as football, hockey, soccer or other contact sport; the risk is further increased if there’s a lack of proper safety equipment and supervision
*Being involved in a motor vehicle collision
*Being a soldier involved in combat
*Being a victim of physical abuse
*Falling, especially in young children and older adults
*Having had a previous concussion

Complications:
Potential complications of concussion include:

*Epilepsy. People who have had a concussion double their risk of developing epilepsy within the first five years after the injury.

*Cumulative effects of multiple brain injuries. Evidence exists indicating that people who have had multiple concussive brain injuries over the course of their lives may acquire lasting, and even progressive, cognitive impairment that limits functional ability.

*Second impact syndrome. Sometimes, experiencing a second concussion before signs and symptoms of a first concussion have resolved may result in rapid and typically fatal brain swelling. After a concussion, the levels of brain chemicals are altered. It usually takes about a week for these levels to stabilize again. However, the time it takes to recover from a concussion is variable, and it is important for athletes never to return to sports while they’re still experiencing signs and symptoms of concussion.
Diagnosis:
Diagnosis of Concussion is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia (PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15). Neuropsychological tests exist to measure cognitive function. The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient’s condition. Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury.

Health care providers examine head trauma survivors to ensure that the injury is not a more severe medical emergency such as an intracranial hemorrhage. Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting, increasing disorientation or a deteriorating level of consciousness,   seizures, and unequal pupil size. People with such symptoms, or who are at higher risk for a more serious brain injury, are CT scanned to detect brain lesions and are frequently observed for 24 – 48 hours.

If the Glasgow Coma Scale is less than 15 at two hours or less than 14 at any time a CT recommended.[8] In addition, they may be more likely to perform a CT scan on people who would be difficult to observe after discharge or those who are intoxicated, at risk for bleeding, older than 60, or younger than 16. Most concussions cannot be detected with MRI or CT scans.   However, changes have been reported to show up on MRI and SPECT imaging in concussed people with normal CT scans, and post-concussion syndrome may be associated with abnormalities visible on SPECT and PET scans. Mild head injury may or may not produce abnormal EEG readings.

Concussion may be under-diagnosed. The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead clinicians to miss the injury, and athletes may cover up their injuries to remain in the competition. A retrospective survey in 2005 found that more than 88% of concussions go unrecognized;.

Diagnosis of concussion can be complicated because it shares symptoms with other conditions. For example, post-concussion symptoms such as cognitive problems may be misattributed to brain injury when they are in fact due to post-traumatic stress disorder (PTSD).

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Treatment:
Usually concussion symptoms go away without treatment, and no specific treatment exists. About one percent of people who receive treatment for MTBI need surgery for a brain injury. Traditionally, concussion sufferers are prescribed rest, including plenty of sleep at night plus rest during the day. Health care providers recommend a gradual return to normal activities at a pace that does not cause symptoms to worsen. Education about symptoms, how to manage them, and their normal time course can lead to an improved outcome.

Medications may be prescribed to treat symptoms such as sleep problems and depression. Analgesics such as ibuprofen can be taken for the headaches that frequently occur after concussion, but paracetamol (acetaminophen) is preferred to minimize the risk for complications such as intracranial hemorrhage. Concussed individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor, as they could impede healing.

Observation to monitor for worsening condition is an important part of treatment. Health care providers recommend that those suffering from concussion return for further medical care and evaluation 24 to 72 hours after the concussive event if the symptoms worsen. Athletes, especially intercollegiate or professional athletes, are typically followed closely by team trainers during this period. But others may not have access to this level of health care and may be sent home with no medical person monitoring them unless the situation gets worse. Patients may be released from the hospital to the care of a trusted person with orders to return if they display worsening symptoms or those that might indicate an emergent condition, like unconsciousness or altered mental status; convulsions; severe, persistent headache; extremity weakness; vomiting; or new bleeding or deafness in either or both ears. Repeated observation for the first 24 hours after concussion is recommended; however it is not known whether it is necessary to wake the patient up every few hours.

Prognosis:
Concussion has a mortality rate of almost zero. The symptoms of most concussions resolve within weeks, but problems may persist. Problems are seldom permanent, and outcome is usually excellent. People over age 55 may take longer to heal from MTBI or may heal incompletely. Similarly, factors such as a previous head injury or a coexisting medical condition have been found to predict longer-lasting post-concussion symptoms. Other factors that may lengthen recovery time after MTBI include psychological problems such as substance abuse or clinical depression, poor health before the injury or additional injuries sustained during it, and life stress.  Longer periods of amnesia or loss of consciousness immediately after the injury may indicate longer recovery times from residual symptoms. For unknown reasons, having had one concussion significantly increases a person’s risk of having another. Having previously sustained a sports concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. Other strong factors include participation in a contact sport and body mass size. The prognosis may differ between concussed adults and children; little research has been done on concussion in the pediatric population, but concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, sufferers of concussion exhibited effects including loss of episodic memory and reduced muscle speed.

Prevention:
The following tips may help you to prevent or minimize your risk of head injury:

*Wear appropriate protective gear during sports and other recreational activities. Always use the appropriate protective gear for any sport you or your child undertakes. Make sure the equipment fits properly, is well maintained and worn correctly. Follow the rules of the game and practice good sportsmanship. When bicycling, motorcycling, snowboarding or engaging in any recreational activity that may result in head injury, wear protective headgear.

*Buckle your seat belt. Wearing a seat belt may prevent serious injury, including an injury to your head, during a traffic accident.

*Make your home safe. Keep your home well lit and your floors free of clutter — meaning anything that might cause you to trip and fall. Falls around the home are the leading cause of head injury for infants, toddlers and older adults.

*Protect your children. To help lessen the risk of head injuries to your children, pad countertops and edges of tables, block off stairways and install window guards. Don’t let your children play sports that aren’t suitable for their ages.

*Use caution in and around swimming areas. Don’t dive into water less than 9 feet (3 meters) deep. Read and follow posted safety rules at water parks and swimming pools.

*Wear sensible shoes. If you’re older, wear shoes that are easy to walk and maneuver in. Avoid wearing high heels, sandals with thin straps, or shoes that are either too slippery or too sticky.

Prevention of  Concussion  involves taking general measures to prevent traumatic brain injury, such as wearing seat belts and using airbags in cars. Older people are encouraged to try to prevent falls, for example by keeping floors free of clutter and wearing thin, flat, shoes with hard soles that do not interfere with balance.

Use of protective equipment such as headgear has been found to reduce the number of concussions in athletes. Improvements in the design of protective athletic gear such as helmets may decrease the number and severity of such injuries. New “Head Impact Telemetry System” technology is being placed in helmets to study injury mechanisms and potentially help reduce the risk of concussions among American Football players. Changes to the rules or the practices of enforcing existing rules in sports, such as those against “head-down tackling”, or “spearing,” which is associated with a high injury rate, may also prevent concussions.

Post-concussion syndrome:
In post-concussion syndrome, symptoms do not resolve for weeks, months, or years after a concussion, and may occasionally be permanent. Symptoms may include headaches, dizziness, fatigue, anxiety, memory and attention problems, sleep problems, and irritability. There is no scientifically established treatment, and rest, a recommended recovery technique, has limited effectiveness. Symptoms usually go away on their own within months. The question of whether the syndrome is due to structural damage or other factors such as psychological ones, or a combination of these, has long been the subject of debate.

Cumulative effects:
Cumulative effects of concussions are poorly understood. The severity of concussions and their symptoms may worsen with successive injuries, even if a subsequent injury occurs months or years after an initial one. Symptoms may be more severe and changes in neurophysiology can occur with the third and subsequent concussions. Studies have had conflicting findings on whether athletes have longer recovery times after repeat concussions and whether cumulative effects such as impairment in cognition and memory occur.

Cumulative effects may include psychiatric disorders and loss of long-term memory. For example, the risk of developing clinical depression has been found to be significantly greater for retired American football players with a history of three or more concussions than for those with no concussion history.[74] Three or more concussions is also associated with a fivefold greater chance of developing Alzheimer’s disease earlier and a threefold greater chance of developing memory deficits.

Dementia pugilistica:
Chronic encephalopathy is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition called dementia pugilistica, or “punch drunk” syndrome, which is associated with boxers, can result in cognitive and physical deficits such as parkinsonism, speech and memory problems, slowed mental processing, tremor, and inappropriate behavior. It shares features with Alzheimer’s disease.

Second-impact syndrome:
Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases. The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away. No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain’s arterioles lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow.  As the brain swells, intracranial pressure rapidly rises. The brain can herniate, and the brain stem can fail within five minutes. Except in boxing, all cases have occurred in athletes under age 20. Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.

Epidemiology:
Most cases of traumatic brain injury are concussions. A World Health Organization (WHO) study estimated that between 70 and 90% of head injuries that receive treatment are mild. However, due to underreporting and to the widely varying definitions of concussion and MTBI, it is difficult to estimate how common the condition is. Estimates of the incidence of concussion may be artificially low, for example due to underreporting. At least 25% of MTBI sufferers fail to get assessed by a medical professional. The WHO group reviewed studies on the epidemiology of MTBI and found a hospital treatment rate of 1–3 per 1000 people, but since not all concussions are treated in hospitals, they estimated that the rate per year in the general population is over 6 per 1000 people.

Young children have the highest concussion rate among all age groups. However, most people who suffer concussion are young adults. A Canadian study found that the yearly incidence of MTBI is lower in older age groups (graph at right). Studies suggest males suffer MTBI at about twice the rate of their female counterparts. However, female athletes may be at a higher risk for suffering concussion than their male counterparts.

Up to five percent of sports injuries are concussions. The U.S. Centers for Disease Control and Prevention estimates that 300,000 sports-related concussions occur yearly in the U.S., but that number includes only athletes who lost consciousness.  Since loss of consciousness is thought to occur in less than 10% of concussions, the CDC estimate is likely lower than the real number. Sports in which concussion is particularly common include football and boxing (a boxer aims to “knock out”, i.e. give a mild traumatic brain injury to, the opponent). The injury is so common in the latter that several medical groups have called for a ban on the sport, including the American Academy of Neurology, the World Medical Association, and the medical associations of the UK, the U.S., Australia, and Canada.

Due to the lack of a consistent definition, the economic costs of MTBI are not known, but they are estimated to be very high. These high costs are due in part to the large percentage of hospital admissions for head injury that are due to mild head trauma, but indirect costs such as lost work time and early retirement account for the bulk of the costs. These direct and indirect costs cause the expense of mild brain trauma to rival that of moderate and severe head injuries.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/concussion1.shtml
http://en.wikipedia.org/wiki/Concussion
http://www.mayoclinic.com/health/concussion/DS00320
http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview?page=2

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