Concussions – Part 1 of 2

Concussion management is a hot topic these days, made even more popular by the media following of high profile athletes such as Sidney Crosby and his long road to recovery. We will delve into this topic with two articles. The first article will cover what a concussion is, what causes a concussion, and what the signs and symptoms of a concussion are. The second article will describe the types of concussions and how they should be managed. I will also touch upon often overlooked injuries that occur alongside a concussion, and how they can be managed in the second article.

Concussion: What is it?
The International Symposia on Concussion in Sport, held at Zurich in 2010 defined a concussion as: “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.” Huh? What this essentially means is that a concussion is caused by a force that transmits to the head. This force can be a direct blow to the head, such as an elbow-to-head collision in basketball, or an indirect force, such as what might occur during a car accident whereby the head whips forwards and/or backwards. Both of these forces essentially cause the brain to bounce around inside the skull, “bruising” the brain as it rebounds off the surfaces of the inner skull. However, neuroimaging studies (head CT, x-ray, or MRI) will not show any visible changes. The signs and symptoms that occur as a result of a concussion are more functional than structural, meaning the brain function is disturbed, but there are no visibly damaged structures such as blood vessels or brain matter.

A concussion typically results in a rapid onset of impairment in brain function that spontaneously resolves. Usually this impairment in brain function is relatively short lived; however, occasionally it can persist and develop into something termed “Post Concussive Syndrome” which I will explain in the next article.

What causes a concussion?
Surprisingly, sport is not the main cause of concussion – car accidents are. Motor vehicle accidents account for approximately 45% of all concussions seen in the ER in North America. This percentage could be even higher, as concussions are thought to be greatly under-reported. Falls are the second most common cause of concussions, accounting for approximately 30% of reported concussions. Occupational and recreational accidents are tied for third place at approximately 10% each, and thankfully, assaults are last place at 5%. As for sport, collisions sports such as hockey, football, rugby, soccer, and basketball, are the most risky with regards to sustaining a concussion.

What does a concussion look like?
The following signs and symptoms can occur in any combination as a result of a concussion:

  • Unaware of surroundings, time of day, etc.
  • Confusion
  • Memory loss
  • Loss of consciousness
  • Headache
  • Balance problems or dizziness
  • Nausea
  • Feeling “dinged,” “foggy,” or dazed
  • Visual disturbances (seeing stars or lights, double vision)
  • Hearing disturbances or ringing in the ears
  • Irritability or emotional changes
  • Fatigue or a feeling of slowness
  • Convulsions or seizure
  • Slowness in answering questions or following directions
  • Poor concentration and easily distracted
  • Inappropriate emotions (e.g. laughing at something sad)
  • Vomiting
  • Vacant staring
  • Slurred speech
  • Personality changes
  • Inappropriate playing behaviour in sport (e.g. shooting at the wrong net, passing to opposing players)
  • Decreased work or sport performance
  • Sleep disturbances

Do you need to be showing all these symptoms to be diagnosed with a concussion? No, in fact, you can sustain a concussion without even losing consciousness. The list above just describes what someone who’s sustained a concussion may present with. Check back next newsletter to find out how a concussion should be managed so that you can return to full function and lower your risk of sustaining a life-threatening second concussion.

By: Dr. Stephen Zwart

Dr. Zwart Practices at the Shawnessy Location with Optimum Wellness Centres