Is A Concussion A Traumatic Brain Injury?
Are concussions the new silent epidemic? The National Institutes of Health states there are four million sports-related and recreational concussions annually, and that’s not factoring in car crashes and falls, increasing that number exponentially. The good news is most concussions are mild, with the majority of people recovering within two to four weeks. A smaller percentage of people aren’t as fortunate, with the consequences being more dire, and even life-altering. Is a concussion a traumatic brain injury?
What Is A Concussion?
A concussion is a mild traumatic brain injury, resulting from impact to the head, neck, or face, causing shaking of the brain, and twisting of the spinal cord. that causes the brain to shake, and the spinal cord to twist. This causes inflammation and can also cause neuronal damage negatively affection brain function. The damage from a concussion is usually not structural in nature, due to the fact that a concussion is a mild brain injury, rather than a severe one.
The brain is comprised of soft tissue, which is normally protected by the skull, along with the blood and spinal fluid. However, when the skull receives a significant enough impact, the brain can shake and shift, hitting against the skull. This leads to swelling and bruising of the brain, nerve injury, and tearing of the blood vessels.
It’s the same idea as injuring your knee if you fall really hard. You’ll notice bruises on your skin, and you knee will swell, and be sore to the touch. A concussion follows the same line of thinking; if you hit your head hard enough, it will bruise the brain’s delicate tissue. The neurons in the injured area can also be affected, and won’t be able to perform their functions optimally, resulting in cognitive impairments and other symptoms.
Many people within the 10-20 percent category that don’t recover within a month after sustaining a concussion, may experience physical, cognitive and emotional symptoms they fail to correlate with their injury. Because many of the symptoms aren’t visible, and they seem normal otherwise, the person makes excuses for their memory lapses, fatigue, and changes in personality with phrases like “I’m just stressed,” or “I haven’t been getting enough sleep.” It’s difficult to link symptoms to causation even though many of them can be quite debilitating.
Couple that with the fact than most healthcare practitioners focus on physical symptoms alone. After structural damage and brain bleeds are ruled out, patients are sent home to rest and recover. But what happens if they don’t? More on that below. Keep in mind that mild traumatic brain injuries typically do not show up on Xrays, CT scans, or MRIs. They can, however, detect brain bleeds which are dangerous.
The take home message here is don’t discount symptoms or rationalize them away. Although, most symptoms following a concussion resolve after a few weeks, some may not, leading to long-term repercussions.
Mild Concussion Symptoms
Concussions range on a continuum from mild, to moderate, to severe. Concussion risk is associated with two factors; the hardness of the surface the injury occurred on, and the speed of the impact.
A fall that takes place on a wood floor or carpet is going to be less severe, than a surface such as concrete, that has no bounce or give to it, helping to dissipate the energy, and lessen the impact of the fall. Symptoms generally show up within a few hours from the onset of injury, coming on either immediately or gradually over the course of several hours. What causes the symptoms? The shaking of the brain.
Warning signs of a mild traumatic brain injury:
- Excruciating headache
- Nausea and vomiting
- Extreme sleepiness or insomnia
- Changes in vision and vacant stare
- Uneven gait
- Difficulty concentrating and memory lapses
- Dizziness and unresponsiveness
- Loss of consciousness
- Slowed reaction time and flat expression
How Are Concussions Diagnosed?
There is no concrete diagnosis for a concussion, it is clinical in nature, meaning how the person is presenting. The following three questions can help determine the severity of the head injury as there are no universal tests that can diagnose a concussion. Imaging technology is not useful in diagnosing mild traumatic brain injuries, but they can rule out a severe brain injury.
1. How and where did the injury happen?
2. How is the person feeling and what are their symptoms?
3. What is the person capable of in terms of their abilities?
Concussions are graded according to severity.
Grade 1: considered a mild concussion, with symptoms clearing within fifteen minutes. There is no loss of consciousness.
Grade 2: this grade of concussion is considered to be moderate. Symptoms last longer then fifteen minutes, and may persist for hours. There is no loss of consciousness.
Grade 3: this is a severe concussion and head injury characterized by a loss of consciousness, no matter what the other symptoms are.
Most concussions are sports related. Think of rugby players banging their heads together, gymnasts falling on their heads, soccer players hitting balls off their heads, and the multiple aggressive hits football players sustain. Concussions can also be caused by falls, slips, and accidents, including car, bike, skateboard, and playground accidents.
Keep in mind, an injury doesn’t have to directly impact the head to cause a concussion, it can come from being hit it another part of the body, with the shock radiating to the brain. Whiplash is a prime example of this scenario. Interestingly, women are more susceptible to concussions than men due to the fact that their necks aren’t as strong, which can help to lessen the force of the impact.
Heal Your Concussion
The number one remedy to heal a concussion is prolonged rest, and this isn’t just physical rest, but cognitive rest as well. Stimulation needs to be kept to a minimum, no loud noises or bright lights
Resting the eyes is important too so television, movies, video games, social media scrolling, and reading should all be kept to a minimum. Slow walking is acceptable a week or two post injury, and social events should be postponed until the concussion has healed. How can you tell when a person has healed?
A flat affect, or lack of expression, can be a symptom of a mild brain injury. Being aware of the changes in affect is one way to gauge a person’s progress because facial expressions are easy to ascertain. You can be confident they are on the road to recovery when their expression becomes more animated.
Cognitive And Emotional Symptoms
Other cognitive and emotional symptoms may be more difficult to recognize, and keep in mind this fact: just because a person feels better after a few days, does not mean they are better. 80 to 90 percent of head injury victims will be back to normal within two to four weeks, with the remaining subset suffering for months, and even years. Even though the majority of symptoms may have resolved, that doesn’t mean there are not lingering performance problems, such as issues with balance, lack of coordination, and slow reactions times.
People with these symptoms need to be evaluated, and considered for brain injury rehabilitation to access the degree of physical, cognitive, emotional, and/or behavioral impairments. Specialized testing is available for these types of injuries. A bit of trivia; helmets are protective, and should always be worn, but they don’t prevent concussions.
Why Are Concussions Dangerous?
A little bit of nausea and a slight headache is normal following a concussion. It gets worrisome when symptoms worsen or don’t abate. Brain swelling can become an issue, but because the brain is housed within the skull, which is an enclosed space, there isn’t room for it to swell. If the swelling continues, eventually the brain will crush itself under the pressure.
This is frightening because when nerves and neurons are damaged, the consequences can be far reaching, and function inhibited. If cognitive symptoms persist, or get worse after three or four weeks, the symptoms need to be taken seriously as the person may be suffering more serious, long-term consequences from the concussion.
The brain may continue to swell, which as stated above, is dangerous. It’s difficult to determine the extent of the injury because the person will most likely look normal, but in reality, they haven’t fully recovered mentally and emotionally. Since a concussion is considered a mild traumatic brain injury, the person may not realize how the concussion has affected them, although they may be experiencing mild personality changes, and lapses in memory that are easily reasoned away.
It’s these lingering symptoms you want to keep an eye. The lack of awareness surrounding how brain injuries can manifest, doesn’t help matters. Recognizing the symptoms and the need for treatment can make all the difference in the prognosis. At this point, the person should be evaluated and possibly seek out a neuropsychologist for cognitive treatment. Fortunately, this type of therapy is covered by insurance. Cognitive therapy is appropriate for those experiencing persistent and lingering symptoms after a concussion.
Living with Post Concussion Syndrome
The 10-20 percent of people that don’t get better a month after sustaining a concussion may go on to develop Post Concussion Syndrome (PCS). This syndrome is characterized by intractable symptoms that fail to resolve. This is why it’s so imperative to keep an eye on symptoms as they are a barometer of what’s happening internally. The most common symptoms people experience in PCS are dizziness, fatigue, vision disturbances, frequent or constant headaches, difficulty concentrating, anxiety and insomnia. Quite a miserable and exhaustive list.
Check out this book for more information:“Coping with Concussion and Mild Traumatic Brain Injury, A Guide To Living With the Challenges Associated with Post Concussion Syndrome and Brain Trauma.”
The bad news with Post Concussion Syndrome is if symptoms are present at three months post injury, it’s likely they will still be noticeable after a year if rehabilitation hasn’t been started. The good news is that injured tissue can be rehabilitated, but unfortunately, medications are not an option in treating concussions.
Think about this statistic. Up to 50 percent of people with concussions can’t return to work after two weeks, and half of that number aren’t well enough to go back to work one month post injury. So even though the majority of concussions resolve within a month, some don’t, and the quality of life of these people is greatly affected as concussions can cause multiple dysfunctions in the brain.
Each Concussion Is Unique
Concussions have a high degree of variability. They’re kind of like fingerprints, and each person is unique in their presenting symptoms. To be diagnosed with Post Concussion Syndrome, one must have at least three symptoms, across three categories, four weeks following the head injury. Loss of consciousness, following the concussion, is also a defining feature of this syndrome. Symptoms must include both physical and cognitive impairments.
To clarify, a loss of consciousness is not imperative to be diagnosed with a concussion, but it is a precipitating factor in Post Concussion Syndrome. Considering the staggering number of people sustaining concussions per year, think how many of those individuals will be diagnosed with PCS. That’s a staggering amount of suffering.
It makes me wonder how many cases of depression, learning disabilities, and problematic relationships are the result of a concussion.
Check out this informative book titled: “The Ghost in My Brain: How a Concussion Stole My Life and How the New Science of Brain Plasticity Helped Me Get It Back.”
Following a head injury, the blood brain barrier immediately breaks down. This means the blood vessels going to the brain are no longer tight, enabling other substances besides oxygen and glucose, to enter the brain. Inflammation from the body can also enter the brain. The brain has its own immune system that is separate from the body, but with the blood brain barrier compromised, the body’s immune system begins to negatively affect the brain’s immunity, leading to inflammation. This is a significant underlying component of PCS.
Another factor is that stress hormones can rise up to 300 percent following a concussion. These high levels of cortisol and adrenaline then break down the intestinal lining, which houses 70 percent of your immune system, leading to leaky gut, food sensitivities, autoimmunity, body-wide inflammation, and immune system dysregulation. It’s easy to see why symptoms are so variable and persistent in Post Concussion Syndrome.
These chronic inflammation and immune system abnormalities can lead to a host of biochemical, metabolic, and hormonal symptoms because of the wide-spread effect on all body systems. Inflammatory and immune markers, at this point will be elevated on lab testing findings. In essence, a brain injury perpetuates the breakdown of the intestinal lining, creating inflammation in the brain.
This is a vicious gut-brain axis cycle that keeps the body in a chronic state of inflammation, resulting in a number of deleterious symptoms, and is one of the main mechanisms behind Post Concussion Syndrome.
Concussion awareness is on the rise thanks to the movie “Concussion” and the NFL’s declaration that brain injury is indeed an issue among professional players.
In summary, concussions are mild traumatic head injuries that typically resolve within a month’s time. Rest, and a low-stimulation environment are the best methods for recovery.
The majority of concussions resolve on their own, but a minority of people may not be as fortunate, and go on to develop Post Concussion Syndrome, a diagnosis that should be taken seriously.
Have you had a concussion? What were your symptoms and did you recover quickly? Let me know in the comments:)