Concussion - commotio cerebri - mTBI

Concussion, often referred to as mTBI

The term concussion originates from the latin verb 'concutere' meaning: dash together or shake violently.

A concussion is a 'mild' form of brain injury following a blow to the head or after a fall in which the brains are shuffled back and forth. A brief unconsciousness is often associated with this, although the latest reports tell us that unconsciousness does not always occur. The unconsciousness often takes a few minutes but never longer than fifteen minutes. With the increasing severity of the concussion, the duration of loss of consciousness and of 'the hole in the memory'; retrograde amnesia, is even longer.

After awakening, there is often a memory disorder of instantly before and after the injury. One can have nausea and / or vomiting.

COUP CONTRECOUP INJURY= ACCELERATION DECELERATION INJURY

A common way that a person can experience a traumatic brain injury is when an impact or violent motion brings their head to a sudden stop causing the brain to slam into the skull.

This is called a coup contrecoup injury also known as an acceleration deceleration injury In this kind of injury the brain bounces back and forth inside of the head causing damage to the brain where it hits the skull The brain is injured at the point of direct impact and because it bounces back into the opposite side of the skull the opposite side of the brain is injured as well.

Coup contrecoup injuries can involve damage to the brain at the specific point of impact called focal injuries or to a large part of the brain known as diffuse injuries It s important to know that coup contrecoup injuries can happen as the result of trauma without direct impact to the head since it is the movement of the brain inside of the skull that causes the injury.

PROBLEMS AFTER CONCUSSION OR WHIPLASH

With most concussions, there is no injury or neurological changes in the brains. These people also recover after the concussion or whiplash.

About ten percent are mild bruising or minor bleeding. And less than one percent can have severe bleeding due to damaged blood vessels and skull fracture.

In a mild concussion may be that the person in question for some time suffer from residual symptoms such as:

     Fatigue
     Headache
     Dizziness
     Concentration problems
     Tinnitus
     Anxiousness
     Quickly irritated; irritability, tearfulness or feeling down
     Sensitive to light and sound
     Suffer from cloudy thinking

If these sequelae exist then bed rest is not necessary, but it is good to take it easy with cognitive tasks. (thinking, watching television, gaming, working on the PC) The symptoms can be quite long, sometimes months. It is wise to contact the doctor when these complaints seems to be permanent.

Although recognized less and not well known to the public, people can have cognitive and / or physical problems a long time after a concussion or whiplash.

In the event that (based on current research methods), no injury can be found in the brain and this person continues to have symptoms, it is not always a matter of 'affectation'. Insurance companies should take this into account. See this Belgian website about this issue.

Recently scientists discovered that a circulationproblem was detectable in the time shortly after a concussion with a SPECT scan (contrast fluid) scan.

POST-CONCUSSION SYNDROME (PCS)

A concussion is usually without complications and usually lasts no longer than a few days or a few weeks. In some cases, however, the symptoms of rhe concussion continue to exist after months and years. In that case, it is no longer referred to as a concussion, but as a post-concussion syndrome.

Merck medical manual: The post-concussion syndrome is a group of symptoms that can occur after a concussion. This syndrome involves a number of weeks or months, but rarely longer.

The patient usually feels somewhat confused, has a headache and is abnormally sleepy. There may be dizziness, difficulty concentrating, forgetfulness, depression, lack of feelings or emotions and anxiety occur. In the meantime, the patient may have difficulty working, studying and maintaining social contacts.

OBSERVED CHANGES

A study in America showed 53% of people with long-term post-concussion syndrome (PCS) observed a disturbance in the blood flow in the brains. A Canadian study shows, even after years, altered brainwave activity that concentration problems stated.

However, not many people end up in this medical research mill in the period following a concussion. They do have something 'else on their mind' in the recovery stage. In a study among compared with MRI or CT scan showed that the SPECT scan showed more abnormalities in this area. Read more...

A more recent study on the SPECT scan is this study.

A biomarker (calpain-cleaved αII-spectrin N-terminal fragment (SNTF)) in blood predicts the risk of white matter lesions and cognitive complaints following mild traumatic brain injury.

A neuropsychological assessment may reveal hidden cognitive damage, but is very pricey.

If the person holds a lot of complaints and "interpreted" with the term "mild" brain injury, it would certainly be advisable to inquire about a neuropsychological assessment.

Especially when there is nothing to see on MRI or CT scan this might help.
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VARIETY OF SYMPTOMS

There are a variety of symptoms associated with concussion, or 'mild' TBI, but keep in mind that not all patients will have all of the symptoms. Typically, concussion patients demonstrate some combination of the following symptoms:

Nausea
Vomiting
Fatigue
Feeling light-headed or dizzy
Trouble getting things organized
Blurred vision or eyes that get tired easily
Headaches or ringing in the ears

Other common symptoms of concussion, or 'mild' TBI, include:

Feeling sad or anxious
Being easily irritated or angry
Feeling tired all the time
Having trouble with memory, attention, or concentration
Being bothered by sounds, lights or distractions
Having trouble making decisions or solving problems
Having trouble with self-control
Thinking, moving, speaking or reading slower than normal
Feeling easily confused or overwhelmed
Having changes in sleep, including much more or much less
Having changes in sexual interest or behavior

The chances of having ongoing problems is the same whether a patient is only dazed or actually loses consciousness for less than 30 minutes after the traumatic event. Another important fact is that after one brain injury, the risk of a second injury is three times greater, and after the second injury, the risk for a third brain injury is eight times greater than average.

The more brain injuries that a person suffers, the greater the chance of having long-term problems.

When the results of a head injury are worse than mild TBI, or concussion, the injury may be classified as moderate or severe TBI.

The factors used to define moderate TBI are:

A loss of consciousness that lasts for more than 30 minutes but less than 24 hours
Memory loss after the traumatic event, called post-traumatic amnesia or PTA, lasting for 24 hours to seven days
A Glasgow Coma Score of 9 – 12

Severe TBI is classified based on:

A loss of consciousness that lasts for more than 24 hours
PTA lasting for seven days or longer
A Glasgow Coma Score of 8 or less, which indicates that the patient is in a coma

There are also several factors that will help predict the level of recovery from a moderate to severe brain injury. Those factors include:

How severe the injury is
How fast and how well the body recovers
The brain functions affected by the injury
The areas of brain function that are not affected by the injury
The age of the patient at the time of injury
Other injuries to the body from the same traumatic event

The long-term effects of moderate to severe TBI can include challenges with attention span and the ability to concentrate and remember. These are known as cognitive problems. Difficulties with processing input from the senses, such as touch, vision, hearing, taste and smell may also occur. Other effects can include, seizures, chronic pain, sleep disorders, loss of bladder or bowel control, and a variety of social and emotional challenges.

A severe traumatic brain injury involves an unconscious state or coma that lasts days, weeks, months, or even years. Typically, the greater the amount of brain damage, the longer a person remains in a coma, and the more challenging the recovery may be.

It’s important to keep in mind that every traumatic brain injury is different, and every person responds differently.

THE LONG TERM SYMPTOMS

The long-term symptoms of TBI can be divided into several categories, including physical changes, cognitive effects, sensory effects, perceptual effects, social/emotional changes and others. You’ll find a partial list of these symptoms and effects below.

Keep in mind that the symptoms and effects will vary greatly from one patient to another, depending inter alia on the severity of the TBI.

Physical

Physical changes:

Sleep disorders
Loss of stamina
Appetite changes
Physical paralysis/spasticity
Chronic pain
Control of bowel and bladder
Seizures
Difficulty regulating body temperature
Hormonal challenges

Cognitive

Cognitive difficulties relating to:

Attention
Concentration
Distractibility
Memory
Speed of processing
Confusion
Perseveration, the abnormal persistent repetition of a word gesture or act.
Impulsiveness
Language Processing
Executive functions, which are involved in brain processes, such as planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information.

Speech and Language

Speech and language effects:

Receptive Aphasia — which involves difficulty understanding the spoken word
Expressive Aphasia — in which the patient knows what he wishes to say but is unable to get the words out. In some cases, the patient is able to perceive and comprehend both spoken and written language, but is unable to repeat what he sees or hears.
Slurred speech
Speaking very fast or very slow
Problems reading
Problems writing

Sensory

Sensory difficulties relating to the interpretation of:

Touch
Temperature
Movement
Limb position
Fine discrimination

Perceptual effects:

Difficulty integrating and understanding information gained through the five senses

Vision:

Partial or total loss of vision
Weakness of eye muscles and double vision (diplopia)
Blurred vision
Problems judging distance
Involuntary eye movements (nystagmus)
Intolerance of light (photophobia)

Hearing:

Decrease or loss of hearing
Ringing in the ears (tinnitus)
Increased sensitivity to sounds

Smell:

Loss or diminished sense of smell (anosmia)

Taste:

Loss or diminished sense of taste

Social-Emotional

Social-emotional effects:

Dependent behaviors
Fluctuating emotions
Lack of motivation
Irritability
Aggression
Depression
Lack of inhibition
Denial/lack of awareness

Someone who experiences this tells about it:

Physiologic Post Concussion Disorder

First and foremost, an individual’s resting heart rate is increased after traumatic brain injury.(King, Lichtman, Seliger, Ehert, & Steinberg, 1997) Perhaps more importantly, the rate at which the heart rate increases with exercise is accelerated in concussed patients. (B. Gall, W. S. Parkhouse, & D. Goodman, 2004) The heart rate increase seen with cognitive stress is also greater in concussed patients. (Hanna-Pladdy, Berry, Bennett, Phillips, & Gouvier, 2001)

Individuals with post concussion disorders also have autonomic nervous system dysregulation, which is expressed as overactive sympathetic nervous system activity. (B. Gall, W. Parkhouse, & D. Goodman, 2004; King, et al., 1997) Dr. Meagan remarked that this would explain why many patients complain of light sensitivity. She knew that pupils are dilated during sympathetic activity. We explained that it may also be responsible for why so many patients have difficulty falling asleep. In order to fall asleep, the parasympathetic system has to take charge, and an overactive sympathetic system prevents the individual from entering the relaxed state that is required in order to fall asleep.

Finally, we pointed out that patients with post concussion disorder often have difficulty regulating cerebral blood flow. (Junger et al., 1997) Simply put, the brain cannot perform well when the blood pressure in the brain is too high. During exercise or any other time that one experiences a substantial increase in blood pressure, the brain is protected by an auto-regulatory process. After a concussion this auto-regulatory process is disrupted. Dr. Meagan interrupted the educational program: “While I can certainly see the advantages to evaluation of signs versus symptoms of concussion, as a general practitioner I don’t see how I can assess someone for cerebral blood flow or autonomic nervous system balance in my practice”.