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Heads Up! What You Need to Know About Concussion

Tuesday, December 27, 2016 3:03 PM

While the current discussion surrounding concussions often involves athletics, head injuries are a serious issue for anyone. Knowing how to recognize and react to a potential injury can save a life. Dr. Nicole Reams, Sports Neurologist within NorthShore’s Neurological Institute recently gave some must-read advice about the subject in an online chat, and answers common questions about concussion below:

What are some of the common causes of concussion?
Concussion can happen in all types of circumstances. I often see athletes that participate in contact or collision sports (ie. Ice hockey, football, and women’s soccer top the list), all ages that have a mechanical fall resulting in head trauma and those involved in motor vehicle accidents.

For athletes, what are some important steps to take in order to protect against head injuries?
Ensure proper technique in athletic competition such as tackling technique. Helmets have not reliably been shown to prevent concussion, but wearing an appropriately-fitted helmet is important for preventing skull fractures and intracranial bleeds. Lastly, if there is any concern that a head impact has resulted in symptoms, the athlete should tell someone right away and remove themselves from the sport until they can be evaluated. These, of course, are not always concussions, but should be evaluated and treated appropriately to prevent a second hit within the recovery window.

If you see someone injure their head, what can you do to help? What steps should a person take if they have injured themselves?
If you see someone injure their head, be sure that they get immediate medical attention, be that from an athletic trainer, family physician or emergency department. You can get a sense for the seriousness of the injury by asking them general orientation questions like where they are, what they were doing, and how the injury happened.

If you are concerned yourself for a head injury, be sure you receive medical attention immediately. Do not go to sleep to see if symptoms are improved in the morning. Do not take aspirin, ibuprofen or other medications that can thin the blood. In either scenario, it is smart to remain in the company of others so they can monitor your symptoms if there is a delay to consultation with a medical professional.

Who should someone go to if they think they have a concussion; an ED or a primary care physician?
I recommend that anyone with a head injury who has prolonged loss of consciousness >1 minute, recurrent vomiting, or changing neurologic signs (worsening disorientation or lethargy, new weakness or numbness, etc) to go to the ED so a CT scan can be done to rule out intracranial bleeding. If the individual is stable, they can be evaluated by a primary care physician or a concussion specialist as an outpatient. Always err on the side of caution and if you are not sure, go to the ED.

What do specialists look at to diagnose concussion?

We look at the mechanism of the hit (location, force), the nature of the symptoms and the timing of symptom onset and evolution in relationship to the impact. 

Typically, how long does it take to recover from a concussion?
Generally, 7-14 days in most people. This may be a little big longer in the youth and elderly, and can be extended based on the presence of additional injuries (cervical strain or vestibular injury) or genetic factors.

Are there any long-lasting side effects? Can having a concussion make you more vulnerable in the future?
This is the hardest question is concussion medicine currently. Concussion is largely a treatable injury and the vast majority of people recover with no clinical long-term effects. It is generally accepted that there is a threshold at which having too many concussions can result in long term clinical effects such as cognitive decline or behavioral change, and eventually result in a syndrome called Traumatic Encephalopathy Syndrome. That threshold, however, is unknown, so it is difficult to counsel patients on their risk for long-term effects based on their concussion burden. There is also current attention being paid to the risk of a single or multiple concussions and the subsequent development of other neurodegenerative diseases such as Alzheimer’s and Parkinson’s. The data is mixed at this point, but the concern remains.

How long after a concussion can someone return to their normal physical activities?
This is very individual and wholly dependent on their symptom burden and symptom recovery. We encourage early light physical activity as this has been shown to help brain recovery, and over-rest can actually prolong recovery. We encourage early, but symptom-limited physical activity when symptoms are mild, and then a gradual progression through increasing intensity and complexity of exertion when symptoms return to baseline. This is called “return to play”, but applies to non-athletes also. The return to play progression typically takes 5 days if there is no exacerbation of symptoms during the progression, so generally speaking, if someone’s symptoms resolve from concussion in 7 days, then they could be back to normal activity including their sport by 2 weeks.