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Dispelling Myths and Providing the Facts on Concussion

August 26, 2015 11:59 AM with Dr. Elizabeth Pieroth

Playing a sport, whether contact or not, puts you at increased risk for concussion. Do you know how to recognize the signs? 

  Kathryn (Moderator) - 12:00 PM:
Our chat on concussions is now open. Feel free to submit questions at any point during this chat.

  Anonymous - 12:01 PM:
Can you get a concussion by getting hit in the head with a volleyball once or does it have to be multiple times?
Dr. Elizabeth Pieroth (NorthShore)
Most concussions occur with one significant blow to the head so you do not need to have multiple contacts. We do see volleyball players who suffer a concussion after being struck with significant force. If it was not a very hard hit and the symptoms are just headache, it may be a neck injury and not a concussion.

  Carla (Northbrook, IL) - 12:04 PM:
Are chills a common symptom after a concussion; and can you have a "relapse" of symptoms (dizziness, exhaustion, emotional swings, chills) if you get back into sports too soon?
Dr. Elizabeth Pieroth (NorthShore)
No, chills would not be a symptoms of concussion. Yes, people can have a return of symptoms if they are not fully recovered and engage in activities that aggravate your symptoms. However, concussions don't return. If someone is truly recovered and their symptoms return at a later date than it would be due to another cause. Emotional swings can be seen immediately after a concussion. If they return at a later date they are more likey due to something unrelated to the neurologic changes of concussion. However, athletes can feel quite stressed by their symptoms and be more emotional. Lack of sleep, hormonal changes and many other factors can causes emotional lability (shifting emotional states) in young people.

  John (Chicago, IL) - 12:12 PM:
What is a concussion as defined technically? That is, is a concussion when the brain bleeds or is "damaged" in some way
Dr. Elizabeth Pieroth (NorthShore)
A concussion is a brain injury but does not result in bleeding of the brain or tissue damage. If someone does suffer bleeding of the brain or other structural injury to the brain, we do not call that a concussion. However, a concussion is a brain injury and should be taken seriously though! It's an injury that occurs at the cellular level so it cannot be seen on CT or MRI. We also do not have a blood test to detect concussion. The diagnosis is based on symptoms reported by the patient.

  Justin (Chicago, IL) - 12:19 PM:
Is it truly dangerous to go to sleep after a head injury?
Dr. Elizabeth Pieroth (NorthShore)
That depends. If someone is hit in the head with significant force, they may suffer a hemorrhage (i.e., bleeding). If the bleeding continues, this can cause increased intracranial pressure and displacment of the brain tissue, which can be fatal if not managed. If someone is awake they would experience a significant increase in their symptoms which would be reported by the patient or observed both others (e.g., increasing confusion). If they are asleep, this could be missed. Fortunately, this is very rare. If someone has been examined by a physician, had a negative CT, or has been monitored for several hours without an increase in symptoms, it is not recommended to wake them frequently. We tell parents to contact their primary care docs or pediatricians for advise about symptoms to watch for or take them to the local emergency room.

  Lauren (Chicago, IL) - 12:26 PM:
Many athletes return to play after mTBI because their injuries are not properly recognized. What can we do to quickly and efficiently detect concussions during gameplay?
Dr. Elizabeth Pieroth (NorthShore)
There are two main strategies. First is education to the players, coaches and parents. Some players do not realize their symptoms are suggestive of a concussion. Others do not know that dangers of continuing to play while concussed. Good education can improve self-reporting of concussions, and help improve teammates, coaches and parents noticing behaviors that suggest concussion. Coaches need to create an environment where players are comfortable reporting their symptoms. Second, is to have a qualified athletic trainer available at all games and practices. They are well-trained and know their athletes so are more likely to pick up signs of a concussion. There is a great deal of sensors on the market designed to assess contact to the helmet or head but unfortunately there are too many problems with the current ones to recommend them.

  Kristina (Bolingbrook, IL) - 12:35 PM:
My daughter experienced a concussion 3 years ago playing volleyball. The ball was spiked, hit her in the front of head and there was a whiplash effect. Initially she wasn't instructed about recovery. During recovery she hit the back of her head on a cabinet. This caused regression in recovery. She has had constant headache pain at varying levels for 3 years. No break in pain. Lowest right now is 1 but won't go below. Any hope without taking meds with horrible side effects?
Dr. Elizabeth Pieroth (NorthShore)
I am sorry to hear about her injury. First, has the true cause of the headaches been determined? We often see headaches that have been called "post-concussion syndrome" are actually due to something else? Has she had a thorough examination of her neck by a cervical specialist? With this mechanism of injury, we can see constant headaches from cervical injuries. Is there a family history of migraines? Migraines don't typically present as constant headaches. Has she seen a neurologist? Any pattern or triggers for increases in the headache pain?

  Anonymous - 12:42 PM:
Can you die from a concussion?
Dr. Elizabeth Pieroth (NorthShore)
No, concussions are not fatal. However, a more severe trauma to the head that results in hemorrhage, increase intracranial pressure, or damage to parts of the brain responsible for functions such as your heart beating or breathing can be fatal. Traumatic brain injury is on a spectrum from mild (mTBI) to severe TBI. The types of injuries that are fatal are considered severe TBI. That does not mean we take concussions lightly. They are still brain injuries and need to be monitored and managed correctly. Sometimes the media reports that a person died from a concussion but further examination indicate there was a hemorrhage or other severe injury.

  Richard (Des Plaines) - 12:48 PM:
Are concussions common with younger kids, especially when they’re starting to be more active and run around?
Dr. Elizabeth Pieroth (NorthShore)
Yes, concussions occur in all ages and in many different activites. We see plenty of concussions in younger kids from falls, bicycle accidents, and other causes. That is why we need to be diligent about having kids where helmets when riding bikes, scooters or skateboards. However, every blow to the head is not a concussion so you want to distinguish between a concussion (a brain injury) and those frequent contacts to the head that do not cause a concussion.

  Jane (Northfield) - 12:52 PM:
Are there tests given to determine when a post concussive patient is ready to get back to high level exertion exercise?
Dr. Elizabeth Pieroth (NorthShore)
There are four things we look for to allow higher level exertion. First, are they asymptomatic (fully without symptoms)? Second, is there balance intact? We do not want a patient engaging in activities that risk them falling if they are still demonstrating impaired balance. Third, is there any evidence of residual cognitive (thinking) changes? There are a number of tests that are administered to asses this. Fourth, does lower level exertion cause a return of the symptoms? If someone meets all four criteria, they are allowed to increase their exertion. This should be monitored by an athletic trainer, if possible. Of note, we used to say that the patient should not participate in any physical exertion until they were fully without symptoms but that is no longer the case. Increasing evidence shows that "active rehabiliation" (getting them back to limited exertion sooner) is better for patients, especially athletes.

  Kathryn (Moderator) - 1:00 PM:
This will be the end of our chat today. Thank you everyone for your questions.

  Kathryn (Moderator) - 1:02 PM:
For more information on concussions, visit our Concussion and Head Injury Program page.

Dr. Elizabeth Pieroth (NorthShore) - 1:04 PM:
Thanks to all who submitted questions. I hope you found the information helpful.

This chat has ended.

Thank you very much for your participation.