Concussions: What You Should Know

Lacrosse Magazine Article: Nov./Dec. 2004 Issue

by: Dr. Amiel Bethel

Concussion is a clinical syndrome that is characterized by impairment of the brain’s normal function. A concussion is due to mechanical forces that cause violent shaking or jarring of the brain. Since the brain is a very delicate structure within the hard skull, forces that cause sudden bouncing of the brain against the rigid skull may cause injury deep within brain. This injury may cause alterations in the cognitive function, vision, eye movement, facial movement, or speech. Although the most common causes of head injuries in the United States is motor vehicle crashes, falls, and assaults, participation in organized and recreational sports represents a significant number of concussions that occur every year.

Concussions have been categorized from mild to moderate to severe, for the purpose of evaluation, treatment, and study. A concussion is described as mild in a person who does not "pass out" (lose consciousness), but may seem dazed. Moderate concussions occur when the person does not lose consciousness, but cannot recall the injury event, and suffers a period of confusion. Severe concussions occur when the person looses consciousness, usually for more than 15 minutes, and has no memory of the event. This is the classic form, and evaluation by a health care provider should be sought as soon after the injury as possible.

The signs and symptoms of concussion may include confusion, severe headache, nausea and vomiting, dizziness, and weakness in an arm or leg. A person suffering from a concussion may experience certain psychological or physiologic complaints such as irritability, anxiety, fatigue, sleep difficulties, loss of appetite, memory problems, or impaired concentration. The specialized (cranial) nerves of the brain may be affected as well. They may experience impaired calculation, reaction time, and coordination. These signs and symptoms may continue beyond the initial injury period, and constitute what is commonly termed the "postconcussion syndrome". The ongoing signs and symptoms can cause significant problems with performance in the classroom, workplace, and in athletic competition.

In general, athletes who suffer concussions have the advantage of a health care provider at the scene in many cases, in the form of a team physician, athletic trainer, or individual trained in basic life saving techniques. Athletes can be evaluated and treated in a rapid manner. Athletes suspected of suffering a concussion may need evaluation in a hospital setting, and evaluation may include diagnostic testing by CAT scan or MRI scan of the brain. Treatment of the concussion can be assessed, and appropriate management can be administered. Treatment usually involves observation, and may require short hospitalization, but most commonly does not result in surgery. Recovery from concussions and the post concussion syndrome may be very slow, and return to competition time prolonged. It is important to recognize that the sequelae of concussion may interfere with performance on the field, leading to even greater risk of injury.

The study and treatment of concussions in athletes has gained great momentum in the past decade. As we develop a greater understanding about how the brain works, we develop a greater knowledge of the diseases of the brain. As more people become involved in the sport of lacrosse, a better understanding of the injuries will occur through study and evaluation. A better understanding will be needed, since statistically we know concussions are prevalent in contact sports, and a very small percentage of head injuries in athletes are actually monitored by health care professionals in comparison to other injuries, such a knee injuries. A revitalized interest in concussion management is taking place in the fields of neurology, neurosurgery, and sports medicine.

–Dr. Amiel Bethel is a specialist in neurosurgery and neurology for Baltimore Neurosurgical Associates. He is a member of the US Lacrosse Sports Science and Safety Committee.

This article was published in the November/December 2004 issue of Lacrosse Magazine.