Concussions: More Than a Smack Upside the Head

Although the recent news flurries about concussions have centered around the NFL after the suicide of Junior Seau on May 2nd, the vast majority of concussion victims are ordinary citizens.

The signs and symptoms of a concussion include: headache, dizziness, nausea, vomiting, feeling dazed, irritability, visual disturbances, ringing in the ears, confusion, slurred speech, amnesia, fatigue, depression and problems with concentration, memory, judgment, balance and coordination.  Symptoms may be immediate or may be delayed.  Symptoms usually disappear entirely within three weeks.

The CDC reports that there are about 1.7 million traumatic brain injuries treated in ERs or admitted to hospitals annually.  About 90% of TBIs that occur each year are concussions. Of those people, about 80% percent recover from the concussion within three months.  However, these statistics cannot be considered accurate as concussions are notoriously under-reported and untreated.  

The diagnosis for a concussion is based on a good history and presenting symptoms.  Concussions are considered invisible injuries.  There is no test to confirm a diagnosis; neither a MRI nor a CT scan can accurately detect a concussion.  However, brain imaging may be used to determine whether the injury is more severe and has caused significant bleeding or swelling in the skull. 

Rest, time and monitoring are really the only current treatments for a concussion.  Rest needs to be both physical and mental to allow the brain to recover.  This means the subject must avoid general exertion as well as activities that require mental concentration (playing video games, watching TV, texting, smart phones, computers, etc).  Workloads should also be temporarily reduced or suspended. Concussions can take days or years to heal.  Additional care is required to prevent repeated concussions.  These concussions can cause cumulative brain damage such as second-impact syndrome or chronic traumatic encephalopathy. For unknown reasons, having had one concussion significantly increases a person's risk of having another.

However, there is new treatment hope on the horizon.  Clinical trials have initially demonstrated that the female hormone progesterone might protect against neurological damage of a concussion if administered within the first few hours following a traumatic brain injury or stroke.  Studies, first performed at Emory University, found no side effects from this treatment.   Participants who had received progesterone after a TBI were 1/2 as likely to die, and if their concussions were moderate, they were significantly less disabled.

Second-Impact Syndrome

Second-impact syndrome develops in people who receive a second head injury minutes, days or weeks after an initial concussion, before its symptoms have resolved.  The condition is often fatal, and almost everyone who is not killed is severely disabled.

 Chronic Traumatic Encephalopathy (CTE)

The result of multiple concussions frequently results in chronic traumatic encephalopathy. The outward symptoms of chronic traumatic encephalopathy are very similar to the symptoms of Alzheimer's disease and other dementias: memory problems, disorientation, and difficulty concentrating are the earliest signs.   As the disorder progresses, additional symptoms occur: poor judgment, erratic behavior, significant memory loss, and some degree of Parkinson's disease (impaired speech, difficulty with motor skills, slow movement and a loss of balance). In more advanced stages of CTE, individuals suffer with tremors, full-blown Parkinsonism, a staggering gait, deafness and dementia.  Chronic traumatic encephalopathy also causes significant psychological problems: depression, agitation, aggression, violence, loss of inhibitions, sexual compulsiveness, euphoria, drug/alcohol abuse, and suicide. There is no specific treatment for CTE. 

Tips for Law Enforcement Officers and Supervisors

Law enforcement officers can sustain a concussion under a variety of scenarios other than during training with an overzealous trainer.  Imagine yourself chasing Joe B. Badguy on foot, you grab him and you both tumble to the sidewalk, hitting your head on the concrete… Or, the code 3 call that results in a traffic accident…Motor and bicycle patrol officers are at even greater value.  What about an assault by a suspect carrying hidden brass knuckles (or any other of a variety of weapons)… Concussions happen.  The best advice is to arm yourself with knowledge before a concussion happens. 

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