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The Answer Doc by Dr. Christopher Munger
The break down on concussions
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    I have recently received several questions about concussion. Some have come from patients in the office, others from concerned parents of athletes. I wanted to explain what concussions are, how they are diagnosed, and how they are treated.
    The most common cause of concussion is automobile accidents, which account for 50 percent of all concussions in the United States. Other major sources of concussion include falls and injury from sports, most commonly from football and soccer.
    A concussion occurs when the brain is injured by striking the skull which surrounds it.  This usually occurs from rapid deceleration of the head. When the head is brought to an abrupt stop, the brain essentially mashes up against the skull. What occurs to the brain is essentially a bruise.     
    The effected brain tissue suffers from two levels of injury. First there is “shearing” of capillaries and axons (which are special parts of brain cells) which causes mild bleeding in the area. Second, there is swelling and inflammation in the area of the injury, not unlike a bruise. The extent of the injury to the brain depends on the mechanism in which the injury occurs.
    The most commons symptoms of concussion include confusion, headache, vomiting, nausea, unsteady gait, and sometimes loss of consciousness. Symptoms often resolve quickly, many times in 15 minutes or less. However, there are a small percentage of patients with concussion that have persistent headaches and nausea that can last for up to 6-8 weeks in a condition know as post-concussion syndrome.
    Concussions are medically divided into three grades:
     Grade 1: Transient confusion less than 15 minutes in duration and no loss of consciousness.
     Grade 2:  Transient confusion that last more than fifteen minutes, but no loss of consciousness.
     Grade 3: Loss of consciousness for any duration of time.
    The vast majority of concussions don’t need any special treatment other than time for the brain to heal. If a person has suffered a grade 3 concussion, many physicians will request that a patient have a CT or MRI of the brain to rule out more significant injury such as skull fracture, or subdural hematoma, which is a collection of blood between the skull and brain. Doctors will occasionally prescribe medication to control the symptoms of nausea and headaches that may persist after a concussion.  Physicians no longer ask that patients be kept awake or observed for a prolonged period of time.     There is no good scientific data to support this old fashioned way of following a concussion.  In fact, if a patient’s symptoms are significant enough from a concussion, including prolonged loss of consciousness or prolonged confusion, the patient will most likely be admitted to a hospital for observation and frequent neurologic examinations.
    Next time we’ll discuss specific guidelines for further participation for athletes that have sustained a concussion.

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