Apple #603: Concussions

A couple weeks ago, I fell off my bike.  I was standing up & pedaling hard to get up some speed, changing gears, a wall was approaching faster than I realized, I tried to swerve, and I lost my balance and bang, over I went.  The fall itself seemed to happen in slow motion, and I could see that I was going to hit my chin on the pavement.  I tried to keep that from happening by bracing myself with my hands (which had already slammed hard onto the pavement), but the force of my fall was greater than my strength and my chin smacked with a bang on the cement.

I was afraid my teeth were going to get broken, but fortunately that did not happen.  The impact jarred my jaw pretty hard so that it hurt to work my jaw for some time afterward.  My chin started swelling up and later developed quite a dark bruise.

Chin bruise, courtesy of a fall off my bike. It got darker over the next day or two.  What's up with that weird downturn on one side of my mouth? I look like I've had a stroke or something. Fortunately, that is not the case.
(Photo by the Apple Lady)


Throughout the course of that day, I developed a headache that got stronger and stronger.  I kept taking ibuprofen, but it didn't seem to make a dent in the pain.  Usually one pill does the job, but I took four over the course of a few hours and I didn't notice any difference.  That's when I started to wonder if I'd gotten a concussion.

Naturally, as the Apple Lady, I had to find out about concussions.

• A concussion can happen after getting hit hard in the head. But a strong blow to the body can result in a concussion, too.

• Your brain is like Jell-O. It's soft, a little jiggly, and it doesn't stand up very well to direct, physical pressure.

  
Jell-O. Your brain is about this defenseless inside the skull.
(Photo from Allee Willis)

• The brain is protected from the outer world by the skull, but it needs still more protection than that. Within the skull, the brain is cushioned by the fluid that surrounds it, which keeps the brain from banging against the hard bone that is your skull.  

• If you get hit hard in the head, though, the blow can cause the brain to hit bone, and the Jell-O brain can be affected as a result.  That's a concussion.

• You don't have to be hit in the head to get a concussion.  If you get hit in the body hard enough that your head whips forward hard and suddenly, your brain can be flung against the inside of your skull and get injured that way.  It's the same kind of injury as occurs in shaken baby syndrome, though usually less severe.  In fact, the word concussion comes from the Latin concutere, which means "to shake violently."

What Happens When a Concussion Occurs

• As a result of the impact, your brain is shoved against the inside of the skull (this is called the coup). Then when your head snaps back, the brain hits the opposite side of the skull (contrecoup). 

The coup -- first impact of the brain against the skull -- and contrecoup -- the second impact against the skull on the opposite side of the brain.
(Image from KIN450 Neurophysiology)

• So you get two bruises on opposite sides of your brain.  The size and severity of the bruises depend on the force of the impact.

• If the impact is a complex one with lots of jostling and motion in many directions, like, say, while getting tackled by lots of people during a football game, the impact of the brain against the skull may also be more complicated, with rotational movements and shearing forces. It's usually in the more complex type of impacts that loss of consciousness occurs, but a single, direct impact can cause loss of consciousness too.

• You might think bruises don't seem too bad, but your brain reacts to bruising with reversible but immediate temporary paralysis of the nervous system.  Everything shuts off for a second. This is a protective mode, but for that brief shut-off time, there is no one manning your ship.  The brain controls your breathing, your heart rate, all kinds of stuff you need to survive.  For those few milliseconds or moments, all that is shut off.  You do not want this to happen for very long, or very often.

• Along with the bruises comes swelling, which first of all means pain, but it also means restricted blood flow, which means a reduction in oxygen, which means a reduction in brain function.

• You can also get torn axons, which are nerve fibers that carry messages in the brain. If those are torn, the messages won't get through. Unlike lots of other types of tissue in the body, axons do not heal themselves back together. Once they're torn, that's how they'll stay.

• If this isn't enough to convince you that concussions are serious, here's more.  As we learned in a previous entry, bruises are bleeding that's contained under the skin. If the impact on the brain is severe enough, those bruises can rupture and then you've got bleeding on the brain. You really do not want this because a) the blood carries oxygen which the brain desperately needs to do its thing and if the blood is leaking out, it's not getting that oxygen and b) bleeding can put pressure on the brain within the skull and with enough pressure, the whole thing will stop working and you can die.

• Now that I've scared the pants off you, I will say that bleeding in the brain is not at all common with a concussion.  Most of the time you get the two bruises.  But those bruises mean the brain has been injured, and that's not something to take lightly. Capice?

How Do You Know if You've Had a Concussion

• It's not always obvious if a concussion has occurred. A concussion might cause you to pass out or blank out, or it might not.  Symptoms can be mild or severe. They can last for hours, or days, or weeks, or months, depending on the severity of the injury, or how many concussions you've already suffered.  

• It's also possible that symptoms won't appear right away but develop after some time has passed.

• There are four types of symptoms of a concussion.  Chances are, if you have a concussion, you won't experience all of these symptoms, or maybe even half of them.  But if more start popping up, or if any of them get worse over time, then absolutely go see a doctor. 

  
A headache was the only symptom I had.  I put a bag of frozen peas on my head for a while, and that helped.
(Photo from LAdodgertalk)

• 1. Physical

• Headache
• Fuzzy or blurred vision
• Nausea or vomiting
• Dizziness
• Sensitivity to noise or light
• Ringing in the ears
• Balance problems
• Feeling tired, having no energy

• 2. Thinking or Remembering

• Difficulty thinking clearly
• Feeling slowed down
• Difficulty concentrating
• Difficulty retaining new information

• 3. Emotional / Mood
• Irritability
• More emotional
• Unexplained sadness
• Nervousness or anxiety

• 4. Sleep
• Sleeping more than usual (unintentionally so)
• Sleeping less than usual (unintentionally so)
• Difficulty falling asleep

• If you think you've had a concussion, the primary and most important thing to do is go see a doctor.  The doctor will conduct a lot of simple tests to determine whether you've had one, and then will determine what kind of rest or therapy you need.

• The second most important thing is don't immediately go play a demanding, contact sport where you could get injured further.  Your brain is a delicate instrument that you need to survive. You've already subjected it to some damage. Give it some time to recover before you go slamming it around again.

 

  
In football, most concussions occur due to impacts from the side and to the lower part of the face, such as in this hit between two high school players in Pennsylvania.
(Photo by Christine Baker, The Patriot-News)

• If you do go back to playing your sport before your concussion has healed and you re-injure your brain, you'll have what's called Second-Impact Syndrome. Basically it means all the symptoms of a concussion can be worse, but you're also more likely to suffer a permanent disability, and even death.

• When you go see the doctor (you see how I'm assuming that this is a given?), the doctor will tell you how long you have to wait before you can play your sport again.

• The doctor will also tell you if you need to stay in the hospital for observation, or if you need to have someone monitor your sleeping and wake you up if you've been asleep for too long and also help watch for any changes in your behavior or mood, or if monitoring your own symptoms is sufficient.

  
Some of the tests a doctor will conduct will test your reaction time, such as this simple test designed by a teen-age named Ian Richardson.
(Photo from the University of Michigan, sourced from NPR)


How to Treat a Concussion

• You can't exactly put a Band-Aid on your brain, so the best ways to help your brain heal all require patience.

• The best thing to do is to rest.  This might mean not playing the sport in which you were injured. It might mean giving yourself a break from doing really demanding mental tasks. It might mean getting more sleep than usual.  It might mean giving yourself a break from using the computer (!) or playing video games.

• You can take Tylenol to help with the headaches. Aspirin and ibuprofen aren't recommended because if your brain is on the cusp of bleeding, either of those could push it over the edge.

• Don't take any other pills unless the doctor prescribes them. Again, your brain is a sensitive creature.  Pumping it full of stuff when it's injured is not doing it any favors.

• The same goes for alcohol or illegal drugs.  Don't go pouring those things onto the problem.  You'll only make it worse.

All right, now that I've read and learned all this, do I think I sustained a concussion?  At first, when I saw all the symptoms, I didn't think so.  The only symptom I experienced was that headache.  I didn't have any of those other things.  But then I remembered what that headache felt like.  It felt different than a usual tension-type headache.  It felt -- this is going to sound strange -- hot, like an electric throbbing, as well as painful.  Even more tellingly, it started at the top of my head and radiated down.  That spot where it started was almost exactly opposite of where I hit my chin on the cement.

So I think I did have a concussion.  The headache was gone the next day, thankfully, and I haven't had any other symptoms since then.  If the headache had persisted another day, I would have gone to the doctor.  I maybe should have even gone the day I fell, but it didn't even occur to me that I might have had a concussion until several hours into the day.

Although a helmet would have been completely useless in this situation, I am now wearing my helmet when I ride my bike.  (Stupid and dorky-looking though that thing is.)  I like my axons intact.



This is how happy your brain will be if you wear your helmet.
(Photo from Kids Bike Helmets)


Related entries: Bruises; Aspirin

A note to my readers: While I dearly cherish any comments posted to my blog, if you ask me whether you've suffered a concussion, I cannot help you. I'm not a doctor and I can't diagnose these things.  I can only provide you some information to start with.  If you think you may have suffered a concussion, go see the person who is best equipped to help you: a doctor.


Sources
CDC, Tramatic Brain Injury, What are the Signs and Symptoms of Concussion?
WebMD, Traumatic Brain Injury, Concussion - Overview
Mayo Clinic, Concussion
brainline.org, What Happens When a Brain Bleeds? and Facts About Concussion and Brain Injury
Patrick J. Fernicola, M.D., Concussion: When the skull just isn't protection enough
Richard Smayda, D.O., "What happens to the brain during a concussion?" Scientific American, February 3, 2012
Nerve Regeneration, BI 108, Brown University