Diane Stoler, EdD
Diane Stoler, EdD, a neuropsychologist in private practice in Boxford, Massachusetts, and the author of Coping with Concussion and Mild Traumatic Brain Injury.
With all the recent talk about athletes suffering concussions that have caused permanent brain damage, you might think that these brain injuries occur only on sports fields.
But that’s far from the truth. Anyone can suffer a concussion. More than 40% of concussions are caused by falls…and 14.3% by car accidents.
So how can you tell when a concussion might lead to permanent damage…or will simply heal on its own? Here’s what you need to know to make that call…
Most people imagine that the brain is firmly anchored inside the skull. Actually, it floats on cushions of fluid and air, with plenty of room to move. This means that if you bang your head hard enough, or if your head is “whipped” during a car accident, the brain can slam against the skull. The violent movement stretches and shears nerve fibers.
What most people don’t realize: Even if your head feels fine, there might be areas of microscopic damage that impair normal brain functions and may cause headaches, dizziness, fatigue and other symptoms for weeks or longer.
Fortunately, a single concussion is unlikely to cause long-term problems, and symptoms usually begin to improve within hours. Most people recover completely within a month to six weeks.
The risk: Once you’ve had a concussion, you’re more likely to get another one if you suffer an additional brain injury—and the brain is more susceptible to long-term damage if you do.
For example, recent studies have linked repeated concussions to Parkinson’s-like symptoms, such as hand tremors and gait problems, and other cognitive problems, such as memory loss. People who have suffered repeated concussions may also experience concussion symptoms (sometimes years after the last brain injury) if they receive anesthesia or medication that affects the central nervous system, such as pain medications and steroids. Repeated concussions, such as those suffered by some football players and boxers, can even lead to progressive, life-threatening dementia.
You may assume that you don’t have a concussion if you didn’t “black out.” In fact, a concussion may not cause a noticeable loss of consciousness. You’re more apt to be dazed…unaware of where you are…or briefly confused.
Because injuries to the brain can feel minor even when they’re life-threatening, I would advise anyone who’s been in a car accident that caused significant head movement, taken a hard fall or been hit hard on the head to go to a hospital emergency department.
Doctors can usually diagnose a concussion in a few minutes. You’ll be given a quick, in-office neurological exam to assess the degree—and location—of brain damage.
Examples: You might be asked to recite numbers backward and forward…and/or recall what the doctor just said. You will also be given tests to check your balance, reflexes, vision and hearing.
If you have acute symptoms—for example, severe headaches and/or repeated vomiting—you may be hospitalized for further tests, such as an MRI or a CT scan, which also check for conditions that are even more serious, such as hemorrhagic (bleeding) stroke or subdural hematoma (in which blood collects on the surface of the brain).
If these tests are inconclusive and your symptoms suggest a concussion, you can ask your doctor for a specialized test called diffusion tensor imaging. It’s a type of MRI that can identify extremely small areas of nerve damage, blood clots or bleeding in the brain.
However, unless you are planning a personal injury or workers’ comp claim, you probably don’t need to prove your diagnosis with these imaging tests. If you have symptoms of a concussion, your doctor will probably advise you just to wait it out. Symptoms usually subside within six weeks.
If you suffer a concussion, getting enough rest—including mental rest—is crucial. Until you’ve recovered, use your television, computer and smartphone only when absolutely necessary and for no more than two hours a day for the first few weeks after a concussion.
Also important…
Many people who have had concussions complain that they sleep fitfully or sleep too little or too much.
To promote sleep: Go to bed and get up at the same time every day…avoid bright lights in your bedroom…and create a soothing atmosphere. Helpful: Try Bach Flower Rescue Remedy, which promotes the calm and relaxation that’s needed to heal the brain.
Because the brain is inflamed after a concussion, avoid foods that promote inflammation, such as sugar and other refined carbs. Instead, eat plenty of anti-inflammatory foods, such as omega-3-rich salmon and sardines. Also: Give up all alcohol while a concussion is healing because it can increase the severity of your symptoms.
Concussion symptoms may linger for three months or longer, especially if you’ve had multiple concussions. If you have post-concussion syndrome (PCS)—continued symptoms may include sleep problems, difficulty concentrating, memory problems, sensitivity to lights or sounds, or unexplained emotional ups and downs-see a neurologist with training in traumatic brain injury. For a referral, consult the American Academy of Neurology, Patients.AAN.com/FindaNeurologist, and click on “Traumatic Brain Injury” under “Subspecialty.”