Concussions

• The most common injury in athletics
• In high school football up to 20% of players sustain a concussion
• Once a concussion has occurred, a player becomes 4-6 times more likely to sustain a 2^nd concussion
• Repeated concussions can cause long term impairments in cognitive function
• Concussion is brief disturbance of neurologic function caused by trauma

Signs and Symptoms of Concussion

• Signs – vacant stare (dazed), slow to answer questions, disoriented, slurred speech, incoordination, memory problems, loss of consciousness
• Symptoms – early (minutes to hours) – headache, dizziness, nausea and vomiting, muddled thinking, unaware of surroundings

Late (days to weeks) – persistent headache, lightheadedness, poor memory, east tiredness, sleep disturbance, blurred vision

Concussion grading scale

·        Grades assigned 1,2,3

·        Depends on loss of consciousness, length and duration of symptoms

·        Grade 1

            No LOC, momentary confusion, concussion signs and symptoms resolve in15 min

            Most common type, referred to as having bell rung

·        Grade 2

No LOC, momentary confusion, concussion signs and symptoms last more than 15 minutes, memory loss for events preceding hit

·        Grade 3

LOC for any period of time

Rules for return to play

·        Grade 1

Remove from contest, may return if symptoms clear within 15 minutes

2^nd grade 1 concussion same game remove from game

·        Grade 2

Remove from game, disallow return that day, evaluate by physician

May return to practice only after 1 full week without symptoms

·        Grade 3

Transport from field to ER for examination

May return to practice only after 1 full week without symptoms

Prolonged LOC withhold from game for 2 weeks

Implications of Concussions

·        Serious risk associated with return to play before symptoms of first concussion have resolved.  2nd blow to the head can result in death from herniation of the brain.  Called Second impact syndrome.

·        Since 1992, 17 cases of death from second impact syndrome.

·        Evidence that repeated concussions result in cumulative brain damage.

·        Repeat concussions 4-6 times more likely after 1^st concussion, often requiring less severe blow.  Classic example was Troy Aikman in his last year with the Cowboys.

If you have any questions or issues you would like addressed in future articles you can email ghoffman@usapathway.com . For appointments, call Family Medicine Associates at 817-447-1151.

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