Up Side the Head
By all accounts, Jim McMahon was a talented and tough quarterback, known as much for his punk “do” as his capacity to take vicious hits from 300- pound defenders. He played at the very top level of NFL quarterbacks, leading the Chicago Bears to a Super Bowl title in 1986. Like many athletes, he often played with injuries including concussions.
Today, his memory, by his own description, is pretty much gone. “There are a lot of times when I walk into a room and forget why I walked in there,” he recently told the Chicago Tribune. “I’m going through some studies right now and I am going to do a brain scan. It’s unfortunate what the game does to you.”
According to the Centers for Disease Control and Prevention (CDC), there will be more than a million cases of concussion in the U.S. this year. Concussion is caused by a head trauma that moves the brain violently inside the skull and causes a period of unconsciousness or a diminished level of consciousness. It can be the result of any trauma to the head, including car accidents, falls and sports activities.
Also known as mild traumatic brain injury or MTBI, concussion causes an alteration of brain function. The brain regulates many functions – from sensory (smell, sight, sound, etc.), to motor (walking, talking, balance, etc.), to cognitive (memory, attention, etc.), to higher order (ability to answer a posed question, consciousness, awareness of surroundings, etc.). Altered brain function can result in either overt or subtle changes of one or more of these functions.
Subtle changes in brain function can be as simple as being confused. Most contact sports-related concussions are associated with loss of memory (referred to as post-traumatic amnesia or PTA) or periods of confusion and disorientation. If any of these signs are observed, a careful clinical examination by a medically trained professional is recommended.
A concussed brain needs time to recover. For most concussion victims, typical symptoms (see below) go away in a matter of three to four weeks.
Because athletes may not report symptoms, or symptoms may go away in a few minutes, players often return to the game before their brain has had enough time to heal. “Back then, it was just tape an aspirin to your helmet and you go back in,” McMahon said.
“Jim McMahon most likely suffered a number of concussions during his career,” notes neuroscientist Pramod Dash, PhD, of The University of Texas Health Science Center at Houston (UTHealth). He no doubt played while he had a concussion, and might have received multiple concussions at the same time. “Suffering a second concussion while still recovering from an earlier one can lead to long-lasting neurological problems, including loss of memory,” says Dash, professor in the Department of Neurobiology and Anatomy at UTHealth Medical School.
Symptoms of a concussion can range from mild to severe. They can include:
- Any period of loss or decreased consciousness
- Memory loss for events prior to or after injury
- Headache, confusion, disorientation or slow to respond to questions
- Weakness, loss of balance, problems with vision
Emergency signs include:
- Altered level of consciousness (drowsy, hard to arouse, or similar changes)
- Muscle weakness on one or both sides
- Persistent confusion
- Persistent unconsciousness (coma)
- Repeated vomiting
- Unequal pupils
- Unusual eye movements
- Walking problems
Sitting it out on the playing field and the battlefield
How long should adults wait to resume physical activities after they have suffered a concussion? “When symptoms go away, usually in three to four weeks,” answers Dash. But, he continues, this creates big problems in school sports because some young athletes may lie about their symptoms in order to play.
Having to rely on the victim’s own assessment is also a big problem on the battlefield. “With no simple way to screen for concussion, we end up with concussed soldiers with diminished decision-making ability putting themselves and those they are leading at great risk,” Dash explains.
Computed tomography (CT) head scans are commonly used to determine the severity of brain trauma. However, a negative CT scan cannot rule out concussion. A “baseline” neurological exam by a health care professional can determine the level of treatment for an uncomplicated concussion. Most signs and symptoms will manifest immediately after a concussion. Some may occur alone or in varying combination. However, other signs and symptoms may be delayed. If the injury leads to a strong headache, some confusion, or loss of consciousness, a trained person must decide when the athlete can return to playing sports.
If a child or young adult lost consciousness, that athlete should not play sports for three months. Studies have shown an increased rate of brain damage and occasionally death in people who have had earlier concussion accompanied by unconsciousness.
Call your doctor if anyone suffers a head injury and loses consciousness, or received a head injury without loss of consciousness that produces symptoms that cause concern. If emergency symptoms develop, call 911 or go to the ER.
Complete recovery may be expected from an uncomplicated concussion. However, CDC research indicates that up to 15 percent of MTBI patients may experience persistent disabling problems with memory, attention, headaches, sleep disturbances, irritability, depression, anxiety, agitation and/or aggressive behavior. Some of these effects, known as post concussion syndrome (PCS), can be managed by prescription medications.
To lessen the risk of concussion, always use safety gear such as helmets and seatbelts when recommended.