Imagine a hard, hairy coconut filled with something that has the consistency of Jell-O. What if you hit the coconut really hard – what would happen to the Jell-O? Chances are it would contract toward the side of impact, then bounce to the other side of the coconut, and maybe wobble like Jell-O does until it finally stops.
This is exactly what happens when someone hits their head. The human brain is not really solid at all, having a consistency more like that Jell-O in the coconut (you’ve suspected that among some people, right?). It wobbles back and forth in the skull on impact, where it may tear some of the blood vessels that feed it. This might also happen with violent shaking such as the “shaken baby syndrome.” The acceleration and deceleration affects the way the brain functions at least temporarily, and most of the time, the effect is reversible.
The recent lawsuit brought by former players in the NFL has brought concussions to the national spotlight. Any athlete (and sometimes a referee/umpire) in a contact sport is susceptible to this kind of injury, including football, basketball, baseball, soccer, rugby, and cheerleading. It can also happen in domestic violence with physical abuse, a motor vehicle accident or a fall.
Young children are more susceptible to concussions because their skulls are still forming. Senior adults are more susceptible because brains actually shrink with maturity. Going back to the coconut and Jell-O, imagine the coconut being soft so that the Jell-O might be displaced by squeezing it. This might be analogous to the young skull that is not fully hardened yet. In the adult, the Jell-O has shrunk, but the coconut is the same size it has been through adulthood. This means there is more room inside the coconut for the Jell-O to wiggle, producing more injury, so senior adults are even more susceptible to this kind of problem. This is especially alarming because falling is the number one cause of both fatal and nonfatal injuries for seniors over the age of 65.
Symptoms can last for days or weeks, and sometimes longer. Following a blow to the head, there is a temporary loss of consciousness and amnesia regarding events around the injury. People awaken confused, not knowing what hit them. There may be headache (a big one), ringing in the years, slurred speech, nausea and/or vomiting, delayed response to questions, fatigue, or a dazed appearance. Later, there may be difficulty concentrating, irritability, sensitivity to light or noise or both, restlessness and inability to sleep, and sometimes even changes in senses of smell or taste.
In children, we have to be more observant because they may not be able to tell us what is happening. Look for a dazed appearance, irritability, excessive crying, change in behavior, and change in appetite. Be alert to large bruises on the head that suggest an unobserved fall. If signs and symptoms worsen over time, get your child to your pediatrician as soon as possible.
Whether it is an adult or a child, the victim should see a physician urgently if there is progressive drowsiness, change in vision, change in the diameter of the pupils, or seizure activity.
You may expect your physician to acquire an adequate history. Because someone who has a concussion also has amnesia about the event, there should be someone else available who knows the person’s history to provide information. A physical exam should include assessment of vision, reflexes, mental status, balance, hearing, and coordination. Imaging is likely going to be required if the exam is positive or suspicious. The imaging of choice would be computerized tomography, or a CT scan of the head. In the meantime, we should not leave this person alone. They should be awakened frequently to assess their status.
Treatment will include rest. This means abstention or limitation on video games, television, and other things that may stimulate the brain. Remember, it is the brain itself that we want to rest, which is a hard sell to teenagers. Activity is gradually increased to tolerance with frequent resting periods. It is very important to avoid pain medications that include nonsteroidal anti-inflammatory drugs (NSAIDs) because they increase bleeding, which is the last thing we want to happen. Acetaminophen (Tylenol) is by no means a benign drug, but it does not increase bleeding, and will likely be used to control headache.
Resuming sports should only be considered after one is cleared by the physician. Returning to contact sports too early is a particularly bad idea because having a concussion predisposes you to having another one.
There is new evidence that women recover from concussive injury slower and less completely than male counterparts. This could contribute, of course, to the mystique of men having hard heads, but it is more complicated than that. There may be a size factor, as men have more muscle mass to stabilize the head to lessen injury, but this is not clear yet.
These injuries can be prevented in some circumstances. For example, always wear a helmet when riding a bicycle. Buckle your seat belt.
Make your home safe, particularly if you have seniors living with you. Fall prevention is of paramount importance, so use nightlights, handholds, friction tape for the bathtub, and keep clutter out of the hallway. These are common sense things that will come to you if you just walk through the house and look for potential threats that could cause a fall. Seniors should exercise regularly to maintain their balance and muscle strength to make a fall less likely. Look for table tops or other objects that children might hit as they run by.
If you hit your head hard enough to sustain that kind of injury, you can be certain that there are bony segments (skull, cervical vertebrae, etc.) that are displaced. This can contribute to lack of balance, dizziness, and headache. If this is the case, your chiropractor can help you with pain control and speed your recovery to normal activity. Massage therapy may also be an avenue to pain control if headaches persist. The post-concussion headache is itself sometimes debilitating, and you’ll want help with it.
So…watch your head!!!