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Dispelling myths of concussions

Local News

MURRAY, Utah (ABC4 Utah) — Whether you call it a concussion or a TBI, all forms of brain injury require a treatment plan customized for your individual needs. Research has shown that trying to apply a “one size fits all” approach to any severity of brain injury is not helpful. 

That’s why the experts at the Intermountain Medical Center Neurosciences Institute we tailor each treatment plan to each patient’s individual needs.

Amelia Wilcox, 34, of Holladay had injured her wrist in a car accident 7 months ago, but didn’t know she had also suffered a severe concussion. 
“I was really confused.”
What she did know was that her brain wasn’t working as it used to.
“It got really scary. I was having a hard time talking, forming sentences. I would forget things.”
Amelia never hit her head in the accident. All of her brain scans came back normal.
When Amelia came to see Dr. Cara Reddy at Intermountain Medical Center Neurosciences Institute, the diagnosis was clear.
Dr. Reddy, “this is a chemical change we can’t see this type of injury on images like this. A concussion is a traumatic brain injury that results when there is rotation or stretch to the cells in the brain and causes chemical imbalance. Even with a direct hit with the body for instance in football where that force is transmitted through the body, neck and brain and causes rotation moving within the skull.”

Signs and symptoms may not be noticeable right away, but if the headaches, dizziness, confusion and nausea persists, you should see a doctor.
“a concussion does not require someone to hit their head or lose consciousness and those are two things that confuse people sometimes.”
Amelia still runs her multi-million dollar business but she’s had to scale back. It also means the chores pileup.
With continued individualized care at Intermountain Medical Center, Amelia is slowly getting back on track..
“I just started cooking and I love to cook.”
Dr. Reddy, “I think in the long term, Amelia is going to do really well. She’s showing signs of progress and she can put this behind her.”

A concussion is a serious injury to the brain resulting from the rapid acceleration or deceleration of brain tissue within the skull. Rapid movement causes brain tissue to change shape, which can stretch and damage brain cells. This damage also causes chemical and metabolic changes within the brain cells, making it more difficult for cells to function and communicate.
More common than we realize

The CDC estimates as many as 3.8 million concussions occur in the U.S. annually through sports and recreational activities, but only 5-10% are recognized and eventually diagnosed by coaches, parents, and athletic trainers. Surveys of high school athletes after the season find that 20% had concussion symptoms after a head impact at least once over the course of the last season, and over 50% of the contact sport athletes report at least one event in their career.
Complex recovery: Post Concussion Syndrome

Recovering from concussion means re-balancing a delicate combination of chemicals within brain cells. This process takes a lot of energy, so it is important to conserve energy during recovery. When properly managed, the majority of concussion symptoms will resolve within a couple of weeks, however over-exertion of brain cells during recovery can cause symptoms to persist for months or even years. A significant percentage (estimates vary between 10% and 30%) of concussion patients suffer from extended recovery, known as post concussion syndrome.
Catastrophic re-injury: Second Impact Syndrome

During recovery, the brain is more vulnerable to re-injury. In rare cases, a second concussion sustained during recovery can cause the brain to undergo massive swelling. This extremely rare condition is known as Second Impact Syndrome (SIS). Approximately half of SIS patients die from their injuries, and the survivors often suffer from life-long catastrophic disability.
A preventable epidemic

The good news is we can stop concussions before they happen. There are many opportunities to reduce concussions through smart policy decisions. Research has shown over half of all head impacts and concussions in football occur during practice; in middle school soccer players there are 100,000 concussions caused by heading every three years. In 2012, the Concussion Legacy Foundation led a movement to reduce hitting in football practices at the youth through professional levels. Through our Safer Soccer campaign, we are now focused on delaying heading in soccer until high school. There is still a lot to do to make sports safer for all athletes and the Concussion Legacy Foundation will continue to be on the forefront of research and education.
What are the causes of concussion?
Sports injuries are a common cause of concussion. Helmets and protective equipment can reduce risk.
The brain floats in cerebral fluid, which protects it from jolts and bumps. A violent jolt or a severe blow to the head can cause the brain to bump hard against the skull. This can result in the tearing of nerve fibers and the rupturing of blood vessels under the skull, leading to a build-up of blood.
Concussions are most commonly caused by:
automobile accidents
sports injuries
horseback riding accident
playground accidents
cycling accidents
Symptoms of concussion

Signs and symptoms of concussion may not be noticeable straight away.
Immediate signs and symptoms

loss of consciousness
slurred speech
ringing in the ears
tiredness (fatigue)
Non-immediate symptoms

The following symptoms may not be noticeable for several hours, or even days:
disturbed sleep
hyperacusis – sensitivity to sounds
lack of concentration, focus
photophobia – sensitivity to light
Serious symptoms that need immediate attention

The following signs and symptoms of concussion may be linked to a more serious injury, and immediate medical help should be sought:
prolonged headache
prolonged dizziness
dilated pupils
the two pupils are not the same size
prolonged nausea and vomiting
memory loss does not improve
ringing in the ears
loss of sense of smell or taste
Signs and symptoms of concussion in children

Concussion signs and symptoms are most difficult to detect in very young children because they do not have the ability to explain how they feel. Signs may include:
lethargy, listlessness
irritability – the child gets mad easily
changing sleeping patterns
altered appetite
walking or standing unsteadily (any signs of balance, dizziness problems)
Serious symptoms that need immediate attention

The following signs usually mean the child needs immediate medical attention:
loss of consciousness
after attempting to stem the bleeding, a cut continues to bleed
any change in the way the child walks
bleeding from the ears or nose
blurred vision
confusion – the child does not know where they are, may not recognize familiar people
continuous crying
convulsion (seizure)
discharge from the ears or nose
loss of appetite
prolonged headache
prolonged irritability
prolonged listlessness, fatigue, lethargy
repeated or forceful vomiting
slurred speech
worsening headache
Diagnosis of concussion

If an individual has experienced a severe jolt or blow to the head, which has left them dazed, confused, or wobbly – they have concussion.
Determining the severity of the concussion is more difficult because the signs may not be evident. A report published in The American Journal of Sports Medicine explains that athletes may have severe concussion without becoming unconscious. According to the authors, amnesia and confusion on the field after injury may be as important, if not more important, in making a return-to-play decision.
A doctor will ask the patient details about the trauma. It may be necessary to question the people who accompanied the patient. A neurological examination will also be done, which will include evaluating the patient’s:
A CT scan may also be ordered if internal bleeding or swelling of the brain is a concern.
Treatment for concussion

Most concussion or mild traumatic brain injury (MTBI) symptoms will go away without treatment. Guidelines for managing a concussion include:
Rest – rest is vital. It takes time for the brain to recover, and recovery is quicker if the body is resting and getting good sleep each night.
Headaches – acetaminophen (paracetamol, Tylenol) is the best painkiller for headache due to a head injury. Drugs such as aspirin, ibuprofen, and other NSAIDs should be avoided because they thin the blood and increase the risk of internal bleeding (hemorrhage).
Sports – it is important not to return to any sporting activity too soon. Ask a doctor.
Alcohol – patients should avoid consuming alcohol until all symptoms have completely disappeared because it slows healing.
Migraine – migraine after concussion may indicate an increased risk of neurocognitive impairment.
Worsening symptoms – if symptoms worsen, patients should see their doctor.
Only a small percentage of patients with MTBI require surgery.

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