Researchers have hypothesized what happens inside the human brain during a concussion through tests on mice, but there is not yet a truly accurate way to physically see what is going on in the brain when it receives a concussion.
The cells in the brain receive sudden overloads of energy, and some of the brain’s transceivers may be damaged, but the deeper effects on the cellular level still elude researchers, said Richard Ellenbogen, chief of the division of neurosurgery at Seattle Children’s Hospital.
The Centers for Disease Control and Prevention defines a concussion as a traumatic brain injury caused by a twist of the neck. That twist causes the brain to bounce or twist around inside the skull, usually as a result of a bump or serious blow to the head or body.
Ninety percent of concussions fade away within seven to 10 days, but the 10 percent that do not are the more dangerous cases, Ellenbogen said.
The concussive process
A concussion can result from a strong blow to the head, multiple blows that stack up or a hit to the body that is strong enough to cause the brain to rattle around from a twisting of the neck, said Wayne Sebastianeli, M.D. in orthopedics at the Penn State Center for Concussion Research and Service.
After somebody receives a concussion, there are a variety of possible symptoms split into the categories of clinical, sleep-related and behavioral, Ellenbogen said.
Clinical symptoms may involve headaches, the most prominent example of all, he said, but go on to be part of a longer list including dizziness, blurred vision, confusion, nausea and other similar items. Sleep-related symptoms include restlessness or sudden jolts of consciousness during the night, which can further disrupt a victim’s recovery, Ellenbogen said.
Both of these categories can lead to behavioral symptoms, which include some of the most dangerous ones, such as depression, sadness and irritability.
“We think of concussions as a spectrum of things,” Ellenbogen said. “But, it is always about rapid onset associated with some sort of neurological impairment, and it resolves spontaneously.”
Symptoms may appear and vanish without notice, but sudden, brief periods of un-wellness can be indicators of a deeper injury on their own, he said.
Depression is a well-known problem that can occur after suffering a concussion. It is often severe, and is common in 50 percent of all severe brain trauma victims, Ellenbogen said. If this isn’t recognized right away, it can be problematic to treat.
“You have to be proactive and encourage kids to be honest with you,” Ellenbogen said. “Know the symptoms. Is the player confused, disoriented? You never ask the player how they’re doing, because most players want to get back in the game. You ask them questions that take some executive functioning, and if they can’t answer those questions, it’s likely that they can’t go in to play.”
Dealing with dangers
Concussions do not directly cause death, but they can lead to more rare and dangerous impairments, such as Second Impact Syndrome, Yakima neuropsychologist and concussion specialist Jane Thompson said.
“In a teenager, if you have one concussion and then a few days or a couple weeks later you have another, you can have a catastrophic cascade of events in the brain that causes brain swelling,” Thompson said. “It can actually be fatal if it’s not treated fast enough, or it can leave a person with very severe cognitive deficits.”
There is research being done that shows that in players under the age of 18, concussions of any severity permanently lower an individual’s threshold for head, neck and brain related injury, Sebastianeli said.
A single concussion causes irreversible damage, and with every succeeding one, a person’s ability to function mentally or even physically seriously falters, Bellingham physical therapist Brian Weeda said.
“Let’s say someone suffers a concussion in a game. What’s really important is that they don’t suffer another hit in that same time frame,” Weeda said, referring to the typical recovery period for minor concussions of seven to 10 days. “If they’re hit a second time, that can really create issues for a long period of time.”
Young athletes are put at a more significant risk when playing sports than older players, due to a higher susceptibility to concussions and other head injuries as a result of weaker bone structure and overall bodies.
The Southwest Athletics Trainers’ Association reports that high school football players get around three times as many serious injuries as college athletes.
Research continues to grow
The obscurity of medical evidence in the study of concussions is an obstacle when it comes to advancing the field, Arizona neurologist at the Mayo Clinic Amaal Starling said.
The process for concussion recovery is ongoing, and the effects and dangers are newly being studied as a field.
The first recorded studies on concussions range back to the 1800’s, but the examination of sports-related concussions became most prominent in the 1990s and started as the study of people who had already suffered a brain injury, Thompson said. It is only recently that studies have begun moving into researching prevention.
The lack of accurate data on concussions comes from the difficulty of looking at a fresh injury, since most medical scans only give a possible representation of what is going on in the brain, Thompson said.
Due to an initial concussion being a non-fatal injury, there are no autopsies of concussion victims, thus no way to look at the brain freshly enough to fully understand the damage, Ellenbogen said.
Concussion research partially has its roots in early boxing, with the idea of getting “punch drunk,” which is how the dizzy state after a particularly strong hit was referred to, Thompson said. When boxing began to recognize head injuries as an issue, it swelled into interest in other sports and has continued to grown the past couple of years.