DRHOOK- Concussions: They're all in your head

Kiefer Sutherland's TV hit, 24, is truly whacked– as in whack everyone in the head. I've never seen so many people knocked out in any show. It's so medically unrealistic: they're all clearly suffering concussions, yet they function at a high level when they regain consciousness. But then again, Jack Bauer has died twice and been brought back to life each time. (My brother says I take the show too seriously.)

What is a concussion?

A concussion is a low-grade traumatic brain injury (TBI). Of the 1.4 million TBIs a year, 75-95 percent of them are mild. The injury to the brain causes functional problems, like confusion or amnesia. But don't think a concussion results only from a bonk on the head. Blows to the face, neck, and chest can injure the brain, as well as sudden acceleration and deceleration. (Have you ever been on those roller coasters that go from 0-60mph in a millisecond? I feel like my brain smashes the back of my skull!) 

Your brain is like Jell-o. It can get smooshed against the inside of the skull by intense motion, and then ricochet to the other side of the skull (called coup contrecoup). It's not only your ego that can be bruised.

However, unlike in 24, you don't need to lose consciousness to have a concussion—a fact most people don't realize. In fact, one survey showed that 80 percent of people with a past concussion didn't know they had one. Seeing stars, being confused, having headache, dizziness, imbalance, nausea, lack of awareness of one's surroundings, and not remembering the traumatic event are all symptoms of a concussion. ‘

If you hear someone say they don't remember the physically traumatic incident, that's due to Post-Traumatic Amnesia (PTA– hmmm, good thing Parent-Teacher Associations are now the PTO). 

Often I hear, "I remember driving my car, swerving off the road, and next thing I remember is lying on the ground with paramedics around me." 

The longer the PTA, the worse the prognosis for recovery from the concussion. So if that person instead said, "I remember getting into my car, but I don't remember driving. I just remember waking up on the ground with paramedics around me," a lot of brain cells were probably killed. 

Some people can lose weeks or months of memory from before and after a concussion. Global amnesia is pretty rare, though in the movies (like Mary Ann on Gilligan's Island when she thought she was Ginger) people often have no memory of their identity or anything else. 

Signs of a concussion include a vacant stare (like the Treasury Department trying to answer where all the billions of bail-out dollars have gone), delayed responses and/or slurred speech, inability to focus attention or walk or move normally, poor memory, disorientation, and out of proportion emotions (like crying over spilt milk). 

A person with a concussion needs to be observed for at least 24 hours, because brain swelling or increased pressure in the skull can be deadly. Increased headache, lethargy, confusion, and neurological deficits (like a body part becoming weak, or lost feeling somewhere) are bad signs and need immediate medical attention. 

Persistent Post-Concussive Syndrome (PPCS) can occur for weeks, months, and even years after the TBI. Depression, anxiety, and sleep disturbances are common with PPCS, as well as poor concentration, poor initiative, and personality changes (ask the significant others who live with people with PPCS!). 

Prevention is key to TBI. The number-one cause of concussion is motor vehicle accidents, followed by falls (especially for senior citizens), occupational accidents, sports, assaults, and soldiers in combat.

You don't have to be a hero like Jack Bauer on 24 to sustain a concussion. For more information on this important issue, check out internationalbrain.org 

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.

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