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Concussion


OVERVIEW OF Concussion :

A concussion is a traumatic brain injury that affects your brain function. Effects are usually temporary but can include headaches and problems with concentration, memory, balance and coordination. Concussion are caused by  the blow to head.


CAUSES :

Accidental injury

Sudden blow to head

Sports injury


PATHOPHYSIOLOGY :

In acute phase the patient is still experiencing the symptoms. The phase can lasts more than a week. During this phase the concussed brain requires mental and physical rest to recover from the injury.

All brain processes that are affected by a concussion. People suffering from concussion should avoid texting, computer use, video games, television, driving, loud music and music through headphones because all of these activities make the brain work harder to process information and can exacerbate symptoms and slow the recovery process.

People with concussions should get sustained from sternous exercises.

Recovery phase:

 The patient feels physical improvement such as headaches and postconcussion neurocognitive test scores has been improved. During the period the person might slow amount of recovery .

The patient should not think in excess and should avoid getting stressed.

Concussion symptoms might differ from person to person. Few patient might recover within a week. And other few might takes atleast a month or longer to get relieve from the symptoms.

No two concussions are exactly the same, so individualized treatment is necessary. Developing brains are highly variable, so the symptoms experienced by one person may be completely different from  another. Some patients will take longer to recover from a concussion for various reasons. Therefore, each concussion is managed on an individual basis.

Concussion of the brain results in impaired neurotransmission, loss of regulation of ions, deregulation of energy use and cellular metabolism and a reduction in cerebral blood flow.

Excitatory neurotransmitters such as glutamate serves to stimulate the nerve cells which are released in excessive amounts. The cellular excitation causes neurons to fire excessively. This creates an imbalance of ions such as potassium and calcium across the cell membranes of neurons (a process like excitatory toxicity).

The cerebral blood flow is reduced. The reduction in blood flow is not as severe as in ischaemia. The cells tends to get reduced glucose which might result in the energy crisis.

The activity of the mitochondria is reduced which causes cells to rely on anaerobic metabolism to produce energy, increasing levels of the byproduct lactate.

For a period of minutes to days after concussion the brain is suspected to intracranial pressure, blood flow and anorexia. During this process a large number of neurons might get died.

Concussion damage result in diffuse damage to the tissues, it does not cause the damage to the localized area.

The pathology of a concussion seems to start with mechanical stress and stretching forces disrupting the cell membrane of nerve cells through "mechanoporation".This results in potassium outflow from within the cell into the extracellular space with the subsequent release of excitatory neurotransmitters including glutamate which leads to enhanced potassium extrusion, in turn resulting in sustained depolarization, impaired nerve activity and potential nerve damage. In an effort to restore ion balance, the sodium-potassium ion pumps increase activity, which results in excessive ATP (Adenosine Triphosphate) consumption and glucose utilization, quickly depleting glucose stores within the cells.

 


COMMON CLINICAL SIGNS AND SYMPTOMS :

Common symptoms after a concussive traumatic brain injury are headache, loss of memory (amnesia) and confusion. The amnesia usually involves forgetting the event that caused the concussion.

Physical signs and symptoms of a concussion may include:

  • Headache
  • Ringing in the ears
  • Nausea
  • Vomiting
  • Fatigue or drowsiness
  • Blurry vision

Other signs and symptoms of a concussion include:

  • Confusion or feeling as if in a fog
  • Amnesia surrounding the traumatic event
  • Dizziness or "seeing stars"

A witness may observe these signs and symptoms in the concussed person:

  • Temporary loss of consciousness (though this doesn't always occur)
  • Slurred speech
  • Delayed response to questions
  • Dazed appearance
  • Forgetfulness, such as repeatedly asking the same question

You may have some symptoms of concussions immediately, and some can occur for days after the injury, such as:

  • Concentration and memory complaints
  • Irritability and other personality changes
  • Sensitivity to light and noise
  • Sleep disturbances
  • Psychological adjustment problems and depression
  • Disorders of taste and smell


DIAGNOSTIC :

The following can be used in the diagnosis of concussion:

CT scan:

A CT scan is a type of Xray that creates detailed images of the tissues and internal organs. These images can show whether the brain is bruised, swollen or bleeding.

MRI scans:

A MRI scan aids in better viewing of the brain and determines whether there is any swelling or bleeding. MRI uses a magnetic field and radio waves to create two or three dimensional pictures that might reveals smaller areas of bleeding and bruising in the brain.

Neurophyscological testing:

This test is used to determine if difficulty with cognition and memory after a concussion. This test might also detect emotional changes. For example to test for attention span and memory the doctoe physician might ask us to repeat a series of numbers. Letters or words. To test for language and speech skills, the doctor might be asked to name the objects in pictures or as many words as you can think of that begin with a certain letter.

Neurodiagnostic Testing:

To diagnose with a brain injury and pinpoint its location in the brain. It is used to track eye movements. A person with a suspected brain injury watches a small picture move on a computer screen for a few minutes while a device tracks the person’s eye movements.

Electroencephalogram(EEG): the doctors might suggest EEG to detect any abnormalities in the brain.

Grading of Concussion:

  • Grade 1: Mild, with symptoms that last less than 15 minutes and involve no loss of consciousness
  • Grade 2: Moderate, with symptoms that last longer than 15 minutes and involve no loss of consciousness
  • Grade 3: Severe, in which the person loses consciousness, sometimes for just a few seconds

 


TREATMENT AND PROGNOSIS :

Medication:

There is no definite medicines are available for the concussion. The doctors might advice for the rest. Some times antidepressants can be used to relieve certain symptoms.

Psychotherapy:

Therapy includes improving the cognitive behaviour of the patients.

Upper cervical care:

Sometimes concussion might result in the misalignment in the upper cervical spine(neck) specifically the C1 (atlas) oe C2(axis) which surround the brain stem.an upper cervical chiropacter is as specialist who uses a x rays to identify misalignments in the upper cervical spine then gently repositions the two bones of the neck.

Education:

Since stress exacerbates the symptoms of post concussion should be educated how to cope up with the stress.

Neurotherapy:

Neurotherapy is an operant condition test where the patients are given conditional audio/visual rewards after producing particular types of brainwave activity. Recent advancement in neurotherapy such as quantitative electroencephalopathy can identify the specific brainwave patterns that need to be corrected. Hence neurotherapy plays a vital role in treating the concussion syndrome.

 


PROGNOSIS :

90% of the patient shows the good prognosis and recovery within 30 days. Sometimes it might takes months or year for the prognosis.


PREVENTION :

  • Wearing helmets while biking, skiing, and doing other sports
  • Regularly checking sports equipment for proper fit and function
  • Wearing seatbelts
  • Keeping the home safe with well-lit rooms and removing objects from floors that might cause someone to trip. 
  • Falls in the home are a leading cause of head injury.