It's a concussion; take it seriously.

Two articles showed up recently, both related to concussions and kids.

Dr. Michael Stuart writes an excellent primer for parents, and Dr. Gerard Gioia is mentioned in a press release about his "SCORE Program:

The program is one of the first of its kind. Currently, most concussion management programs for youth sports lag behind collegiate and professional sports, despite the serious consequences of brain injury on a developing brain.

"Implementing an effective sports concussion management program is essential to safeguard young participants and reduce long term risks,” writes Dr. Gioia. “Management of this serious injury must consider the various effects in the home, school, social and sports environments.”

Consider these "must-read" resources for someone new to concussions.

Interesting Logic

Pardon the brief political slant, but it appears that returning Vets from Iraq did not receive evaluations to diagnose Mild TBI:

"The fear of discovering a massive war syndrome among American troops returning from Iraq was the cause of Pentagon's postponement of routine brain screening among American soldiers for mild brain injuries.

Col. Kenneth Cox, head of Pentagon's medical assessment division, explained the Department of Defense delayed the conduct of brain screenings to steer clear of another potential Gulf War syndrome discovered among American soldiers in the 1990s."

On the bright side, the DOD has granted significant funds to researchers studying Mild TBI:

The Department of Defense has awarded a consortium of Houston institutions a $33 million grant to investigate mild traumatic brain injury, or concussion, the potential severity of which has long been underappreciated.

The grant, an unusually large amount for the government, targets better understanding and treatment of the injury that afflicts about 1.5 million Americans a year and is considered one of the Iraq war's signature wounds.

Valadka said one emphasis of the research will be to determine if the mild traumatic brain injury suffered in blast explosions is similar to such civilian injuries. If so, the research will have great applicability, he said.

However, the project will not end until 2013, so it willbe a long while before these efforts translate into results.

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Research reveals brain changes from concussion

Dr. Erin Bigler, from BYU, has identified "subtle but significant" brain changes that normally go undetected using traditional imaging techniques. In this article they explain the benefits of using diffusion tensor imaging (DTI to look at what he calls "the microenvironment" of the brain, an analysis not provided by traditional MRIs:

The researchers found differences in the appearance of the corpus callosum, which separates the right and left sides of the brain, in 10 teenagers who had sustained concussions one to six days previously and who suffered symptoms such as headaches. The study compared these to the brain images of 10 uninjured teens.

The study found that the concussion patients with the worst symptoms had the most substantial changes on the DTI images. Because the DTI imaging is still "several steps removed" from looking at actual brain tissue, Bigler explains, it's hard to tell if those changes represent swelling.

This story will likely hit the AP and Reuters in the next few days, and should span a tremendous amount of new research.

What is a Concussion Worth?

On Wednesday (March 12th) Buffalo defenseman Nathan Paetsch was knocked unconscious by a "cheap shot" elbow (see the video here). The offending player, Georges Laraque, was suspended for 3 games, while Paetsch remains out "indefinitely".

Interestingly, if you watch a hit Paetsch took only two days ago in a game against the Rangers, you can see that he was clearly concussed as he lay motionless on the ice. In fact, in this ESPN article referring to his condition in the Pittsburgh game, they say:

"Paetsch was already sore, playing with a stiff neck after he was checked heavily into the boards by New York Rangers' Sean Avery during Buffalo's 3-2 shootout loss on Monday."

Not to suggest that Paetsch could have avoided the elbow, but it is possible that he not only shouldn't have been on the ice, but the fact that it appears to have been his 2nd concussion in 3 days may have contributed to the severity.

Recovery times

Conventional wisdom states that athletes tend to recover in 7-10 days, with some requiring up to 30 days, and only a select few experience lingering symptoms akin to "post concussion syndrome".

Let's see how concussed athletes in the recent limelight fared:

Some players are out for their season:

Tiffany Roulhac (NCAA-W-Basketball) - out for the season following 2nd concussion.

Mark MacDonald (NCAA-M-Basketball) - Missed 10 games so far (2 months+)

Simon Gagne (Professional Ice Hockey) - Out for the season after suffering 3rd concussion.

Some players miss extended playing time:

Taylor Procyshen (Minor League Ice Hockey) - Missed 21 games (approx. 2 months)

Tracey Kelusky (National Lacrosse League) - Missed 8 games (Approx 2 months).

Other Players miss only a few games:

Tyler Morris (NCAA-M-Basketball) - Misses 2 games (approx 1 week), now practicing.

Chris Higgins (NCAA-M-Ice Hockey) - Missed one game

And some players don't even leave the game in which they sustained the concussion:

Kate Lance (High School Girl's Basketball) - Returned to the same game after falling face-first during overtime, but returned to hit the game-winning shot, then was examined by doctors to determine if she suffered a concussion and, possibly, a broken nose.

Concussions and then some!

Looking at concussion-related news articles for months and months has revealed that concussions do not always happen in isolation, often with other secondary injuries, some of which could be expected:

Concussion and shoulder separation (Hockey):

"Smyth suffered a concussion and a minor shoulder separation after Kings defenseman Jack Johnson checked him into the padded glass partition near the Colorado bench. The Avalanche said Smyth won't return to the ice until he shows no lingering signs of the concussion.

Concussion and spinal contusion (Hockey):

"Lupul returned to the lineup Feb. 9 after missing 14 games with a concussion and spinal contusion."

Concussion and broken nose (Hockey):

"Bergeron was leveled from behind by Flyers' defenseman Randy Jones and went head first into the boards. He suffered a serious concussion and broken nose and has been absent from the Bruins lineup since late October."

Concussion and brain tumor? (Rugby):

"Wallaby fullback Julian Huxley discovered he had a brain tumor after undergoing medical scans following a concussion in a weekend Super 14 match. Huxley was cleared in preliminary scans after he was carried from the field after having convulsions following a head knock in win over Queensland on Saturday night."

It's not very often that neuroradiological studies are positive, so this would definitely be a case of a concussion being a good thing!