By Dr. Jeff Daniels EBS Medical Columnist
One of the more common injuries that we’re seeing in the medical clinic this winter is head trauma, with signs and symptoms of a concussion. Most of the time the symptoms have been mild, which may be due to the fact that nearly all of these patients were wearing a helmet at the time of their injury.
Most of the injuries involved skiing or snowboarding, but we did see one person who wasn’t wearing a helmet because she was on a dog sled adventure, and when the sled tipped over her head hit the trunk of a tree. She wasn’t very dazed or confused, but had a swelling the size of a tennis ball, which prompted us to get a CT scan.
A concussion occurs when the substance of the brain is traumatized, either by a direct blow to the head, or by a violent shaking (think whiplash injury). There does not have to be loss of consciousness, and symptoms begin immediately.
Most will experience confusion and memory loss, which becomes readily apparent to anybody around. A common scenario is when the person after suffering head trauma continues skiing, and then on the chairlift repetitive questions and confusion of immediate events become apparent to friends and family.
Loss of memory of the event is a given. Memory loss for anything that happened earlier that day—I usually ask what was for breakfast—and failure to remember anything done or asked after the event are ways for judging the severity of the concussion, the rapidity of improvement, and the need for further studies (e.g., a CT scan).
Signs of a concussion, in addition to bruises, cuts or goose eggs on the head, include vomiting, visual abnormalities—blurry vision or double vision—and balance issues. Simply standing still with your eyes closed is sometimes impossible. Balancing with one foot in front of the other, or with all weight on one foot, is a test being used on football fields and in other sports venues to determine if there’s been a concussion, in order to establish the ability of returning a player to sports.
The symptoms of a concussion can linger for days or weeks. One mitigating factor will be if there have been previous concussions, especially in the recent past. A post-concussive syndrome of headache, sleep disturbance, and inability to concentrate is common, and it’s recommended not only to avoid any situation that might lead to another concussion, but also to put the brain into complete rest—no school, no reading, no video games—until symptoms have cleared.
When we discharge a patient from the clinic after an observation period, we’ve convinced ourselves, the patient, and family and friends that the concussion was mild and the risk of complications are minimal. For those where symptoms don’t improve, or worsen, a CT scan is considered to prove that there has not been any internal bleeding inside the skull or into the substance of the brain.
Concussions are a problem for young and old, and the risk is inherent in many of the activities in which we participate. Wearing head protection is important, but also limiting the risk of head trauma, especially if there has been a previous concussion, has to be considered.
Have a safe ski season, enjoy this great snow year, and remember that the Medical Clinic of Big Sky, on the mountain seven days a week, is there to help.
Dr. Jeff Daniels was the recipient of the 2016 Big Sky Chamber of Commerce Chet Huntley Lifetime Achievement Award and has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.
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