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Ask Dr. Dunn: Head injuries



From concussions to traumatic brain injuries
By Dr. Maren Dunn Health Contributor
There has been a buzz recently about head injuries, especially among athletes—think Muhammad Ali and Junior Seau—and veterans returning from Iraq and Afghanistan. But anyone can suffer a traumatic brain injury.
Almost 2 million Americans report TBI’s in each year. Of these, 45 percent were caused by motor vehicle accidents, 30 percent by a fall, 10 percent from a work accident, another 10 percent from recreational accidents, and 5 percent were caused by assaults. Luckily, the majority of these are concussions, or mild traumatic brain injuries.
What happens to cause the injury?
Imagine you had a hollow rock into which you placed a ripe peach then bounced that rock on the ground. The brain after a TBI looks just like that peach: bruised and damaged. The brain tissue swells, and the axons (long tentacles of nerves) are stretched, torn and bumped when bounced against the inside of the skull.
This damage can happen with a blow to the head, or with rapid acceleration forces without actual impact, like whiplash. In severe cases, blood vessels rupture inside the skull, causing a life-threatening situation.
With concussions, which are really mild TBI’s, symptoms of headache, dizziness, nausea, vomiting, loss of balance, and even amnesia are common. As hours to days pass, mood changes, sensitivity to light or sound, sleep problems and difficulty concentrating can also be expected.
In severe cases with damage to the blood vessels, concussion symptoms escalate dramatically and can include lethargy, stroke-like neurologic problems, intense headaches and loss of consciousness. These symptoms can intensify at such a rate as to cause death rapidly. That’s why doctors recommend closely monitoring head injury patients for changes in mental status or other symptoms for at least 24 hours after the incident.
When is it appropriate to seek medical attention?
Children under age 2 are at high risk of skull fracture or severe brain injury with only minor trauma. This age group should be seen by a doctor ASAP.
Everyone else should see a doctor when any of the following are present: loss of consciousness, significant headache, confusion, seizure, vomiting, or when the mechanism of injury is unknown or high-risk such as motor vehicle accident or a fall from a considerable height.
It’s the physician’s job to determine whether the injured person requires further testing, admission to the hospital or just close monitoring.
Treatment for mild head injuries involves time and rest.
Current guidelines support keeping anyone who sustained a loss of consciousness or has symptoms of head injury for longer than 15 minutes from participating in sports for at least 1 week. The person can only resume play when the symptoms are completely gone.
Ultimately, medical evidence points toward preventing repeated head injuries, or “second impact syndrome,” no matter what age you are. Sustaining another head injury before healing the first can cause symptoms that may become permanent, as evidenced by professional football players and Muhammad Ali.
Symptoms of most properly treated concussions will likely fade over a few weeks to months with no residual effects.

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