“Concussion” the movie has brought even more attention to a topic that is constantly in the minds of parents around the nation. The topic is a question, should I allow my children to play contact sports that are known to result in concussions? This is a very valid concern, but the best way to approach any concern is to have the proper understanding and a plan. It is important to understand what happens in the brain following a concussion, symptoms they may have, and what to do next.
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Why Do I have the Symptoms I have?
In order to understand why you have the symptoms you have, you must first understand some of the neurochemical and physiological changes that occur in the brain immediately following a concussion. The normal function of the neurons and immune cells within the brain change. These changes normally last up to two weeks. The immune cells become inflammatory and release many harmful chemicals. The neuron structure and function is altered. The membrane has receptors which controls the amount of calcium coming into the cell. Following a concussion the amount of calcium entering increases dramatically and this results in damage to the cell. This further increases the inflammatory responses leading to prolonged neuronal dysfunction. There should be a balance of potassium and sodium inside and outside of the cell. After a concussion the neurons go into an energy crisis where they do not utilize and create energy appropriately. This leads to an imbalance of potassium and sodium as ATP is used to transfer these electrolytes. The neurons resting potential increases and it results in less stimulation needed for it to fire. This results in it firing at a higher rate. This uses more energy and is responsible for many symptoms that people have.
The amount of blood flow to the brain decreases following a concussion. This decreases the amount of blood and oxygen getting to many areas of the brain causing even further neuronal injury. There is blood sugar dysregulation that creates a lot of stress in the brain which leads to impaired ability to recover. All of these things lead to an altered blood brain barrier. When this is breached, it allows for substances that should not normally get to the brain to enter and cause inflammation.
What are Common Symptoms and How Does it Impact me
Symptoms are the results of changes that occur in the brain following a concussion and pre-existing dysfunction. As stated above there are many things that occur in the brain following a concussion, but alterations in blood sugar, hormones, infections, gut and thyroid to name a few play a major role in the symptoms you experience and your ability to recover. Symptoms can either be localized to an area of the brain or be the result of global physiological and chemical changes. The most common symptoms that people experience are changes in mood, personality, emotions, memory, focus, attention, academic performance, balance, executive function, and social interactions. Headaches, sleep difficulties, brain fog, slowed processing, slowed reaction time, head pain, migraines, light, and sound sensitivity. One of the most important symptoms are headaches, especially migraines. These have shown to be predictors of the ability to recover from a concussion or whiplash especially if these were pre-exiting. A study looked at cognitive function of those post concussive that had no headache, general headache, or migraine. Those with headache and migraine performed worse than the individuals who had none. The individuals who performed the lowest and did not return to baseline were those with post concussive migraines.
Concussion, now what do I do?
1. Limit activity
2. Pay attention to your symptoms and how they change
3. Comprehensive examination that identifies factors that impact recovery
4. Musculoskeletal examination of the neck as many times soft tissue and joint injury occur.
5. As you return to normal function monitor your symptoms and don’t push through them
Blaylock, RussellL, and Joseph Maroon. ‘Immunoexcitotoxicity As A Central Mechanism In Chronic Traumatic Encephalopathy-A Unifying Hypothesis’. Surgical Neurology International 2.1 (2011): 107. Web.
Giza, Christopher C., and David A. Hovda. “The Neurometabolic Cascade of Concussion.” Journal of Athletic Training 36.3 (2001): 228–235. Print.
Giza, Christopher C., and David A. Hovda. ‘The New Neurometabolic Cascade Of Concussion’. Neurosurgery 75 (2014): S24-S33. Web.
Kontos, A. P., & Henry, L. (2013). Predicting recovery from concussion: The role of post-traumatic migraine symptoms.Pediatrics for Parents, 29(7/8), 22.