Effects Of Concussion On The Human Body

Effects of a Concussion on the Human Body

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9th February 2010

The effects of a concussion on the human body

Key words;

concussion, commotion cerebri and mild traumatic brain injury.

Abstract

Over the years, controversies have existed in explaining the meaning and application of concussions. This paper begins with a brief historical development in the definition of concussive head injuries. It will further present the effects it has on the human body through evidence supported by various authors as presented on the annotated bibliography. This paper then ends with a persuasive analysis of data found from the secondary sources that state that injuries of the head be described on the basis of available evidence, on the duration of altered

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consciousness and its severity, and the variability associated with physiological, imagining and neurological signs. The aim of this paper is to identify controversial issues on the concussion that have arisen due to different explanations of the consequences of the injury.

Introduction

Concussion has several meanings in relation to the effects it has on human body. It reflects the trend of a medical term. It has been defined differently by various researchers. This leads to a possibility of not fully understanding this kind of head injury and effects it has on the human body. With this misunderstanding, it is also possible that concussion has been underreported and people who have suffered from it is known or lowly rated. The term concussion originated from the Latin words concutera ‘to shake violently’ and concussus ‘action of striking together.’ In the United States, estimates of one hundred and twenty eight people per one hundred thousand populations are affected by this brain disorder yearly. Children of the ages five to fourteen are at the highest risk for concussions, mostly from bicycle and sports accidents. For adults, common causes of concussion come from falls and vehicle accidents.

The term has been applied in defining minor injuries with no pathological or clinical effects. However today, a lot of definitions have been developed that focus on the impact of a blow. Other definitions explain the term in relation to the resultant effects from the brain injury such as memory loss and consciousness. This therefore makes the term equivalent to commotio cerebri. Commotio cerebri is a form of head injury that affects the brain but there no noticeable skull fracture. It is therefore a mild form of brain injury.

The brain disorder was first recognized in Edwin Smith Papyrus manuscript of 17000 BC. It defined the stupor and confusion caused by altered consciousness and comma due to injury of the head. It further explained those injuries that damaged the skull and scalp but were not brain injuries. This was written in a short Hippocratic text. The first clarification of concussion was made by a Persian physician Rhazes at Baghdad Hospital in c. 860-932 in which concussion was termed as a mild traumatic brain injury MTBI. It occurs when there is a sudden brain shift or shakes and ends up knocking against the hard bony surface of the skull.

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Trephination which is the removal of a circular piece of bone, especially of the skull, trephine (a medical tool) began to be conducted in the sixteenth century. By the nineteenth century, earlier works by Flamm on the dilapidated pupil and head trauma began to be appreciated.

The following annotated bibliography is a collection of various authors dealing with the subject of concussion and the effects it has on human body. The effects of concussion differ from one other to another as exemplified in the annotated bibliography below.

Overview

1. Document title: heads up on sport concussion

Reference: Gary, S., Johnston, K and Lovell, R (2006) the heads-up on sport concussion.

Human Kinetics publishers, pp 1-25 & 67-92.

Summary:

The introductory part of this book fully expands information on guidelines for professional, athletes as well as their families and patients of head injury. This book is has complete compiled information on concussion in sports. In Chapter two, it discusses the chemical and physical

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changes of the brain during the brain injury. It further explains its typical symptoms like the loss of consciousness. It states that the biochemical force affects the brain both indirect and directly. Two major types of force are given in this book. First is the rotational and secondly a linear or acceleration- deceleration force. Whichever the type of force, the brain is affected especially the neurons cells in it. Rotational force that causes concussion is the mostly common among sports people especially among boxers such as knockout punches. After the injury the brain enters into a resting position known as hypo-metabolism. The brain will be at this state for a period between five to ten days but may exceed

The book further gives a difference between the traditional and modern understanding of concussions. Modern studies have revealed methods of measuring brain activity during concussion by use of specialized imagining. The traditional means of MRI structure only reveal the shape of the brain but do not tell us of its function. Other symptoms of concussion proposed by the book include dizziness, fatigue, drowsiness, vomiting, loss of balance, irritability among others.

This is an ideal book for physicians, neurologists, sports psychologists and trainers, students, coaches and athletes. It has general issues on concussion and is an important source of this research for it covers different fields’ views concerning a concussion which is, neuropsychological, epidemiology, biochemistry and neuroimaging. From these topics we find the different effects the injury has on the human body.

2. Document title; Adams and Victor’s manual of neurology. The illustrated document from McGraw- Hill Professionals.

Reference;

Ropper, A. & Maurice V. (2001) Adams and Victor’s manual of neurology. McGraw-Hill Professional. Seventh edition pp323 -348

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Summary

This is a companion handbook that provides a summary of neurology at a glance. On the topic titled “craniocerebral trauma”, the authors say that head injuries are common to a lot of people in the population who add up to one percent. They suffer from all forms of concussive effects which often require neurosurgeon care. However, nothing much has been done in taking care of concussion cases for what is really done is simply cleaning the wounds in the scalp or the extraction of intracranial hemorrhage. Concussion refers to a violent reaction of the brain as a result of a blow on the head. This results into paralysis of neurons to function effectively. Immediately the force takes place, the cerebral hemisphere experiences a rotational movement which leads to loss of consciousness.

Internally, a concussion leads to hemorrhage, bruises and coup due to folding of the inner skull surface and tearing and the adjustments of the nerve fibers. These rotational forces may also lead to damage of nerve fibers in the white matter characterized by rapture and shear of the axons. A serious effect of concussion is characterized by skull fractures.

The primary objective of this book is to provide brief presentation of cardinal and phenomenal manifestations of neurological dysfunction. It is intended to be a companion book on basic neurological principles to satisfy the needs of students during their practical for it offers a pedagogic perspective that is most usually interfered with by most clinicians.

3. Document title: Text book of traumatic brain injury an illustration by the American psychiatric publishers.

Reference: Silver, J, McAllister, T & Yudofsky, S (2005) textbook of traumatic brain injury.

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American psychiatric publishers’ pp 279-281

Summary:

The book provides and extensively expanded and updated work by experts. It has forty chapters and more than one hundred informative illustrations and figures. These chapters are on function imagining, neuropsychological assessment, care systems alternative treatment as well as the real treatment models. In this research I will focus on sports injuries in which concussion has been featured. The authors have grouped concussion into grade one, two and three. Grade three concussions is very brief or prolog ed minutes while that of grade two causes transient confusion like those of mental status abnormalities which last for more than fifteen minutes. Grade one also causes that e same effects as those of grade two but the effects subside in less than fifteen minutes. This book is for the benefit of sport people, coaches and people in clinical field.

4. Document title: Certain minor injuries of the brain. Lancet publishers

Reference; Trotter, W (1924). Certain minor injuries… Lancet Publishes, pp 935

Summary; the objective of this book is to give the primary consequence after a head blow and the squeal consequences that might be mild. The significance of the book is to assist clinical and medical practitioners in outlining the early symptoms associated with concussion. Trotter defines the head injury as one which manifests paralytic symptoms immediately after the blow. According to him it is instantaneous and leads to a transient state. It however does not display any form of structural damage on the cerebral which is immediately followed by amnesia. These effects are handy for this research.

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5. Document title: Brain injury .com on little known symptoms

Reference: brain injury.com, (2009) little known symptoms. Retrieved from

http://braininjury.com/littleknownsymptoms .

On 6th February 2010.

Summary; the website was created by Attorney Steven Igou so as to assist patients suffering from traumatic brain injury. He dedicated this website to his sister who had died eight years earlier. The website is useful for leaning more about concussions. It indicates that a concussion usually results in transient loss of memory or consciousness then an alteration of conscious awareness after the head trauma.

6. Document title: Head injury Nomenclature. By the committee from Neurological Surgeons. A copy of Br J Sports medicine.

Reference: The committee of head injury (1966). Head injury, Vol 12, pp 386-394. Summary: the journal aims at clarifying earlier definitions by Denny-Brown et.al and sports medicine journal which indicated concussion to be a term that can be applied to mean all forms of traumatic injury and also as a mild brain injury. The paper aims to come up with a uniformly agreed meaning of concussion. It postulates that a concussion happens because of a mechanical force that will immediately lead to neural function impairment. The post traumatic experience is characterized by alteration of consciousness, lack of proper vision and loss of

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balance.

7. Document title: Cerebral concussion. Physiol review. Neurological unit, Boston Hospital, department of Neurology, Harvard Medical School.

Reference: Denny- Brown, D, et .al (1945). Cerebral concussion. Physiological review, Vol 25, pp296-325

Summary: Denny Brown says a concussion is the disturbance of consciousness both consecutive and immediate. It also appears as an intimate link between concussion and amnesia leading to memory loss. He therefore applies the term to mean all forms of traumatic brain injury

8. Document title: The 2001 Vienna summary of concussion in sports.

REFERENCE:

Reference: Aubry M., Cantu, R., Dvorak J., T. et.al (2002). Concussion in sports, Br J Sports Med Publishers .Vol 36, pp 6-7.

Summary: this is a revision and updated part from an earlier Vienna held symposium on sports on the agreement on concussion. It was developed to be used by coaches, health professionals, doctors and therapists at either elite, professional or recreational levels. They defined it as a process that is complex and pathophysiolagical in nature. This activity affects the

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brain because of the biochemical force that is traumatic to the brain. What follow the injury are loss of consciousness and other sets of clinical symptoms which are useful for this paper.

9. Document title: Concussion and its sequelae. Lancet publishers

Reference; Symonds C. (1962). Concussion and its sequelae. Lancet publishers, I, pp 1-5

Summary; the book provides a hypothetical satisfaction as a means of distinction between the effect of uncomplicated concussion on hand and what are supposed to be the results of contusion on the other. A concussion according to the author’s theory was a completely reversible and transient affair. He says that a concussion can happen to cases even without loss of consciousness. It is also characterized by loss of consciousness and later the patient recovers. According to him, the definition should not only emphasis symptoms of short term effect but should include long term symptoms of concussion. That is the mind stability which is often followed by residual signs.

10. Document title: the Department of Physiology on the neurobiology of concussion. Auckland University New Zealand.

Reference: Shaw, N (2002). The neurobiology of concussion, Progr Neurobilol/ Vol 67 pp 281-344

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Summary: the author acknowledges the fact that a concussion is a puzzling and common kind of brain injury. He postulates a clinical definition of concussion as used today. He says that a concussion be seen as a sequel of injury of the brain as it loses memory with a having a paralyzing reflex activity. It is sudden short term impairment of consciousness. He uses a convulsive theory to explain autonomic disturbance, traumatic amnesia. The author talks about the syndromes associated with concussion much more than the previous authors which I will include on this paper.

11. Document title: head injury

REFERENCE:

National Institute for health and clinical excellence (2007) head injury. Triangle, assessment, investigation and early management of head injury in infants, children, and adults.

Retrieved from http://www.nice.org.uk/nicemedia/

On 6th February 2010

Summary; this website aims at improving public health through advanced technology. The guidelines are provided by NHS and the academic world, healthcare professionals, patients and careers, industry. According to the web, concussion involves physical and psychological damage of the brain. Since this other sources of data indicate that no physical damage is noted with concussion, this book becomes handy in highlighting controversial issues of the topic.

12: Document title mild head injury. A Copy of Oxford University press.

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REFERENCE:

Levin, H, Howard E, Arthur B, 2(1989). Mild head injury, Oxford University press, issue no 19505301, pp 105

Summary: the book despite an extensive analysis of the sequences of concussion, also talks on injury management, treatment and understanding of the injury which I will include in the paper. The sources discuss neurobehavioral outcomes and neurosurgical strategies in both adults and children by use of neurophysiological and neuroimaging. It is an essential book for clinicians and medical practitioners.

Controversial issues from the data

From the definitions of a concussion, the most significant effects to the human body are traumatic amnesia and loss of awareness. These symptoms can occur without any gross cerebral damage (Trotter 1924, pp 935). However, the definitions have never been uniform since other definitions indicate that concussion leads to physical injury of the brain (National Institute for health and clinical excellence 2007). A study conducted in Austria of neurological and neurosurgery departments indicated the amnesia was considered the highest effect of a concussion by eighty eight percent; a second effect was loss of consciousness by eighty six percent and lastly post traumatic amnesia at eighty one percent. (Ropper & Gorson 2007, pp 166- 172) Concussion has also been known to cause physical, emotional and a variety of cognitive symptoms. The symptoms usually go away after three weeks though to some cases the effects may continue leading to long term complications.

Concussions which may happen to persons repeatedly cause brain damage like severe complications known as second impact syndrome characterized by a rapid swell of the brain or dementia pugilistica (Denny- Brown, et .al, 1945, pp296-325). Dementia pugilistica is a type of neuron disease normally suffered by professional boxers or amateurs with low progressive development signs over a long period of time of about twelve to sixteen years. It is characterized by declining mental ability, memory and tremors leading to lack of coordination. Other common sports that participants usually suffer from injuries are from bicycle accidents, car accidents and athletic injuries. (Gary, Johnston and Lovell 2006, pp 1-25)

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The force involved from a blow to the head and acceleration forces disrupt cellular processes of the brain. Up to date however it has not been established as to whether a concussion affects the brain structurally or not like other types of brain injury. It is not also well established as to whether a concussion is all about physiological changes and not structural changes. This is well depicted from the above definitions by the different authors. Though studies have found that a concussed brain shows signs of cellular damage, many have refuted the findings claiming that the results could have been affected by artifacts from the studies.

From the various definitions, no single definition can be said to be the universal meaning of concussion. A recent effort in defining concussion is by the international sports symposium. They agreed that concussion is a force induced injury that leads to complex brain rearrangement thus affecting it. It also involves temporary impairment of neurological activity that quickly recovers on its own (Shaw 2002, pp 281-344)

The image and structure of the brain shows no micro changes to the brain. As compared to the classical definitions, there is also no damage in the structure of the brain that can lead to change but the brain may change in the state of its functions. This is due to temporary and primary biochemical changes in the neurons that make the patient show symptoms. The more recent researchers have considered injuries in which damage of the brain structure occurs under the process of concussion. This is especially so according to the National Institute for Health and Clinical Excellence definition of concussion as also involving physiological and physical disruptions of the synapses of the brain (Levin, Howard and Arthur, pp 105)

Many fallacies concerning concussive brain injury have interfered with the diagnosis, assessment of impairment and treatment. Assessment is only possible when an examiner fully understands the consequences of a concussion. The current researches done are often misleading. Some important cases are excluded especially on the notion that the symptoms are only for duration of three weeks and after which they will disappear. Sports people have even ignored seeking medical attention in the assumption that the injury will heal by itself yet later it develops to be more severe. Doctors have administered quick medical procedures which are

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not ineffective. It is therefore important to conduct more reaches and come up with a consensus on understanding the injury and treatment.

Concussion falls under Traumatic Brain Injury but as the definitions indicates it is no longer clear as to whether to classify it as a mild head injury or a brain injury that is mild. Concussion has no specific definition. Since 1970, the statistical classification of diseases described MTBI in all fields of specialists. MTBI is defined by American Congress of Rehabilitation Medicine as a fever that lasts for thirty minutes with loss of consciousness, a twenty four hour of post traumatic fever and a comma scale of thirteen.

The following year 1994, the American Psychiatric Association defined MTBI by the incorporation of both loss of consciousness and post traumatic amnesia. Medical literature treat the two- MBTI and concussion as synonyms yet other head injuries like hemorrhages are taken to be concussions and not MTBI. Forms of MBTI can remain mild or considered as complicated MTBI and implies to a study of change of the normal physical, mechanical and biochemical function of the brain (pathophysiolagical). Concussion on the other hand has been considered to imply to a state of mind that is temporally impaired.

Though it may seem that way, clinicians as well as the researchers have not taken time to distinguish the two terms. They consider them as synonyms or the use of descriptive words of areas of brain injury rather than concussion. Concussion is now commonly used in the field of sports. The many definitions have also posed a challenge as to whether to imply only on to those injuries that lead to loss of consciousness as was the classical definition or to follow the new version which includes amnesia which is a change in consciousness. The best solution to these has been the three grading system developed by Colorado, the medical society and American Academy of Neurology that graded whether the injury was mild or severe (Gary, Johnston and Lovell 2006, pp 67-92)

Signs and symptoms of a concussion

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Concussive injury occurs immediately after injury. Though the concussions range from major to minor, they share a common factor which is a temporal interference of how the brain works which is seen in speech, reflexes, balance and coordination, and memory reasoning. This brain interference does not always involve a blackout. Some people have however had concussions and have never realized it. Every concussion injures the brain however mild it may seem. What a person needs to do is to rest for sometime until they are properly healed.

Symptoms of concussions may last for a period of three weeks. Some may however persist or further complications may happen. The symptoms and signs may also be indirect and may not be immediately felt. The two most common symptoms are amnesia and confusion leading to memory loss after the impact of head blow or acceleration. One may appear to be stunned or flabbergasted, confused about where he is or forgetful. If the person (child or adult) was playing he/she may no longer be sure of the game, opponent or where to score. The person may walk clumsily, speak slowly and be inaudible. He may show personality and behavior change because of lost consciousness (Gordon, Ropper & Bolton 1998, pp 149)

The loss of consciousness makes the person forget events prior and after the blow. Other general signs are amnesia, headaches, seeing stars and feeling dizzy, lightheaded and dazed. The person might also be hearing sounds within his ears, nauseate, fatigued and slurred speech comprising of senseless words. Other signs that are not immediate after the hit are headache, having trouble remembering what happened before and after the blow of brain injury.

The person may suffer from difficulties in reasoning especially when it comes to making decisions and concentrating. He may face the challenge of body parts coordination leading to staggering and even falling due to loss of balance. The patient may also suffer from blurred vision and become sensitive to light. He may have a sleep disorder and be sensitive to noise. There is fatigue, depression and the general feeling of excessive anxiety accompanied by a loss of temper. It is advisable that after a person has been hit even if they are feeling fine, they should not continue playing the game.

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A person with such symptoms is advised to immediately seek medical attention. A base line test is important for every sports person for the results after the test can assist doctors in the treatment and diagnosis of a sports person who has suffered head injury. It determines whether or not a concussion has occurred (Gordon, Ropper & Bolton 1998, pp 149)

Both MTBI and concussions can alter the brain’s physiological structure for hours, days or weeks. This sets the brain to be in motion as it tries to restore itself to the normal state. The brain is usually surrounded by cerebrospinal fluid which protects it from any slight form of trauma. Severe impacts such as head blows and acceleration mostly do not get absorbed by the cushion of the fluid. Such a force causes linear, angular and rotational movement of the brain. The processes are thought to interfere with the brain function as well as with the neurological component. In rotational movement, the head is seen as turning around the center of gravity. This is the major cause of concussion and usually very severe. The disruptions produce loss of consciences and may affect the upper part of the brain. These are the temporal lobe, fontal lobe, the brain stem, corpus callasum, and the fornix.

This leads to the general interference of the neuronal and functioning of the brain. This is because the brain cells are affected and someone may die. Chemicals such as glutamate with the function of nerve cell stimulations are released in plenty leading to brain injury. This causes neurons to move across the brain membrane excessively leading to ion imbalance such as calcium and potassium across cell membranes. A lot of energy to restore balance requires glucose from the cells, leading to a state of hyper metabolism. Concurrently, the blood flow to and from the brain is generally reduced. For a period of weeks and days the brain becomes sensitive to blood pressure changes and oxygen supply (anoxia). This leads to a lasting brain damage leading to other health issues. The cumulative effects may worsen with successive injuries even after years of the first injury (Head injury Nomenclature1966, pp 386-394)

Previous researches have no single findings with athletes who had once incurred concussions. Some see them having been completely healed or the symptoms having accumulated. Cumulative effects may cause long term memory loss and psychiatric disorders. The risk of developing clinical depression is much higher to retried footballers who had had three or more concussions earlier in life than those who had none. The repeated concussions which add up to

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three or more times is a likely cause of Alzheimer’s disease characterized by language breakdown among other symptoms due to brain malfunction.

There are many unanswered questions concerning concussions. Many publications have been published concerning concussions yet several issues are still pending waiting to be answered. For example, is feeling dazed or dizzy in the absence of unconsciousness constitute to MTBI or concussion? Also does a head injury which is not accompanied by a loss of consciousness in which a patient might complain of headaches, dizziness and poor concentration or mood disorders still constitute a concussion? Another is that many can feel dizzy or see stars without any single loss of consciousness. So the big question is if this is the mildest form of concussion. It is also difficult to determine if really there is any structural damage after a concussion thus it becomes equally futile to judge post traumatic as being functions or organic; they always must be both. Another issue is to determine if the symptoms are severe or mild as we have observed in Sir Charles Symonds definition and if the slightest injury effect is truly ever reversible (Symonds 1962, pp 1-5)

Conclusion

The term concussion is indefinite since it creates confusion in both layman terms and that of doctors. This is because of the different points of views and the phenomenon of the two fields. These aspects arise from the extent of the injury, its nature and the severity of the injury. The three aspects remain uncertain. The efforts in defining these aspects are too shallow. Therefore the effects it has on the human body range from one definition to another depending on the point of view of an author. However, we can only rely on the basic effects such as a brief period of amnesia, impaired consciousness, and the destruction of synaptic connection which does not exclude microscopic damages.

It is therefore important to drop the word concussion and come up with more precise words that reflect the point of view one is approaching the injury from in terms of either the clinical point of view or the layman point of view.

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Reference

Ropper A, Gorson, K (2007) concussion. New Engl J Med, Vol 356, pp 166- 172. The American Heritage science dictionary (2009) concussion. Retrieved from

http://dictionary.reference.com/browse/concussion

On 6th February 2010

Trotter, W (1924) certain minor injuries of the brain. Lancet publishers, pp 935.

Brain injury.com (2009) little known symptoms. Retrieved from

http://braininjury.com/littleknownsymptoms .

On 6th February 2010.

Congress of Neurological Surgeons; committee on head injury nomenclature (1966)

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glossary on head injury. Vol 12, pp 386-394

Denny- Brown, D (1945) cerebral concussion. Physiol rev, Vol 25, pp296-325

Aubry M., Cantu, R., Dvorak J., Graf –Baumann, T. et.al (2002) concussion in sport. A

summary and agreement statement of the first international conference on

concussion in sport, Vienna. Br J Sports Med Publishers .Vol 36, pp 6-7.

Symonds C., (1962) Concussion and its sequelae. Lancet publishers, I, pp 1- 5 Shaw, N

(2002) the neurobiology of concussion. Progr Neurobilol/ Vol 67 pp 281-344

National Institute for health and clinical excellence (2007) head injury. Triangle,

assessment, investigation and early management of head injury in infants, children,

and adults. Retrieved from

http://www.nice.org.uk/nicemedia/

On 6th February 2010

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Levin, H, Howard E, Arthur B, (1989) mild head injury. Oxford University press, issue

no 19505301, pp 105

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