Concussions and Brain Injury

Aug. 26, 2009 - PRLog -- Researchers at Albert Einstein College of Medicine of Yeshiva University have, for the first time, compelling evidence that concussions can be likened to mild traumatic brain injury. For years scientists have debated whether or not concussions produced actual physical damage to the brain. Concussive events that get the most attention in the news are explosions in war zones, head trauma during an automobile accident and hard hits in a sporting event.

The evidence produced by the research team led by Michael Lipton, M.D., Ph.D., was due to a different type of medical screening known as diffusion tensor imaging, which is a form of magnetic resonance imaging (MRI). Dr. Lipton is associate director of the Gruss Magnetic Resonance Research Center and also serves as associate professor of neuroscience at Einstein.

Dr. Lipton stated, “DTI has been used to look at other brain disorders, but this is the first study to focus on concussions. It proved to be a powerful tool for detecting subtle brain damage that we found to be associated with concussions.

Over one million Americans sustain a concussion each year in addition to the 1.4 million who suffer traumatic brain injury. While most people recover from concussions with no lasting bad effects, as many as 30 percent suffer permanent impairment. Common lasting effects are memory problems, cognitive problems and changes in behavior. A federal study published in 2003 called concussions a serious public health problem with estimated costs in the United States of $80 billion.

Permanent impairment of brain functions have costs not counted in dollars. Beth Jameson, a brain injury survivor and co-author of Brain Injury Survivor’s Guide, said, “It’s very difficult to explain to people what it’s like to live with an injured brain. Brain injuries affect different people in different ways simply because no two brains are exactly alike prior to the injury. I hope this research by Dr. Lipton’s team causes the medical and athletic communities to develop more consistent diagnosis and treatment programs.”

Dr. Lipton stated, “By detecting brain injury early with DTI, and then initiating cognitive rehabilitation therapies for those patients, we may be able to limit the effects of concussions.”

One problem for people suffering concussions is the lack of standardized guidelines for assessing concussions. Dr. Robert Cantu developed a set of guidelines in 1986 that received wide distribution. The American Academy of Neurology (AAN) developed a second set of guidelines, and Dr. Cantu revised his guidelines. The Colorado Medical Society Guidelines were established in 1991 and were adopted by the National Collegiate Athletic Association (NCAA). AAN, like Dr. Cantu, has revised their guidelines. Some team physicians and trainers evaluate an athlete’s mental status by using a five-minute series of questions and physical exercises known as the Standardized Assessment of Concussion (SAC). The bottom line is that there is no consensus as to which set of guidelines is most appropriate.

“It is important,” Jameson said, “that people become more aware of what can happen as a result of a concussive event. It makes me cringe to see someone on a motorcycle without a helmet. As a parent I understand you must balance risk with common sense when your child wants to participate in sports. I would urge all parents to make sure the coaches have a copy of the concussion tool kit available from the Centers for Disease Control (CDC) and to arm themselves with knowledge about concussion.”

Symptoms of concussion are:
•   Prolonged headache
•   Vision disturbances
•   Dizziness
•   Nausea or vomiting
•   Impaired balance
•   Confusion
•   Memory loss
•   Ringing ears
•   Difficulty concentrating
•   Sensitivity to light
•   Loss of smell or taste

DTI scanning, according to the Einstein study, could provide a standardized, objective way to diagnose concussions, determine whether or not there is evidence of brain injury, and allow immediate follow up therapies to begin, if needed. Concussions have a cumulative effect. While the first concussion may not show signs of an injured brain, the person is more at risk if there is a second one.

Symptoms of brain injury may not appear for days, weeks or, even, months following the injury. Dr. Lipton explained that this could be one of the more significant values of DTI scanning, “The problems in functioning caused by concussions often don't become evident until weeks or months after the injury, suggesting that the brain pathology may actually expand over time," he notes. "By detecting brain injury early with DTI and then initiating cognitive rehabilitation therapies for those patients, we may be able to limit the effects of concussions."

Sources:

Learn to Recognize and Prevent Concussions, Centers for Disease Control, http://www.cdc.gov/Features/Concussion/
Link Found Between Concussions and Brain Tissue Injury, Albert Einstein College of Medicine, http://www.einstein.yu.edu/home/news.asp?id=399
Brain Injury Online, http://www.brain-injury-online.com

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Larry and Beth Jameson are authors of Brain Injury Survivor's Guide and maintain two websites and Beth's Brain Injury Blog to provide additional support to families living with brain injury.