Head trauma: Healing and prevention

Prevention is key in avoiding traumatic brain injury, and tips on dealing with TBI . . .

Over the past decade, emergency room visits for sports/recreation-related traumatic brain injuries (TBI), including concussions, among children and adolescents increased by 60% — and 71% of these visits were males; 71% were aged 10-19 years.

A concussion is a mild traumatic brain injury. It usually occurs from a blow to the head as the result of a car accident, sports injury or fall. Loss of consciousness with the injury is not required for the diagnosis of a concussion.

Post-concussive syndrome (PCS) occurs in the days or weeks after the concussion. The symptoms fall into three categories: 1) physical, 2) cognitive and 3) emotional. These symptoms are the anticipated consequence of a concussion and, in most people, these symptoms decrease over time. There may be a delay after the initial injury before symptoms of PCS present, although most experts agree that symptoms should begin no later than four weeks after the head trauma. Most of the time, the symptoms disappear within three months although, on occasion, they can persist for a year or more.

Symptoms. Physical symptoms include headaches/neck pain, dizziness, nausea and motion sickness, sensitivity to bright light or loud noise, insomnia and fatigue. Cognitive symptoms include poor concentration and memory problems. Emotional symptoms include anxiety, irritability and depression.

Diagnosis. There is no single test that proves the diagnosis of PCS. It’s a clinical diagnosis based on the group of symptoms and history of mild head trauma. Physicians often order a CT scan or MRI after a traumatic brain injury to rule out any other diagnoses. PET scans are not routinely ordered. However, they may show diminished use of glucose by the brain in patients suffering from PCS.

Treatment. There is no treatment specific for PCS. Specific symptoms, however, can be addressed.

• Education. Many patients are reassured to discover that their symptoms are not “crazy” but part of a well-described syndrome. Education also helps family members, employers and teachers to be more supportive.

• Headaches. Medications which treat migraines or tension headaches can be used and are usually effective in treating headaches associated with PCS.

• Cognitive problems. Time may be the best therapy. However, your doctor may make recommendations to help during recovery such as lightening your schedule, increasing your amount of sleep, and asking employers or teachers for temporary accommodations.

• Depression and anxiety. Psychotherapy may be helpful. Symptoms can also be treated with antidepressants or anti-anxiety medication.

Prevention. The only way to prevent PCS is to avoid the head trauma. Measures to reduce the risk include: fastening seatbelts, wearing helmets for sports, and preventing falls around your house. Remove small rugs, install handrails, improve lighting (this is particularly important if you are elderly and more prone to falls).

The symptoms attributed to PCS are greatest within the first 7-10 days for the majority of patients. At one month, most symptoms are significantly improved if not completely resolved. At three months, the vast majority have recovered. Symptoms persist one year or longer in about 10% of patients with PCS.

SUSAN LOCKE, MD, is Healthnetwork Foundation’s medical director.

Healthnetwork is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: [email protected]