Psychosis and Deficits

A New Study from  the University of Tulsa, published in the Journal of Clinical and Experimental Neuropsychology (Neuropsychological impairment and psychosis in mania. Journal of Clinical and Experimental Neuropsychology, 2009;31(5):523-532),  finds Deficits involving executive function, working memory, speed of information processing, and new learning Occur in many people with mania. Factors that predict impairment remain poorly understood, but there are indications that psychotic features may correspond with increased risk of neurocognitive dysfunction during manic episodes.

"The current study examined neuropsychological function in 40 inpatients with bipolar I mania, 24 of whom presented with psychotic features. Compared to a control group, the inpatients showed worse executive function, speed of information processing, new learning, and dexterity. Nonetheless, presence of psychotic features failed to distinguish the inpatients with mania. Thus, psychotic features do not appear to increase neurobehavioral morbidity in people with mania, but presence of mania clearly corresponded with neurobehavioral dysfunction," wrote M.R. Basso and colleagues, University of Tulsa.

Boxing is A Dangerous Sport

Boxing is one of the world’s oldest forms of sport. Dating all the way back to the days of ancient Greece, formal boxing pits one individual against another in a punching match that can sometimes become rather brutal. In modern professional boxing, emphasis is on putting on a good show en route to knocking your opponent completely out. Fighters sometimes take a punishing beating to the head before collapsing to the floor of the ring. This makes boxers extremely susceptible to permanent brain injury. If you’re a boxer, a fan of boxing, or a parent considering letting your child box, you’re definitely going to want to consider a number of things regarding the danger inherent to the sport.

Research has shown that 80-90% of professional boxers will suffer some form of lasting brain injury. In most cases
the problems are rather mild, but nearly 25% of boxers will face severe, potentially debilitating brain damage. Studies have produced evidence that repeated blows to an unprotected head slowly cause deterioration of brain cells and health. When a fighter dies after a fight or develops dementia well after retiring, it is typically considered to be a result of the long term effects of routine beatings.

Read More Here.

New Book on Mild Brain Injury

Here is a book worth checking out on Mild Brain Injury http://www.learningstore.org/we1181.html

"Boxing should be banned from Olympics", says brain injury charity

Although my good friend and woman Muay Thai fighter, Lisa King, advocates and supports woman's fights, I bring this response by Headway - the brain injury association, a charity's, response to the issue.

 "We are deeply concerned to hear that the IOC is considering adding women's boxing to the Olympic programme," said Peter McCabe, Chief Executive of Headway. "This is nothing to do with the sex of the competitors as we believe all forms of boxing should be banned with immediate effect.

"Eleven medical associations around the world, including the BMA and the World Medical Association, have said chronic brain damage is caused by repeated blows to the head, which are experienced by all boxers. Like Headway, these medical associations believe that all forms of the sport should be banned.

I must weigh in on the side of boxing being a dangerous sport.  I have watched Lisa fight and cringe when she hits or is hit in the head.

Coffee and Headaches

People who consume high amounts of caffeine each day are more likely to suffer occasional headaches than those with low caffeine consumption, a team of researchers at the Norwegian University of Science and Technology (NTNU) reports in a study recently published in the Journal of Headache Pain.

Lou Ruvo Center for Brain Health

This announcement from the Lou Ruvo Center for Brain Health is available on the web.  This incredible addition to the Las Vegas Community will be know nationwide for its contributions to the science and care of brain health.

Cleveland Clinic, in collaboration with Keep Memory Alive and the Lou Ruvo Brain Institute, has created a highly specialized clinical center to advance the research, early detection and treatment of patients with neurocognitive disorders that result from neurological diseases including Alzheimer’s, Huntington’s, Parkinson’s, and Amyotrophic Lateral Sclerosis (ALS). Newly name the Lou Ruvo Center for Brain Health, the goal is to prevent the disabling symptoms of chronic brain diseases and to prolong healthy, vital aging in people at risk for dementia or cognitive disorders.

The Lou Ruvo Center for Brain Health provides state-of-the-art care for these disorders and for the family members of those who suffer from them. The physicians and staff at the LRCBH will work towards the development of early diagnosis and the advancement of knowledge concerning mild cognitive disorders, which could one day allow us to delay or prevent their onset.

For persons with mild cognitive impairment (mci) such as early stage dementia and Alzheimer’s disease, the Lou Ruvo Center for Brain Health offers the most up-to-date and technologically advanced diagnostic services, including 3 Tesla MR and PET-CT, performed by one of the leading neuroimaging academic centers in the world. The LRCBH also offers a multimodal treatment program for persons with milder syndromes, including physical exercise, cognitive rehabilitation, and cognitive enhancing medications.

Patients will receive expert diagnosis and treatment at Cleveland Clinic Lou Ruvo Center for Brain Health, which offers a multidisciplinary patient-focused approach to diagnosis and treatment, promoting collaboration across all care providers, offering patients a complete continuum of care and infusing education and research into all that we do.
 

Senator Ensign: "I did Nothing Wrong

This just in from the Associated Press:

Nevada Sen. John Ensign says his affair with a friend's wife was different from former President Bill Clinton's affair because Clinton committed a felony when he lied about it to a grand jury.

The Nevada Republican told The Associated Press on Wednesday: "I haven't done anything legally wrong."

Ensign made the remarks before he was introduced to a standing ovation from about 100 people at a Chamber of Commerce luncheon in rural Fernley. He opened his speech by acknowledging what called a "distraction." He says he made a big mistake, is sorry and intends to work hard to win back the trust of Nevadans.

It was Ensign's first public appearance in the state since acknowledging in June that he had a monthslong extramarital with former campaign aide Cynthia Hampton.

(Copyright 2009 by The Associated Press. All Rights Reserved.)

New Publication in 2010 Social Psychological and Personality Science

SAGE, the world's fifth largest publisher of academic journals, is pleased to announce the January 2010 launch of a new quarterly journal, Social Psychological and Personality Science (SPPS).

SPPS will publish cutting-edge, short reports of single studies, or very succinct reports of multiple studies. The journal's brief, to-the-point research articles will be of broad interest to both professional and lay audiences and will be written in a format accessible to a wide range of readers, including science writers for the popular press. It will feature a speedy review and publication process to allow groundbreaking research to be published quickly.

Source:
Jim Gilden
SAGE Publications
 

The Mysteries Of The Brain: Investigators Search For Answers About Injuries, PTSD

In the first study of its kind, researchers at Saint Louis University are recruiting patients for a clinical trial that will use cutting-edge imaging equipment to map the brain injuries of combat veterans and civilians, aiming to better understand the nature of their injuries. Funded by a $5.3 million grant from the U.S. Department of Defense, researchers will use three types of imaging equipment together, producing better data and a more complete taxonomy of brain injuries, information that investigators hope may lead to better treatment for blast injuries and car accidents.

Scientists once believed that an injured brain was irreversibly damaged and that its function could not be recovered after being lost. It now appears, however, that the brain has the remarkable ability to rewire itself - if one pathway is damaged, another may be able to take over. Researchers anticipate that this study may aid them in identifying specific areas of the brain that can be rewired, as opposed to those which, once damaged, cannot be redirected.

The study will use Tesla 3 MRI, CT (structural imaging) and PET and MEG (magnetoencephalography) (functional imaging).

The results will help science and medicine advance to properly care for traumatic brain injury and PTSD survivors.

 

Culture Change: Caring for Vets

President Obama yesterday spoke with Veterans in Arizona.  He told them that traumatic brain injury and PTSD are the new wounds of war.  Those veterans in Vietnam and other wars who came home only to have depression, alcohol abuse, job loss, and the other "dominoes"  that fall for veterans can be substantially dealt with if treatment is received early enough for veterans of Afghanistan and Iraq.  The government, according to the President, is creating a culture of caring for veterans.

An excellent piece on PTSD in the military and what is being done to address it can be seen by clicking here.

Guide to Selecting Brain Injury Attorney

Mary Retter of the Brain Injury Association of America writes a subperb article entitled Guide to Selecting Legal Representation for Brain Injury Cases.  The article can be found at www.biausawww.biausa.org.
 

Guide to Selecting Legal Representation 
for Brain Injury Cases
By Mary S. Reitter


Introduction
Persons who sustain brain injury resulting from motor vehicle crashes, pedestrian injuries, falls, defective products, negligence and other causes often find it beneficial to consider consulting an attorney with experience in personal injury cases involving brain injury. Given the expensive and extensive need for medical, rehabilitation and long-term services that people with brain injury and their families may face, any and all possible financial resources should be vigorously pursued.
In addition to a personal injury case, other issues which may require legal assistance after brain injury include:
• competency and guardianship
• determination of eligibility for federal and state entitlement programs and appeals, if necessary
• estate planning
• powers of attorney
• separation and divorce
• criminal matters

Depending upon the complexity of the issues, the attorney you select to represent you in a personal injury case also may provide guidance in some or many of these areas, or help you find an attorney who specializes in the particular area of law required.

Personal Injury Cases and Brain Injury
Personal injury cases may afford a person whose brain injury resulted from the negligence of others with the financial resources necessary to maximize recovery and/or provide for long-term care and support needs. Tort law, which includes personal injury cases, is intended to encourage safety and discourage wrongful acts which cause injury. It attempts to provide fair and full compensation for the losses of individuals who have been wrongfully injured or killed. Lost income is an obvious loss. Other damages including pain, suffering, loss of earning capacity and enjoyment of life, as well as the cost of medical and rehabilitation services, also can be awarded as compensation when a judgment is made or a settlement reached.

Consider an Attorney Soon After the Injury Occurs
Important evidence may be lost if an attorney is not involved in the early days following the injury. An attorney can investigate and prepare the case while the person with brain injury and family focus their energies on the process of recovery.

Many people are reluctant to involve an attorney because they feel they cannot afford one. In addition to paying an attorney either hourly or through a negotiated retainer (known as the fee for service basis, personal injury attorneys frequently work on a contingent basis, which means that their fee depends upon obtaining a judgment or settlement for their client. The attorney and client usually negotiate the attorney’s fee before representation begins.

Expenses which are necessary to investigate, prepare and resolve the case may be paid in advance by the attorney but are usually paid out of the consumer’s portion of the total award. This allows individuals to have competent legal representation since they can select the attorney they feel is best qualified to represent them, provided the attorney agrees to accept their case.

Who's the Defendant?
Perhaps one of the most compelling reasons to consider legal representation following a brain injury is the complexity of determining just who may bear some legal responsibility for the injury. For example, in a motor vehicle crash, the driver of an automobile, the automobile manufacturer, the local government and/or its employees and the owner and/or bartender at a local bar all may be liable for the same injury.

The attorney can determine the merit of a variety of possibilities and recommend which cases should be against one or more of the potential defendants. Choose Your Attorney Carefully
The selection of an attorney can have significant long-term implications. The attorney should assist not only in obtaining and preserving any funds resulting from litigation, but also help obtain and preserve any entitlement to federal and state benefits which an individual may have. Without careful planning, valuable benefits may be lost.

It is a decision which requires the serious consideration of many factors. Among these are the attorney’s:
• education and training
• legal experience
• knowledge of the consequences and treatment of brain injury
• knowledge of how to structure and manage awards
• experience with similar cases

In addition, the attorney should be admitted to practice in the state in which the litigation will be filed.

While medical professionals are rapidly becoming more specialized, attorneys usually are still trained to be generalists. Nevertheless, they usually specialize in one area of the law (such as personal injury) soon after beginning practice. A small percentage of all attorneys have specialized knowledge, training, and experience with brain injury and its consequences.

In particular, attorneys may know little about the more subtle cognitive, emotional, physical, behavioral and social difficulties which can occur following brain injury, whether severe or mild. It is important to collect as much information as possible about a prospective attorney before making your selection.

Attorneys Also Choose Their Cases Carefully
Be aware that the attorney has an important decision to make as well. Attorneys will often invest substantial time and money during the investigation, preparation and resolution of the case at their own expense. Under a contingent fee arrangement, the attorney usually receives no fee if there is no recovery for the client. Because of the obvious financial risk involved, attorneys may decline cases if they do not believe there is a reasonable likelihood of success, or if there is limited availability of funds from the defendant(s). Frequently, attorneys conduct a preliminary evaluation before agreeing to accept a case.

Getting Started
The Brain Injury Association of America’s (BIAA) National Directory of Brain Injury Rehabilitation Services (National Directory) lists individual service providers, including attorneys with experience with brain injury cases. These listings are also available online in BIAA’s searchable National Directory at www.biausa.org.

Attorneys who are listed in the National Directory are also available through BIAA's National Brain Injury Information Center at (800) 444-6443. You may also find attorneys through the American Association for Justice (formerly Association of Trial Lawyers of America (AAJ, formerly ATLA) and state and national Bar Associations.

An attorney whom you have used in the past for other matters, or other well-known attorneys in your area, may be able to suggest attorneys who primarily handle cases involving brain injury. Asking physicians and rehabilitation professionals as well as people with brain injury and their families may prove helpful as well.

Lastly, the Martindale-Hubbell Law Directory, provide names of attorneys. While you may search for personal injury attorneys, it does not specify those attorneys with specific brain injury expertise. It may be accessed online at www.martindale.com or your local library may have a copy of the print directory.

Once you have a list of attorneys, schedule a telephone or in-person meeting with each. Be prepared to answer the attorney's questions about the injury as well as ask your own. You may find it useful to compile a written list of questions for each attorney to complete by mail before you meet with them, particularly if the list is lengthy. Include a space for the attorney to sign and date the form.

During the first meeting, you will want to learn about the attorney’s legal background and experiences and his/her experience with cases involving brain injury. This information will be valuable as you compare and contrast the expertise and knowledge of various attorneys in order to make a well informed decision.

The topic areas and specific questions suggested below can help you structure your information gathering. Keep written notes about each of your interviews which include the names of those with whom you talk, the date and time, and maintain copies of all correspondence. You may wish to tape record your interviews for future reference, with permission from those present, or you may wish to ask a friend to accompany you specifically to take notes. This frees you to listen and fully participate in the discussion.

Ask the attorney to suggest other people with similar cases that the attorney has represented (within the limits of attorney/client confidentiality). This means the attorney will need permission from the individual before giving out his/her name. You can benefit from their experiences, both with the attorney and with the legal process you are about to undertake. Bear in mind that some people may not give permission, although they were very satisfied with the representation the attorney provided.

Signing the Attorney-Client Contract
Once you have narrowed your search to a few selected attorneys, you may find it helpful to meet with them once again before an attorney-client contract is signed. This contract formally begins representation in the case. Be sure it clearly spells out the financial and other agreements you have made with the attorney and that you understand your rights and responsibilities as well as those of the attorney.

 Protecting Your Funds
Early in the process, be sure to ask the attorney to help you make arrangements to protect whatever funds you are awarded in a settlement or judgment. The attorney should explore options including structured settlements, trusts and annuities which may enable the person with brain injury to maintain eligibility for government benefits such as Social Security and Medicaid. The attorney should be knowledgeable about and/or explore applicable Social Security asset and resource regulations as the case is prepared.

Taking full advantage of benefits like these may prepare you to provide for expected as well as unanticipated needs that the person with brain injury may have, regardless of the amount of money that may later be awarded.

Questions Which May Help
You will have many questions to ask a prospective attorney. The topics and specific questions suggested below are intended as a guide for your information gathering.

• Try to ask the same questions of each potential attorney
• Write down the responses you receive
• If you are not clear about something the attorney said, either at the time you meet with the attorney or later, do not hesitate to ask for clarification.

Verify the information the attorney has provided by checking with the state bar association, college or university he/she attended, organizations which sponsor education/training the attorney has attended, reading articles written by the attorney and/or other means.

Be observant during the time you spend with each potential attorney. Pay attention to how the attorney, office personnel and staff interact with you and your family and determine if it is comfortable for you. Trust your instincts. Many personal injury cases take years to resolve, so the rapport between you and the attorney can be very important.

Keep in mind that you do not need to know everything about every potential attorney. You will develop more in-depth knowledge about the individual attorney you select as you work together over time.

Questions about How Well the Attorney Understands the Case
• Based on the information you have about my situation, what are the strengths and limitations of my case?
• What additional information about my case do you need and how do you propose to obtain it?
• What is your opinion of (theory of) my case?

Questions to Understand the Resources Available to the Attorney
• Who else in your practice would you involve in my case? What role(s) would these people have? Describe their background and expertise.
• Who will be my primary contact with your practice?
• Are you or your law firm able and willing to advance as much as $50,000 in the investigation, preparation and presentation of my case?

Questions to Understand the Attorney’s Legal and Brain Injury Experience
• How much of your practice is devoted to personal injury?
• Of your personal injury cases, how many are devoted to brain injury?
• What results have you achieved?
• What is your involvement with legal associations, local, state or national brain injury associations or other organizations?
• How did you first become involved in brain injury cases?
• How do you stay up to date with personal injury law and brain injury issues?
• What have you worked on in the past six months?
• What special training or education do you have specific to brain injury or benefits that people can get after brain injury?

Questions to Find References for the Attorney
• Would you suggest three people you have represented that I might contact as references?

Acknowledgments The author wishes to acknowledge the contributions of the following individuals who provided valuable input and review of this guide: C. Michael Bee, Becky Burke, Andy Burnett, Craig Denmead, Bob Eustice, Nathaniel Fick, Simon Forgette, Melody Flinchum Knox, Nick Simkins, Ellen Shillinglaw and Dick Verville.
Note: Originally published in the 1995 and subsequent editions of the National Directory of Brain Injury Rehabilitation Services, the Guide to Selecting Legal Representation in Brain Injury Cases was updated in September, 2007.
© 2007 Brain Injury Association of America, Inc. All rights reserved.

 

Self-Identity Loss and Brain Injury

The leading story in the Sunday NY Times entitled "After Injury, Fighting to Regain a Sense of Self" describes a condition experienced by a small group of traumatic brain injury survivors. 

After a motorcycle accident and brain injury, a 19 year old lost his ability to recognize his mother.  The article decribes the ordeal.

Doctors have known for nearly 100 years that a small number of psychiatric patients become profoundly suspicious of their closest relationships, often cutting themselves off from those who love them and care for them. They may insist that their spouse is an impostor; that their grown children are body doubles; that a caregiver, a close friend, even their entire family is fake, a duplicate version.

Such delusions are often symptoms of schizophrenia. But in the last decade or so, researchers have documented similar delusions in hundreds of people who are not schizophrenic but have neurological problems including dementia, brain surgery and traumatic blows to the head.

A small group of brain scientists is now investigating misidentification syndromes, as the delusions are called, for clues to one of the most confounding problems in brain science: identity. How and where does the brain maintain the “self”?

What researchers are finding is that there is no single “identity spot” in the brain. Instead, the brain uses several different neural regions, working closely together, to sustain and update the identities of self and others. Learning what makes identity, researchers say, will help doctors understand how some people preserve their identities in the face of creeping dementia, and how others, battling injuries like Adam’s, are sometimes able to reconstitute one.

This and other syndromes of traumatic brain injury account for the cognitive deficiencies following injury.

Newborn Brain Damage Stopped

Reporting their results in the Journal of Neuroscience, Scientists show that Inhibiting an enzyme in the brains of newborns suffering from oxygen and blood flow deprivation stops a type of brain damage that is a leading cause of cerebral palsy, mental retardation and death, according to researchers at Cincinnati Children's Hospital Medical Center.

This is a breakthrough which will save lives and promote healthy delivery of newborns.  Although it is still experimental.

 

Hospital Cleared in Deportation of Brain Damaged Man

DEBORAH SONTAG of the  The New York Times reports "In a benchmark case dealing with the obligations of hospitals toward uninsured illegal immigrants, a jury in Stuart, Fla., decided Monday that Martin Memorial Medical Center did not act unreasonably when it chartered a plane and repatriated a severely brain-injured Guatemalan patient against the will of his guardian."

The Hospital prevailed and the man was sent via chartered plane back to Guatemala.  You can read the entire article by clicking here.

What is Alzheimer's?

The incidence of Alzheimer's is known to affect adult brains in later years.  But did you know the incidence also increases after and as a result of traumatic brain injury?

Alzheimer's disease is the most common form of dementia. The disease gets worse as it develops - it is a progressive disease. There is no current cure for Alzheimer's, although there are ways of slowing down its advance and helping patients with some of the symptoms. Alzheimer's is also a terminal disease - it is incurable and causes death.

According the National Institute on Aging, there are estimated to be between 2.4 million and 4.5 million Americans who have Alzheimer's. There are approximately 417,000 people in the UK with Alzheimer's, according to the Alzheimer's Society.

Alzheimer's disease is a progressive neurologic disease of the brain leading to the irreversible loss of neurons and the loss of intellectual abilities, including memory and reasoning, which become severe enough to impede social or occupational functioning.

An excellent look at the history, causes and diagnosis of Alzheimer's can be found by clicking here.

PTSD From 9/11

The Las Vegas Review Journal and Associated Press released the results of a study that determined that witnesses of the 9/11 tragedy were many times more likely to suffer from post traumatic stress disorder than those who did not witness it.  The onset was as much as 5 years after 9/11.

These findings are consistent with what we know about post traumatic stress disorder onset.  The condition affects veterans, those subject to horrifying experiences, accident victims and others.

Mild Traumatic Brain Injury

This article on Mild Traumatic Brain Injury was Written by Christian Nordqvist of Medical News Today.  It is an excellent summary and refreasher of highlights surrounding the condition.

 Concussion is also known as mild brain injury, mild traumatic brain injury (MTBI), mild head injury and minor head trauma. Some experts define concussion as a head injury with temporary loss of brain function, which can cause cognitive, physical and emotional symptoms. Concussion may also be defined as an injury to the brain generally caused by a jolt or blow to the head - in the majority of cases the individual does not lose consciousness.

According to Medilexicon's medical dictionary, concussion is "An injury of a soft structure, as the brain, resulting from a blow or violent shaking."

In sports medicine the term concussion is commonly used, while in general medicine MTBI (mild traumatic brain injury) may be used as well. Lay people are more familiar with the term concussion.

According to the Brain Injury Association of America males are twice as likely as females to sustain a brain injury. Those at highest risk of a brain injury are males aged 15 to 24 years. People who have had a brain injury are more likely to experience a subsequent brain injury. In 2008 there were 351,992 sports-related head injuries that were treated in hospital emergency rooms in the USA, according to the U.S. Consumer Product Safety Commission.

Researchers from the Centre de recherche en neuropsychologie et cognition, Université de Montréal, Canada found evidence that athletes who were concussed during their earlier sporting life show a decline in their mental and physical processes more than 30 years later.

What are the causes of concussion?

The brain floats in cerebral fluid which protects it from jolts and bumps. A violent jolt or a severe blow to the head can cause the brain to bump hard against the skull. This can result in the tearing of fiber nerves as well as blood vessel rupture under the skull, leading to an accumulation of blood.

  • Automobile accidents - concussions commonly occur from severe jolts to the head; this can happen when a vehicle suddenly loses speed or stops dead, causing the brain to jar (bash, bump hard) against the skull.
     
  • Sports injuries - especially contact sports, such as martial arts, boxing, rugby, American football, and hokey. Non-contact sports such as snowboarding and skiing as well.
     
  • Falls - any fall that results in a blow to the head or a severe jolt. The majority of concussion cases in very young children and elderly individuals in the USA and UK occur as a result of a fall in the home.
     
  • Horseback riding accidents - there were 11,749 cases of head injuries resulting from horseback riding accidents in 2008 in the USA, according to the U.S. Consumer Product Safety Commission.
     
  • Playground accidents - especially in playgrounds that do not have proper soft underlays.
     
  • Cycling accidents - according to the U.S. Consumer Product Safety Commission there were 70,802 cases of head injuries that resulted from cycling accidents.
     
  • Assaults - 11% of traumatic brain injuries in the USA are caused by assaults (people being attacked), according to the CDC (Centers for Disease Control and Prevention).

Different grades of concussion

Concussion is usually classified into 3 different grades. Below are three of the most widely used ways of classifying concussion:

  • Cantu guidelines
    (Devised by Dr. Robert Cantu, medical director of the National Center for Catastrophic Sports Injury Research)
    Grade 1 - Some amnesia lasting no longer than 30 minutes, no loss of consciousness.
    Grade 2 - Loss of consciousness lasting no longer than 5 minutes. Amnesia lasting from 30 minutes to 24 hours.
    Grade 3 - Loss of consciousness lasting more than 5 minutes. Amnesia lasting more than 24 hours.
     
  • Colorado Medical Society guidelines:
    Grade 1 - Confusion. No loss of consciousness.
    Grade 2 - Confusion. Amnesia. No loss of consciousness.
    Grade 3 - Any loss of consciousness.
     
  • American Academy of Neurology guidelines:
    Grade 1 - Confusion that lasts less than 15 minutes. No loss of consciousness.
    Grade 2 - Confusion last lasts for more than 15 minutes. No loss of consciousness.
    Grade 3 - Loss of consciousness (IIIa coma lasts seconds, IIIb coma lasts for minutes)

What are the signs and symptoms of concussion?

Signs and symptoms of concussion may not be noticeable straight away. (A sign is what a doctor can see, hear or feel, such as a rash, or slurred speech. A symptom is something the patient describes, such as a headache, or ringing in the ears.)

 

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Immediate signs and symptoms may include:

  • Loss of consciousness.
  • Confusion.
  • Headache.
  • Slurred speech.
  • Dizziness.
  • Ringing in the ears.
  • Nausea.
  • Vomiting.
  • Amnesia.
  • Tiredness (fatigue).

The following signs and symptoms may not be noticeable for several hours, or even days:

  • Amnesia.
  • Depression.
  • Disturbed sleep.
  • Hyperacusis - sensitivity to sounds.
  • Irritability.
  • Lack of concentration, focus.
  • Moodiness.
  • Photophobia - sensitivity to light.

The following signs and symptoms may be linked to a more serious injury and medical help should be sought:

  • Prolonged headache.
  • Prolonged dizziness.
  • Dilated pupils.
  • The two pupils are not the same size.
  • Prolonged nausea and vomiting.
  • Memory loss does not improve.
  • Ringing in the ears.
  • Loss of sense of smell.
  • Loss of sense of taste.

Concussion signs and symptoms in children - this may be more difficult to detect in very young children because they may not yet have the ability to adequately explain how they feel or identify what needs to be reported. Signs may include:

  • Lethargy, listlessness.
  • Irritability - the child gets cross easily.
  • Changing sleeping patterns.
  • Altered appetite.
  • Walking and/or standing unsteadily (any signs of balance, dizziness problems).

Children - the following signs usually mean the child needs medical attention:

  • The child loses consciousness.
  • After attempting to stem the bleeding, a cut continues to bleed.
  • Any change in the way the child walks.
  • Bleeding from the ears.
  • Bleeding from the nose.
  • Blurred vision.
  • Confusion - the child does not know where he/she is, may not recognize familiar people.
  • Continuous crying.
  • Convulsion (seizure).
  • Discharge from the ears.
  • Discharge from the nose.
  • Dizziness.
  • Loss of appetite.
  • Prolonged headache.
  • Prolonged irritability.
  • Prolonged listlessness, fatigue, lethargy.
  • Repeated or forceful vomiting.
  • Speech is slurred.
  • Worsening headache.

How is concussion diagnosed?

Some sources say that most people can diagnose concussion if the symptoms are present immediately. If an individual has experienced a severe jolt or blow to the head which has left them dazed, confused, or wobbly they have concussion. However, a Canadian study revealed that most minor league hokey players are unable to identify a concussion or its related symptoms . Dr. Cusimano, a professor of neurosurgery, education and public health at the University of Toronto said "Serious misconceptions exist among minor league hockey players, athletes, coaches and parents when it comes to understanding the signs and symptoms of a concussion and its treatment."

Determining the severity of the concussion is more difficult because the signs and symptoms may not become evident until later. Mark R. Lovell, Ph.D., director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion program, said that athletes may have severe concussion without becoming unconscious. In a report published in The American Journal of Sports Medicine Lovell explained that amnesia and confusion on the field after injury may be as important, if not more important, in making a return-to-play decision.

A GP (general practitioner, primary care physician) or hospital doctor will ask the patient details about the trauma (the blow to the head, the accident). It may be necessary to question the people who accompanied the patient. A neurological examination will also be done, which will include evaluating the patient's:

  • Balance
  • Concentration
  • Coordination
  • Hearing
  • Memory
  • Reflexes
  • Vision

If the patient is over 65 years old, fell from a height of over 3 feet, was involved in a vehicle accident, has been consuming alcohol or drugs, cannot remember what happened 30 minutes or longer after the incident, has short-term memory problems, has been vomiting, had a seizure, has bruising or cuts and scrapes on the head and/or neck, or appears to have a fractured skull, the doctor may order a CT scan.

Glasgow Coma Scale

Doctors often use the Glasgow Coma Scale (GCS) before deciding whether to use a CT scan. The GCS is a way for doctors and nurses to assess the severity of brain damage following a head injury. It scores patients according to verbal responses, motor responses (physical reflexes), and how easily they can open their eyes.

  • Eyes - Glasgow Coma Scale
      Score of 1 - does not open eyes.
      Score of 2 - opens eyes in response to painful stimuli (when given pain).
      Score of 3 - opens eyes in response to voice.
      Score of 4 - opens eyes spontaneously.

     
  • Verbal - Glasgow Coma Scale
      Score of 1 - makes no sound.
      Score of 2 - incomprehensible sounds (mumbles).
      Score of 3 - utters inappropriate words.
      Score of 4 - confused, disorientated.
      Score of 5 - oriented, chats normally.

     
  • Motor (physical reflexes) - Glasgow Coma Scale
      Score of 1 - makes no movements.
      Score of 2 - extension to painful stimuli (straightens limb when given pain).
      Score of 3 - abnormal flexion to painful stimuli (moves in a strange way when given pain).
      Score of 4 - flexion/withdrawal to painful stimuli (moves away when given pain).
      Score of 5 - localizes painful stimuli (can pinpoint where pain is).
      Score of 6 - obeys commands.

     
  • Brain injury will be classified in the Glasgow Coma Scale as:
      Coma = a score of 8 or less.
      Moderate = a score of 9 to 12.
      Minor = a score of 13 or more.

A computerized tomography (CT) scan - this is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device (the machine) is called a CTG scanner; it is a large machine and uses X-rays. A CT scan is generally accepted as better at looking at bleeding in the brain due to injury than an MRI (magnetic resonance imaging) scan. However, an MRI scan measures changes in brain function from concussion, helping structure return-to-play guidelines, researchers from University of Pittsburgh School of Medicine revealed.

Depending on how the doctor has assessed the patient, he/she may have to stay in hospital overnight. If the patient is allowed to go home the doctor will ask somebody to monitor symptoms for at least 24 hours - this may involve waking the patient up at specific times to check for consciousness.

What is the treatment for concussion?

Most concussion or mild traumatic brain injury (MTBI) symptoms will go away without treatment. In the USA approximately 1% of patients with MTBI require surgery.

Sex and prior history - prior history of concussion and gender account for significant differences in test results following injury, researchers from the Department of Orthopaedics at the University of Pittsburgh Medical Center, reported. Because of these differences, the researchers urge physicians and coaches to take an individualized approach to treating people with concussion.

  • Rest - experts say that the most important treatment is rest. It takes time for the brain to recover, which will happen more rapidly if the body is resting and getting a good night's sleep each night. The International Conference on Concussion in Sports stressed that children and teens must be strictly monitored and activities restricted until fully healed. These restrictions include no return to the field of play, no return to school, and no cognitive activity - including academic activities and at-home/social activities including text messaging, video games, and television watching.
     
  • Headaches - acetaminophen (paracetamol, Tylenol) is the best painkiller for headache due to a head injury. Drugs such as aspirin, ibuprofen and other NSAIDs should be avoided because they thin the blood and increase the risk of internal bleeding (hemorrhage).
     
  • Sports - it is important not to return to any sporting activity too soon. If you or your child had concussion, only do so when your doctor says it is OK. A study by researchers at the University of North Carolina, USA, found that athletes engaging in high levels of activity following concussion demonstrated impaired brain function, while those who engaged in moderate levels of activity demonstrated the best performance.
     
  • Alcohol - patients should avoid consuming alcohol, which can impede healing, until all symptoms have completely disappeared.
     
  • Migraine - migraine after concussion may indicate an increased risk of neurocognitive impairment, researchers at the University of Pittsburgh Sports Medicine Concussion Program found. They said that doctors need to exercise increased vigilance when deciding about managing a concussed athlete with post-traumatic migraine. They need to be extremely cautious about deciding when the patient can return to their sport.
     
  • Worsening symptoms - if symptoms worsen patients should see their doctor.

A person with a grade three concussion will probably be hospitalized if symptoms persist.

Concussion and long term depression

In a report authored by Robert C. Cantu, M.D., FACSM and published in Medicine & Science in Sports & Exercise, a study of 2,552 retired professional football players revealed that recurrent sport-related concussion appears to be related to an increased risk of clinical depression in retired professional football players.

Prevention of concussion

  • Helmets and other protective headgear - such activities as cycling, motorcycling, skiing, hokey, horse riding should only be done if you wear protective headgear. It is important to buy new protective headgear - not second-hand ones. Headgear will need to be replaced periodically.
     
  • Seat belt - wearing a seat belt has been proven to massively reduce the risk of head injury during vehicle accidents.
     
  • Driving under influence - avoiding drinking and driving, or driving under the influence of illegal drugs or as well as some medications.
     
  • Mouthguard - a good mouthguard can help prevent concussion in such contact sports as boxing, martial arts, rugby, American football, etc.
     
  • Your home - consider adding lighting to areas that may be hazardous. Be alert for clutter that may cause people to fall over. Most head injuries among very young children and elderly people occur in the home. If there are toddlers in the house place pads on sharp edges of furniture, place a gate on the stairs, install window guards.
     
  • Playgrounds - there should be an underlay of soft material, either sand or special matting.
     
  • Jogging in busy streets - wear bright colored clothing and use both your eyes and ears when crossing the road. Keep to the sidewalk (UK/Ireland/Australia: pavement).
     
  • Cycling at night - make sure your bicycle has good lighting both in front and behind. Wear bright clothing with reflectors.
     
  • Nutrition and exercise - a well balanced diet and plenty of exercise can help maintain good bone mass and bone density. This is especially important for seniors (elderly people) and post-menopausal women. Stronger bones may reduce the severity of brain injury following a blow to the head.


 

Mild Traumatic Brain Injury

This article on Mild Traumatic Brain Injury was Written by Christian Nordqvist of Medical News Today.  It is an excellent summary and refreasher of highlights surrounding the condition.

 Concussion is also known as mild brain injury, mild traumatic brain injury (MTBI), mild head injury and minor head trauma. Some experts define concussion as a head injury with temporary loss of brain function, which can cause cognitive, physical and emotional symptoms. Concussion may also be defined as an injury to the brain generally caused by a jolt or blow to the head - in the majority of cases the individual does not lose consciousness.

According to Medilexicon's medical dictionary, concussion is "An injury of a soft structure, as the brain, resulting from a blow or violent shaking."

In sports medicine the term concussion is commonly used, while in general medicine MTBI (mild traumatic brain injury) may be used as well. Lay people are more familiar with the term concussion.

According to the Brain Injury Association of America males are twice as likely as females to sustain a brain injury. Those at highest risk of a brain injury are males aged 15 to 24 years. People who have had a brain injury are more likely to experience a subsequent brain injury. In 2008 there were 351,992 sports-related head injuries that were treated in hospital emergency rooms in the USA, according to the U.S. Consumer Product Safety Commission.

Researchers from the Centre de recherche en neuropsychologie et cognition, Université de Montréal, Canada found evidence that athletes who were concussed during their earlier sporting life show a decline in their mental and physical processes more than 30 years later.

What are the causes of concussion?

The brain floats in cerebral fluid which protects it from jolts and bumps. A violent jolt or a severe blow to the head can cause the brain to bump hard against the skull. This can result in the tearing of fiber nerves as well as blood vessel rupture under the skull, leading to an accumulation of blood.

  • Automobile accidents - concussions commonly occur from severe jolts to the head; this can happen when a vehicle suddenly loses speed or stops dead, causing the brain to jar (bash, bump hard) against the skull.
     
  • Sports injuries - especially contact sports, such as martial arts, boxing, rugby, American football, and hokey. Non-contact sports such as snowboarding and skiing as well.
     
  • Falls - any fall that results in a blow to the head or a severe jolt. The majority of concussion cases in very young children and elderly individuals in the USA and UK occur as a result of a fall in the home.
     
  • Horseback riding accidents - there were 11,749 cases of head injuries resulting from horseback riding accidents in 2008 in the USA, according to the U.S. Consumer Product Safety Commission.
     
  • Playground accidents - especially in playgrounds that do not have proper soft underlays.
     
  • Cycling accidents - according to the U.S. Consumer Product Safety Commission there were 70,802 cases of head injuries that resulted from cycling accidents.
     
  • Assaults - 11% of traumatic brain injuries in the USA are caused by assaults (people being attacked), according to the CDC (Centers for Disease Control and Prevention).

Different grades of concussion

Concussion is usually classified into 3 different grades. Below are three of the most widely used ways of classifying concussion:

  • Cantu guidelines
    (Devised by Dr. Robert Cantu, medical director of the National Center for Catastrophic Sports Injury Research)
    Grade 1 - Some amnesia lasting no longer than 30 minutes, no loss of consciousness.
    Grade 2 - Loss of consciousness lasting no longer than 5 minutes. Amnesia lasting from 30 minutes to 24 hours.
    Grade 3 - Loss of consciousness lasting more than 5 minutes. Amnesia lasting more than 24 hours.
     
  • Colorado Medical Society guidelines:
    Grade 1 - Confusion. No loss of consciousness.
    Grade 2 - Confusion. Amnesia. No loss of consciousness.
    Grade 3 - Any loss of consciousness.
     
  • American Academy of Neurology guidelines:
    Grade 1 - Confusion that lasts less than 15 minutes. No loss of consciousness.
    Grade 2 - Confusion last lasts for more than 15 minutes. No loss of consciousness.
    Grade 3 - Loss of consciousness (IIIa coma lasts seconds, IIIb coma lasts for minutes)

What are the signs and symptoms of concussion?

Signs and symptoms of concussion may not be noticeable straight away. (A sign is what a doctor can see, hear or feel, such as a rash, or slurred speech. A symptom is something the patient describes, such as a headache, or ringing in the ears.)
Immediate signs and symptoms may include:

  • Loss of consciousness.
  • Confusion.
  • Headache.
  • Slurred speech.
  • Dizziness.
  • Ringing in the ears.
  • Nausea.
  • Vomiting.
  • Amnesia.
  • Tiredness (fatigue).

The following signs and symptoms may not be noticeable for several hours, or even days:

  • Amnesia.
  • Depression.
  • Disturbed sleep.
  • Hyperacusis - sensitivity to sounds.
  • Irritability.
  • Lack of concentration, focus.
  • Moodiness.
  • Photophobia - sensitivity to light.

The following signs and symptoms may be linked to a more serious injury and medical help should be sought:

  • Prolonged headache.
  • Prolonged dizziness.
  • Dilated pupils.
  • The two pupils are not the same size.
  • Prolonged nausea and vomiting.
  • Memory loss does not improve.
  • Ringing in the ears.
  • Loss of sense of smell.
  • Loss of sense of taste.

Concussion signs and symptoms in children - this may be more difficult to detect in very young children because they may not yet have the ability to adequately explain how they feel or identify what needs to be reported. Signs may include:

  • Lethargy, listlessness.
  • Irritability - the child gets cross easily.
  • Changing sleeping patterns.
  • Altered appetite.
  • Walking and/or standing unsteadily (any signs of balance, dizziness problems).

Children - the following signs usually mean the child needs medical attention:

  • The child loses consciousness.
  • After attempting to stem the bleeding, a cut continues to bleed.
  • Any change in the way the child walks.
  • Bleeding from the ears.
  • Bleeding from the nose.
  • Blurred vision.
  • Confusion - the child does not know where he/she is, may not recognize familiar people.
  • Continuous crying.
  • Convulsion (seizure).
  • Discharge from the ears.
  • Discharge from the nose.
  • Dizziness.
  • Loss of appetite.
  • Prolonged headache.
  • Prolonged irritability.
  • Prolonged listlessness, fatigue, lethargy.
  • Repeated or forceful vomiting.
  • Speech is slurred.
  • Worsening headache.

How is concussion diagnosed?

Some sources say that most people can diagnose concussion if the symptoms are present immediately. If an individual has experienced a severe jolt or blow to the head which has left them dazed, confused, or wobbly they have concussion. However, a Canadian study revealed that most minor league hokey players are unable to identify a concussion or its related symptoms . Dr. Cusimano, a professor of neurosurgery, education and public health at the University of Toronto said "Serious misconceptions exist among minor league hockey players, athletes, coaches and parents when it comes to understanding the signs and symptoms of a concussion and its treatment."

Determining the severity of the concussion is more difficult because the signs and symptoms may not become evident until later. Mark R. Lovell, Ph.D., director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion program, said that athletes may have severe concussion without becoming unconscious. In a report published in The American Journal of Sports Medicine Lovell explained that amnesia and confusion on the field after injury may be as important, if not more important, in making a return-to-play decision.

A GP (general practitioner, primary care physician) or hospital doctor will ask the patient details about the trauma (the blow to the head, the accident). It may be necessary to question the people who accompanied the patient. A neurological examination will also be done, which will include evaluating the patient's:

  • Balance
  • Concentration
  • Coordination
  • Hearing
  • Memory
  • Reflexes
  • Vision

If the patient is over 65 years old, fell from a height of over 3 feet, was involved in a vehicle accident, has been consuming alcohol or drugs, cannot remember what happened 30 minutes or longer after the incident, has short-term memory problems, has been vomiting, had a seizure, has bruising or cuts and scrapes on the head and/or neck, or appears to have a fractured skull, the doctor may order a CT scan.

Glasgow Coma Scale

Doctors often use the Glasgow Coma Scale (GCS) before deciding whether to use a CT scan. The GCS is a way for doctors and nurses to assess the severity of brain damage following a head injury. It scores patients according to verbal responses, motor responses (physical reflexes), and how easily they can open their eyes.

  • Eyes - Glasgow Coma Scale
      Score of 1 - does not open eyes.
      Score of 2 - opens eyes in response to painful stimuli (when given pain).
      Score of 3 - opens eyes in response to voice.
      Score of 4 - opens eyes spontaneously.

     
  • Verbal - Glasgow Coma Scale
      Score of 1 - makes no sound.
      Score of 2 - incomprehensible sounds (mumbles).
      Score of 3 - utters inappropriate words.
      Score of 4 - confused, disorientated.
      Score of 5 - oriented, chats normally.

     
  • Motor (physical reflexes) - Glasgow Coma Scale
      Score of 1 - makes no movements.
      Score of 2 - extension to painful stimuli (straightens limb when given pain).
      Score of 3 - abnormal flexion to painful stimuli (moves in a strange way when given pain).
      Score of 4 - flexion/withdrawal to painful stimuli (moves away when given pain).
      Score of 5 - localizes painful stimuli (can pinpoint where pain is).
      Score of 6 - obeys commands.

     
  • Brain injury will be classified in the Glasgow Coma Scale as:
      Coma = a score of 8 or less.
      Moderate = a score of 9 to 12.
      Minor = a score of 13 or more.

A computerized tomography (CT) scan - this is a medical imaging method that employs tomography. Tomography is the process of generating a two-dimensional image of a slice or section through a 3-dimensional object (a tomogram). The medical device (the machine) is called a CTG scanner; it is a large machine and uses X-rays. A CT scan is generally accepted as better at looking at bleeding in the brain due to injury than an MRI (magnetic resonance imaging) scan. However, an MRI scan measures changes in brain function from concussion, helping structure return-to-play guidelines, researchers from University of Pittsburgh School of Medicine revealed.

Depending on how the doctor has assessed the patient, he/she may have to stay in hospital overnight. If the patient is allowed to go home the doctor will ask somebody to monitor symptoms for at least 24 hours - this may involve waking the patient up at specific times to check for consciousness.

What is the treatment for concussion?

Most concussion or mild traumatic brain injury (MTBI) symptoms will go away without treatment. In the USA approximately 1% of patients with MTBI require surgery.

Sex and prior history - prior history of concussion and gender account for significant differences in test results following injury, researchers from the Department of Orthopaedics at the University of Pittsburgh Medical Center, reported. Because of these differences, the researchers urge physicians and coaches to take an individualized approach to treating people with concussion.

  • Rest - experts say that the most important treatment is rest. It takes time for the brain to recover, which will happen more rapidly if the body is resting and getting a good night's sleep each night. The International Conference on Concussion in Sports stressed that children and teens must be strictly monitored and activities restricted until fully healed. These restrictions include no return to the field of play, no return to school, and no cognitive activity - including academic activities and at-home/social activities including text messaging, video games, and television watching.
     
  • Headaches - acetaminophen (paracetamol, Tylenol) is the best painkiller for headache due to a head injury. Drugs such as aspirin, ibuprofen and other NSAIDs should be avoided because they thin the blood and increase the risk of internal bleeding (hemorrhage).
     
  • Sports - it is important not to return to any sporting activity too soon. If you or your child had concussion, only do so when your doctor says it is OK. A study by researchers at the University of North Carolina, USA, found that athletes engaging in high levels of activity following concussion demonstrated impaired brain function, while those who engaged in moderate levels of activity demonstrated the best performance.
     
  • Alcohol - patients should avoid consuming alcohol, which can impede healing, until all symptoms have completely disappeared.
     
  • Migraine - migraine after concussion may indicate an increased risk of neurocognitive impairment, researchers at the University of Pittsburgh Sports Medicine Concussion Program found. They said that doctors need to exercise increased vigilance when deciding about managing a concussed athlete with post-traumatic migraine. They need to be extremely cautious about deciding when the patient can return to their sport.
     
  • Worsening symptoms - if symptoms worsen patients should see their doctor.

A person with a grade three concussion will probably be hospitalized if symptoms persist.

Concussion and long term depression

In a report authored by Robert C. Cantu, M.D., FACSM and published in Medicine & Science in Sports & Exercise, a study of 2,552 retired professional football players revealed that recurrent sport-related concussion appears to be related to an increased risk of clinical depression in retired professional football players.

Prevention of concussion

  • Helmets and other protective headgear - such activities as cycling, motorcycling, skiing, hokey, horse riding should only be done if you wear protective headgear. It is important to buy new protective headgear - not second-hand ones. Headgear will need to be replaced periodically.
     
  • Seat belt - wearing a seat belt has been proven to massively reduce the risk of head injury during vehicle accidents.
     
  • Driving under influence - avoiding drinking and driving, or driving under the influence of illegal drugs or as well as some medications.
     
  • Mouthguard - a good mouthguard can help prevent concussion in such contact sports as boxing, martial arts, rugby, American football, etc.
     
  • Your home - consider adding lighting to areas that may be hazardous. Be alert for clutter that may cause people to fall over. Most head injuries among very young children and elderly people occur in the home. If there are toddlers in the house place pads on sharp edges of furniture, place a gate on the stairs, install window guards.
     
  • Playgrounds - there should be an underlay of soft material, either sand or special matting.
     
  • Jogging in busy streets - wear bright colored clothing and use both your eyes and ears when crossing the road. Keep to the sidewalk (UK/Ireland/Australia: pavement).
     
  • Cycling at night - make sure your bicycle has good lighting both in front and behind. Wear bright clothing with reflectors.
     
  • Nutrition and exercise - a well balanced diet and plenty of exercise can help maintain good bone mass and bone density. This is especially important for seniors (elderly people) and post-menopausal women. Stronger bones may reduce the severity of brain injury following a blow to the head.


 

New Procedure for Patients with Vertebral Compression Fractures

Vesselplasty, a new minimally invasive procedure, increases mobility and reduces pain and the need for pain killers in patients with vertebral compression fractures (VCFs), according to a study performed at the Hospital Universitario Doctor Peset, Valencia, Spain. Vesselplasty is a new alternative to vertebroplasty and kyphoplasty-two conventional VCF treatment methods. Vesselplasty solves the problem of leakage of cement out of the vertebral body which can happen during both vertebroplasty and kyphoplasty," said Lucia Flors, MD, lead author of the study.

Read more here