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Concussion Management for Healthcare Professionals: Summary
• Chronic Traumatic Encephalopathy • Second Impact Syndrome • Post-Concussive Symptoms
INTRODUCTION
These symptoms can range from issues relating to the neck to issues with vision. Basically, any type of symptom could be related to concussion. Second Impact Syndrome Second Impact Syndrome (SIS) is a term used in cranial traumatology during sports. It is defined by the occurrence of a cascade of clinical events, most frequently leading to dramatic brain lesions without any measure of the observed impact. Second impact syndrome is a condition in which an individual experiences a second head injury before completely recovering from a prior head injury. Symptoms include: • Diffused swelling • Hematoma/bleeding Secondary impact syndrome usually occurs when someone goes back to competition before their brain heals and they sustain another concussion. It is thought to be a severe result of repeated head injuries in sports. This condition is mostly seen in people <25 years (males, especially those who play football) and under. It is a rare but deadly condition. The lesions observed in SIS are very hard to determine and analyze their root causes. Chronic Traumatic Encephalopathy (CTE) CTE correlates with subconcussive impacts to potentially lead to long-term issues. The pathology of CTE is unique. It is considered to be a unique brain lesion seen in head injuries, marked by tau protein buildup around blood vessels and in the folds of the brain's surface. This pattern differs from what is seen in aging or Alzheimer's disease. The tau protein tends to accumulate around blood vessels and in the grooves of the brain's surface. These areas are particularly vulnerable to damage when the head experiences an impact. CTE can be definitively diagnosed only by postmortem neuropathological examination. The corresponding clinical condition is known as traumatic encephalopathy syndrome (TES). The side effects are a result of inflammation and the TAU protein, including vision, balance/postural instability, and vestibulocochlear effects. ANATOMY OF THE BRAIN The brain is divided into four sections: • Cerebrum : Voluntary muscle activities, interprets sensory impulses, controls higher mental functions (memory, reasoning, emotions, etc.) • Cerebellum : Movements of skeletal muscle, coordination of voluntary muscular movements • Pons : Sleep, posture, respiration, swallowing, and the bladder • Medulla oblongata : Regulates heart rate, breathing, blood pressure, etc.
WHAT IS A CONCUSSION? A concussion is a traumatic brain injury either with or without loss of consciousness that occurs when an external biomechanical force to the head, neck, or body is transmitted to the head and impairs brain function. When symptoms and disabilities associated with concussion persist, it is known as post-concussion syndrome (PCS). Concussions constitute between 3.65% and 13.1% of all sport-related injuries. A number of concussions go unreported, so the true annual incidence is likely to be 40% higher because college athletes knowingly hide symptoms of their concussion and choose not to report it. LEARNING TIP!
In the 13th century, a notable figure in neurotrauma, Guido Lanfranchi, emerged. He identified concussion as a distinct condition and explained that the temporary disappearance of symptoms after an injury was due to transient paralysis caused by the brain being shaken. This concept, labeled as commotion, was crucial for the later physiological understanding of concussion.
Hippocrates was the first to associate head injury with difficulties of speech, hearing, and sight. EPIDEMIOLOGY Concussions are unique to every individual. Assessment of concussions is important due to acknowledging their existence and making sure they are treated like other injuries to the body in order to allow the brain a proper amount of time to heal. Mild Traumatic Brain Injuries (MTBIs) are starting to show signs of recovery similar to other injuries in the body. Bruising of the brain can lead to brain diseases and dysfunctions. Symptoms vary, including: • Headaches • Dizziness • Blurred vision • Issues with immediate and long-term memory • Problems with balance • Double vision • Problems with fine motor skills Traumatic brain injuries (TBIs) are often referred to as the ‘silent epidemic.’ This is because many injuries go unrecognized and are excluded from epidemiological data. Concussions can lead to long-term neurological conditions, such as:
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