Ankle sprain – we elevate, ice, rest…take care of it, maybe even pamper it. Yet when we bruise our brains, we shake it off and think it’s not a big deal!

Think again…

A mild traumatic brain injury or concussion occurs when some type of force causes the brain to move about in the skull. The brain can either strike the inside of the skull or there can be a strain or stretching of the blood vessels or nerves inside the brain. This can cause a variety of physical, psychosocial, or cognitive symptoms that often resolve within a few days. There does not have to be a loss of consciousness.

Common symptoms of concussion may include:

• Headache
• Dizziness
• Fatigue
• Mental “fogginess”
• Irritability
• Problems concentrating

If these symptoms do not resolve in a few days, they may persist for weeks or months, and possibly longer. This is called post-concussive syndrome.

Second Impact Syndrome (SIS) is a rare condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. Even the mildest concussion can lead to SIS. The condition is often fatal or can lead to severe disability. The cause of SIS is uncertain, but it is thought that the brain’s arterioles (small blood vessels) lose their ability to expand and contract. Therefore, they lose control over blood flow to the brain, which causes massive brain swelling.

Another serious long-term outcome of repetitive brain injury is chronic traumatic encephalopathy (CTE). This is a progressive, degenerative brain disease. Symptoms may not occur until years after the brain injury. Early symptoms of CTE include problems with short-term memory and executive functions such as planning, organizing, and multi-tasking; depression or apathy; issues with impulse control (e.g. having a “short fuse”). Suicidal behavior may also be present. As the disease progresses, the symptoms become much worse, and eventually lead to dementia.

CTE has been found in people with a history of repetitive brain injury; however, its victims are not only people involved in sports. It has also been found in someone with a seizure disorder, a victim of physical abuse, and even a circus clown. Members of our military are also exposed to repeated brain trauma from blasts and other causes.

Although a history of repetitive brain injury must be present for a diagnosis of CTE, not all people with this history develop CTE. There are several potential risk factors for developing CTE including:

• Genetics
• Family history (e.g. family history of dementia)
• Type of brain injuries sustained
• Age brain injury occurred and the overall length of time for exposure to brain injury (e.g. months, years, etc.)
• Frequency of brain injuries and the amount of “rest” between injuries
• Chronic inflammation associated with conditions such as obesity, high blood pressure, diabetes, and heart disease
• Cognitive reserve (basically the ability of the brain to continue to function well in spite of underlying disease – it may take longer for someone with more cognitive reserve to display symptoms)
• Gender (women may be at greater risk than men for developing CTE, even with the same exposure to brain injury)
• Race

The Veterans Affairs Center for the Study of Traumatic Encephalopathy (brain disease) (VA CSTE) was established in 2008 at the Bedford Veterans Administration Medical Center in Bedford, MA. Its purpose is to collect and study post-mortem human brains and spinal cord tissue in order to understand the effects of trauma on the human nervous system. The VA CSTE brain bank acquires tissue samples and clinical information from deceased athletes.

Hopefully, the research done here will result in helping to establish diagnostic testing for CTE in living persons, identifying CTE risk factors, and developing treatment for CTE.

Still think it’s just a concussion?

Jane Heron RN MBA is a legal nurse consultant at Med League. She recently presented a program on head injuries to a group of attorneys. She prepares detailed chronologies to help attorneys hone in on the medical injuries that result from head trauma.