As Canadians, athletes are our celebrities. They win us championships and gain us worldwide recognition. They put our cities on the map and encourage future generations to continue their success. Because the retirement age for most sports is fairly young, we rarely hear about our celebrity athletes after they leave their sport. Hockey players, football players and boxers all sustain tremendous amounts of head trauma over their career. Repetitive brain injury creates lasting effects on their physical and mental health, which we rarely hear about on the news.
The Anatomy of the Brain
The brain is a vital organ surrounded by numerous layers of protection within our skull. The nutrient-dense cerebrospinal fluid (CSF) bathes the brain and cushions it against the walls of the skull. For most movements of the head, the CSF protects the brain from injury. When an individual sustains head trauma, the brain rattles within the skull and can create an altered mental state. Depending on the intensity of the trauma, the injury can include bleeding in the brain, loss of consciousness and skull fracture.
Concussion
Concussion is one of the many terms that falls under the umbrella of Traumatic Brain Injury (TBI). These other terms may include contusion, second impact syndrome and penetrating injury. At the end of the day, the treatment for all forms of TBI is exactly the same.
In the moment, signs of a TBI can include headaches, loss of consciousness, ringing in the ears, dizziness and vomiting. This may warrant a visit to the hospital or doctor’s office.
However, medical doctors are very limited in their management of head trauma. The current concussion guidelines suggest that rest, anti-inflammatories and avoidance of screen time are the best tools.
Post-Concussion Syndrome
After a few weeks, the initial symptoms may have improved, but a vast array of symptoms can arise that are known as post-concussion syndrome. At this point, a patient may feel irritable, depressed, anxious, fatigued or sensitive to light. They may have trouble thinking, focusing and sleeping at night. Post-concussion syndrome can last for weeks or years and largely depends on the resilience of the person and the area of the brain affected. A small percentage of patients will be referred to a neurologist who will follow their progress with brain imaging. However the bulk of this patient base is given the diagnosis of post-concussion syndrome and sent on their way.
What Brain Imaging Shows
The best way to investigate TBI is through brain CT and MRI. Brain CT’s are important for diagnosing skull fractures, focal brain injuries and intracerebral bleeding. They are not detailed enough to show small injuries that are common with mild TBI. These smaller injuries are often the ones that take longer to repair and produce more clinically significant symptoms. Brain MRI’s have become much more sensitive over time and are able to detect microbleeds within fragile brain structure. MRI’s are great for research purposes, however the availability in the clinical setting renders them less useful. In some parts of the country, a wait for an MRI can be months.
Are blood tests useful?
Blood testing can be useful for determining the downstream effects of concussion but are less relevant in the diagnosis. Because fragile organs such as the hypothalamus and pituitary gland sit in the brain, they can alter hormone levels in the body if they are damaged. Blood work will often show hormone abnormalities shortly after concussion and will normalize within 3 months. If there is sustained injury to these endocrine glands, hormone therapy may be implemented to mitigate these effects.
Future: Managing Recovery and the Importance of Natural Medicine
Concussion and TBI are very broad topics with lots of information to discuss. Next week, we will discuss how to manage recovery and why natural medicine is SO crucial to the healing phase after head trauma.