We have all heard of concussions, but it seems to be not until recently that concussions are finally taken seriously. Many of our popular sports contain some sort of contact. Football is a very popular sport with many times, full contact. What about other sports such as boxing or mixed martial arts where contact, especially head contact is deliberate? Or in NASCAR’s car accidents involving vehicles traveling close to 200mph? Athletes are putting their brains on the line for their sport.

Over the past several years, many precautions were taken to prevent concussions and further damage to the brain following injury. With the addition of rule changes, or specially formatted helmets and guards, professional sport organizations are making their sports safer. But what about the players outside of professional sports? Student-athletes also play these high contact sports and are just as affected by the risks associated with the sport. So why is this so dangerous? It seems that some athletes aren’t taking concussions seriously enough. A concussion is very different than a sprained ankle or wrist.

The word concussion comes from the Latin concutere meaning “to shake violently” or concussus “action of striking together”. It is a head injury with a temporary loss of brain function which can cause a variety of cognitive, physical and emotional symptoms. A concussion is caused by the striking of the brain up against the inside of the skull. Think of your last ride in a car. When the car stops, your body still moves forward a bit until the body stops completely. With soft braking, your body doesn’t move all that much. Our brains are surrounded by cerebrospinal fluid which protects it from light trauma and brain movement, just like this soft braking. The cerebrospinal fluid, however, cannot always protect the brain when it comes to hard trauma.

Now think of hitting your head against the wall. The wall is not moving, but your head is. When you head strikes the wall, it is immediately stopped. Your brain, inside your skull, however, is still moving forward, and strikes the inside of your skull, causing it to completely stop motion. This hard strike, can lead to a concussion.

Concussions don’t always occur during only sport related accidents, but can happen during any accident; a trip or fall, car accident. The symptoms can include headache, dizziness, nausea, vomiting, lack of motor coordination, difficulty balancing, light sensitivity, blurred vision, double vision, confusion, disorientation, and loss of consciousness. A concussion is a diffuse brain injury, meaning that it spreads away from the site of injury. The injury could affect the upper brain stem, the fornix, the corpus callosum, temporal lobe, frontal lobe, midbrain or diencephalon.

The pathophysiology of a brain injury such as this is impaired neurotransmission, loss of ionic regulation, deregulation of energy use and cellular metabolism and reduction in cerebral blood flow.
Upon injury, excitatory neurotransmitters (like glutamate that stimulate nerve cells) are released in excess. This then causes the neurons to fire excessively which then leads to an imbalance of Potassium and Calcium ions across membranes. Too much positively charged ions causes ion pumps to activate to try and restore ionic balance. These ion pumps need energy to run, so now there is an increase in energy use. More glucose must be pumped into the brain to create ATP for the cells. The brain runs like this for days, or weeks, following a brain injury.

Just to add to the chaos, for some unknown reason, the cerebral blood flow decreases, meaning that the cells are not receiving enough glucose to compensate for their increased energy demands. This causes a reduction in mitochondrial activity and a switch over to anaerobic metabolism. This decrease in blood flow can cause some nerve cells to die.
Brain analysis of dead NFL athletes who received concussions in the past, suggest that there may be lasting damage long after the concussion has “healed”. Boxers are extensively studied because of the high occurrence of head related injuries. Up to 20% of professional boxers develop neuropsychiatric issues. Some 10-20% develop persistent neuropsychiatric impairments.

There can be cumulative damage from more than one concussion. This can include longer recovery times (more than the three weeks it can normally take), psychiatric disorders and loss of long term memory. The risk of developing clinical depression has found to be greater. There is also a fivefold chance of developing Alzheimers and a threefold chance of memory deficits.
There is also a chance of what’s called dementia pugilistica. This has also been referred to as “punch drunk” syndrome in boxers. This leads to symptoms of parkinsonism, speech and memory problems, slower mental processes, tremor and inappropriate behavior.

Another complication, called second-impact syndrome is when someone receives another blow to the head before the original damage has cleared up and the brain swells to dangerous sizes. It’s believed that the swelling occurs because the brain arterioles lose the ability to regulate diameter causing a loss of control over cerebral blood flow.  The brain swells and the intracranial pressure rises rapidly. The brain herniates and the brain stem can fail within five minutes. This is rare but is often fatal. Except in boxing, all cases are in athletes under the age of 20.
Dr. Hayley Queller, a primary care sports medicine physicial in East Setauket, Long Island works with many student-athletes. The issue with student-athletes is they often receive a brain injury, shrug it off and go back into the game or play again in a few days, increasing the risk for another, more sreious injury. Dr Queller had developed an idea that is currently being used in about 15 New York school districts. This idea uses baseline testing for all athletes. All athletes must get their neurocognitive status measures including memory, reaction time, and motor speed. If a concussion is suspected, the athlete is tested again and compared to their individual baselines to determine treatment and recovery time.
Better safety measures are necessary and it is not unwarranted that many school districts here on Long Island are looking very closely at concussion incidents and responses to the condition. It’s especially important for those student-athletes with brains that are still developing. Sports may be fun to play, as long as all precautions are taken.