Concussion

Concussion of the brain ICD-10 code: S06.0 ICD-9 code: 850 Concussion, or mild traumatic brain injury (MTBI), is the most common and least serious type of brain injury. A milder type of diffuse axonal injury, concussion involves a transient loss of mental function. It can be caused by acceleration or deceleration forces, by a direct blow, or by penetrating injuries. Contents 1 Pathophysiology 2 Symptoms 3 Grades 4 Lasting effects 5 Second Impact Syndrome 6 See also 7 References Pathophysiology The brain floats within the skull surrounded by cerebrospinal fluid (CSF), one of the functions of which is to cushion the brain from light bounces of everyday movement. However, the fluid may not be able to absorb the force of a sudden hard blow or a quick stop. Concussion is considered a type of diffuse, as opposed to focal, brain injury, meaning that the dysfunction occurs over a more widespread area of the brain. Excitatory neurotransmitters are released as the result of the traumatic injury and cause the brain to enter a state of hypermetabolism which can last for 7 to 10 days (Orlando Regional Healthcare, 2004). During this time, the brain needs extra nutrients and is especially sensitive to inadequate blood flow. Areas of the brain whose function is commonly disturbed in concussion include the reticular formation or the deep structures of the brain, the brainstem or cortices (Dawodu, 2004). Damage to cranial nerves and other white matter tracts may be temporary or permanent (BIAUSA). Other theories hold that concussion is a diffuse injury affecting all parts of the brain, caused by physical trauma that alters neuronal metabolism and excitability through molecular commotion. Having a concussion does not mean that the patient does not have another brain injury as well; in fact, concussion almost always accompanies more serious brain trauma (University of Vermont). Symptoms Symptoms of concussion can include a period of unconsciousness for less than 30 minutes (Smith and Greenwald, 2003), vomiting, confusion, and visual disturbances. Amnesia, the hallmark sign of concussion, can be retrograde amnesia (loss of memories that were formed before the injury) or anterograde amnesia (loss of memories formed post-injury) (Orlando Regional Healthcare, 2004). Patients with concussion may act confused, for example repeating the same sentences or forgetting where they are. Patients with concussion may have focal neurological deficits, signs that a specific part of the brain is not working correctly (Boone and De Montfort, 2002). Since concussions do not include damage to the brain’s structure, the condition of patients with uncomplicated concussions always either improves or stay the same. Thus, a deteriorating level of consciousness means that the patient has another problem such as a worse type of head injury. Similarly, persistent vomiting, worsening headache, and increasing disorientation are all indicative of a rise in intracranial pressure (ICP) (Bernhardt, 2004). Grades Concussion is classified into five grades, with the mildest, grade I, involving only confusion (Shepherd, 2004). Grade II involves anterograde amnesia that lasts less than five minutes as well as confusion, and grade III involves those symptoms plus retrograde amnesia and unconsciousness for less than five minutes (Shepherd, 2004). Grades IV and V include those symptoms with unconsciousness that lasts between 5 and 10 minutes and longer than 10 minutes respectively (Shepherd, 2004). Lasting effects Some concussions can have serious, lasting effects. The symptoms of most concussions are resolved in 48 to 72 hours, but in up to 30% of patients, problems persist (Tolias and Sgouros, 2003; Shepherd, 2004). In postconcussive syndrome (PCS), concussion symptoms persist, and the patient may have headaches, light and sound sensitivity, memory and attention problems, dizziness, difficulty with directed movements, depression, and anxiety. Symptoms usually peak 4 to 6 weeks after the concussion, but may go on longer, some even lasting a year or more (Shepherd, 2004). Postconcussion syndrome is not necessarily more likely to occur with more severe concussions (Tolias and Sgouros, 2003). Children commonly experience more severe symptoms of postconcussion syndrome than adults do (Shepherd, 2004). Physical therapy plus rest is the best recovery technique. Multiple small head injuries that daze the patient can also result in cognitive and physical deficits that occur in what is commonly known as dementia pugilistica, or "punch drunk" syndrome, which is associated with boxers (Drake and Cifu, 2004). Second Impact Syndrome If a patient receives a second blow days or weeks after another concussion, before concussion symptoms have gone away, he or she is at risk of developing Second Impact Syndrome (SIS) or recurrent traumatic brain injury. In this rare condition, the brain swells dangerously after a minor blow. No one is certain of the cause of this often fatal complication, but some think the swelling is due to the brain’s arterioles’ loss of ability to regulate their diameter, and therefore a loss of control over cerebral blood flow (Tolias and Sgouros, 2003). In this dangerous condition, intracranial pressure rapidly rises, the brain can herniate, and brainstem failure can occur within five minutes (Drake and Cifu, 2004). When this condition occurs, surgery does not help and there is little hope for recovery (Tolias and Sgouros, 2003). When it is not fatal, the patient can experience persistent muscle spasms and tenseness, emotional instability, hallucinations, and cognitive problems (BAIUSA). The condition is so rare, only 35 cases were recorded in a 13 year period in football injuries, not all of which were confirmed to be due to SIS (Drake and Cifu, 2004). See also Head injury Brain injury References Bernhardt D. 2004. "Concussion." Emedicine.com. Available. Boon R and de Montfor GJ. 2002. "Brain Injury." Learning Discoveries Psychological Services. Learningdiscoveries.org. Brain Injury Association of America (BIAUSA). "Types of Brain Injury." Dawodu S. 2004. "Traumatic Brain Injury: Definition, Epidemiology, Pathophysiology" Emedicine.com. Drake D and Cifu D. 2004. "Repetitive Head Injury Syndrome." Emedicine.com. Graham DI and Gennareli TA. Chapter 5, "Pathology of Brain Damage After Head Injury" In, Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York. NCERx. 2005. Brain Trauma, Subdural Hematoma and Dementia Pugilistica. About-dementia.com. Orlando Regional Healthcare, Education and Development. 2004. "Overview of Adult Traumatic Brain Injuries." Shepherd S. 2004. "Head Trauma." Emedicine.com. Tolias C and Sgouros S. 2003. "Initial Evaluation and Management of CNS Injury." University of Vermont College of Medicine. "Neuropathology: Trauma to the CNS."he:זעזוע מוח Search Term: "Concussion_of_the_brain" Categories: Neurotrauma

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