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Glenn D. Braunstein, M.D. Headshot

Does a Head Injury Continue to Affect Cognitive Function?

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Last week, a Chino Hills high school quarterback was taken to the hospital after being rendered unconscious from being hit while running with the ball. Fortunately, he woke up and was able to be discharged from the hospital without suffering major neurological damage. This is a reminder that football season is here, giving us the opportunity to watch the end zone antics, head butts ... and a player suffering an occasional concussion. One of the biggest problems with concussions is a simple lack of respect for the gravity of the condition. A concussion is an injury to the brain caused by a sudden impact to, or spin of the head during which the brain (a soft organ) is shaken so hard that the buffering cerebral spinal fluid surrounding it can't prevent it from banging against the hard skull. This trauma causes the brain to go into shock and temporarily stop working properly, affecting memory, judgment, coordination and other neurological functions.

The most common causes are motor vehicle accidents and contact sports, especially football, soccer, ice hockey and boxing. (In October, L.A. Kings defenseman Drew Doughty suffered a concussion that kept him off the ice for a few weeks.) Contrary to popular belief, a person does not have to lose consciousness to suffer a concussion. Concussions can often be incorrectly diagnosed, not diagnosed at all, or worse, even when they are diagnosed, can be dismissed with, "I just have a headache, it'll go away," or "I'm a little dizzy. No big deal." It is a big deal. It's a brain injury, and the effects can reach far beyond the next quarter, the next game or even the next decade. In fact, one study showed that former NFL players had a higher incidence of Alzheimer's disease and other conditions associated with cognitive impairment, and developed these problems at a younger age than the national average.

After one concussion, a patient can be four times more likely to suffer another concussion, and repeat injuries can be caused by less of a blow and will require more time to heal. Teenagers in particular are more susceptible to this second impact risk because teen brain tissue is less developed than adult brain tissue, and more easily damaged. This is why it's so important for a teenager who's received a concussion to heal completely before returning to any kind of intense physical activity. Since 1997, at least 50 football players, high school age or younger, in more than 20 states have been killed or have received serious head injuries on the field.

This also is why parents, coaches and trainers of kids engaged in any kind of sport are encouraged to learn the symptoms of concussion. These include headache, confusion, blurred vision, memory loss, nausea, vomiting, slurred speech, disorientation, personality changes and somnolence leading to frank coma. Emotional changes are as important to watch for as physical ones. A study of retired athletes showed that depression was three times more common in players who had experienced concussions than in players who had not.

Because concussions can have so many nuances, the American Academy of Neurology (AAN) has established five grades of concussion, in ascending severity, from I to V. Symptoms range respectively from unconsciousness for varying amounts of time to confusion, disorientation and also loss of memory, either about events immediately before (antrograde amnesia) or immediately after (post-traumatic amnesia) the event. One high school athlete who had experienced a concussion went immediately back into play, but the next day had no memory of what had happened in the game after he was injured. This meant he was playing with at least a grade III injury.

Even if there are no symptoms right after an injury, there may be bleeding in the narrow space between the brain and the skull. Symptoms of such brain bleeding, known as a subdural hematoma, may not be present until several weeks afterward. During this "lucid interval" as the blood is broken down, it acts like a sponge drawing fluid into the closed space, causing the clot area to expand. As time goes on, pressure in the brain increases, and it can push tissue in ways that actually deform the brain and can cause more injury. This results in headaches of increasing intensity, vomiting, dizziness, confusion, pupils of unequal size, weakness on one side of the body, increased blood pressure and, if left untreated, seizures and death.

With concussions, there's also a danger of post-concussion syndrome, in which the symptoms don't resolve for weeks, months or even years, creating the potential for permanent long-term damage.

So when you hear teenage football players who are asked if they would tell their coach if they got a head injury, say, "No chance. You've got to sacrifice for the sake of the team. The only way I come out is on a stretcher!" it should give you pause.

If anyone close to you, especially your soccer-football-baseball-gymnastics or even chess-playing son or daughter, gets "dinged" in a game (or anywhere else), and is answering you more slowly than usual or can't remember what you just told him (or her) to do, maybe it's not the normal, "Whatever, Mom (or Dad)" reaction. Maybe something is wrong, and just this once it might be wise to "get into their head."

Around the Web

Concussion: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Concussion - MayoClinic.com