Concussion

[tomahawk6]

The Army Times this week ran article about concussion injuries which I found to be rather interesting. As it is a subscriber only article I will post excerpts.

"But something was wrong. In the weeks following the blast, Bradley began forgetting what other Marines had just told him. He struggled to handle more than one task at a time. Taste and smell disappeared. Worst of all, so did the name of his soon-to-be-born daughter, Addison. Bradley said he had to dig through letters from home to remember it.

He was eventually flown to a battlefield hospital where he was diagnosed with a concussion — his second in the Iraq war and the third of his life. Bradley learned that what he thought was post-nasal drip was leaking spinal fluid.

By January, he was back at Camp Pendleton, Calif. Doctors told him his brain may never fully recover, and his career in the Marine Corps is in doubt."

And.

"The number of concussions keeps rising. Almost 30 percent of the patients admitted to Walter Reed Army Medical Center in Washington, D.C., have brain injuries."

Link to the Brain Injury center.

http://www.dvbic.org/

http://www.vnis.com/story.cfm?textnewsid=1457

What is a concussion?
Concussions occur when a blow to the head jars the brain, triggering disorientation and sometimes more severe effects. Symptoms include loss of consciousness, trouble remembering, confusion, dizziness, lightheadedness, vertigo, blurred or double vision, and ringing in the ears. Physicians determine the severity of a concussion by reviewing the length of time a person is disoriented, length of unconsciousness and amount of memory loss.

• Mild. Characterized by confusion and no loss of consciousness. Symptoms vanish in less than 15 minutes.

• Moderate. Confusion that lasts more than 15 minutes and loss of consciousness for less than five minutes.

• Severe. Loss of consciousness for more than five minutes. Symptoms, including amnesia, persist for more than 24 hours.

 

[paracowboy]

Mild. Characterized by confusion and no loss of consciousness. Symptoms vanish in less than 15 minutes.

Been there.

Moderate. Confusion that lasts more than 15 minutes and loss of consciousness for less than five minutes.

Been there, too.

Severe. Loss of consciousness for more than five minutes. Symptoms, including amnesia, persist for more than 24 hours.

Been there, also.

Explains a lot, don't it?

 

[tomahawk6]

Any of the above could also explain a long night of drinking. ;D

 

[medicineman]

One could be a result of the other - though you might have to hunt down witnesses to get the facts straight.

MM

 

[GAP]

paracowboy

Mild. Characterized by confusion and no loss of consciousness. Symptoms vanish in less than 15 minutes.

Been there.

Moderate. Confusion that lasts more than 15 minutes and loss of consciousness for less than five minutes

Been there, too

Severe. Loss of consciousness for more than five minutes. Symptoms, including amnesia, persist for more than 24 hours.

Been there, also.

Explains a lot, don't it?

tomahawk6
Any of the above could also explain a long night of drinking.

Son-of-a-gun....sorry paracowboy! That explains "Re: Good Sports Bras ie: boob talk " A concusion can be the only thing that explains you being accused of impuning the honour of those poor little waifs. You were just trying to help  ....sorry....sorry..  ;D

 

[Hot Lips]

One could be a result of the other - though you might have to hunt down witnesses to get the facts straight.

MM

LMAO indeed MM...indeed

HL

 

[Hot Lips]

Son-of-a-gun....sorry paracowboy! That explains "Re: Good Sports Bras ie: boob talk " A concusion can be the only thing that explains you being accused of impuning the honour of those poor little waifs. You were just trying to help  ....sorry....sorry..  ;D

> > >

Plain and simple  :rofl:

HL

 

[Hot Lips]

Seriously... t6

I vaguely recall seeing that topic on television most recently...I believe it was just an exurb on the news...
Indeed serious business...smashing the brain around repetitively does indeed come with unpleasant and sometimes life long repercussions.

HL

 

[tomahawk6]

Its an injury that is overlooked,but with the number of IED blasts this is going to be a very important issue for commanders and the medical corps.

 

[medicineman]

It is indeed often overlooked - despite some of the signs/symptoms of primary and secondary blast trauma pointing toward the full gammit of concussion syndromes. 

MM

 

[Sawbones]

What can be confusing is that the symptoms of PTSD and post-concussion syndrome (PCS) overlap - or can be present in the same patient.  When PTSD is coincident with post concussion syndrome, the additional anxiety and distress produced by the PTSD symptoms  can make the concussion appear much worse.  There is no simple lab or X-ray test to sort this out, referral to a psychiatrist/traumatologist and/or neurologist may be necessary - hence one of the needs for the brain injury centres.

Keep an open mind about casualties with apparently "minor" traumatic brain injuries, they need followup.  When you screen for PCS and PTSD in these patients, you will find more that you might expect having problems weeks to months later.  Most will get better, but sometimes with more distress and confusion than necessary.

Sawbones

 

[MommyMedic]

Is there a screening tool for diagnosing post-concussive syndrome? Is it important to recognize it, in that it can change pt outcome by altering a chosen course of treatment? (In patients with just PCS)

 

[CF Doc]

Cool subject!

It is always important in my opinion to try and "get the diagnosis" (although not always possible), so yes it is important to diagnose PCS.

Unfortunately, post concussion syndrome (PCS) can not be treated per se (although the benefits of therapy are inconclusive at the present- as far as I know), but it's still important.

Why?  Well, mostly with regards to differentiating it from other possible problems (encephalitis, stroke, infection...)  where some of these other conditions can be treatable to varying degrees.  Think of the guy with the runny nose, he had most likely a basal skull fracture.  This can potentially lead to infection which can in turn lead to meningitis, encephalitis, stroke... all of which could cause some degree of PCS like symptoms.

For example, in a patient with a negative history of head trauma (direct or indirect) and a negative battery of screening tests (for the other conditions as they might apply) one would most likely dig a little deeper for a diagnosis, perhaps even trial a therapy.  If the patient does however have a positive history of head trauma, then potentially unnecessary and even at times risky tests and treatments might be avoided. (the "I put 2 and 2 together" rule)

There is also the whole medico-legal reasons for a diagnosis of PCS... causality, for compensation and benefits potentially.

As for screening tools, as mentioned previously the history of head trauma is probably your most important factor, then your exams (head and neck, neuro, MSE) and imaging (looking for fractures, hemorrhage, structural changes...) come into play.  A good follow-up is necessary as some patients present with symptoms later on.  I've cared for people who had sustained head trauma when they were younger and now present with an early dementia as their only sign.

Some might argue that this might not be related, but just take a look at Muhammad Ali and his Parkinson's... coincidence?  Perhaps, but I always wear my bike helmet!

Congrats to Cher for raising awareness of concussive trauma in battle and otherwise.

I hope I didn't go too far off topic again!?  :

 

[the 48th regulator]

Fantastic thread.

Considering the type of head Injury that I have received, and the diagnosis for PTSD. I am going to follow this thread with interest..

dileas

tess

 

[3rd Horseman]

I second that 48th.

  In the old days (ww1) they called it concussion sickness or sometimes viewed as shell shock. Blast effects and head injuries are close symptoms to PTSD. As 48th has said I am in the same boat as he and I was not diagnosed with traumatic brain injury until too late. I was labeled with PTSD. Now I had a little of that to but the main injury was a massive head injury that was never treated just sluffed off as PTSD. I can say I mirrored the same symptoms, spinal fluid leaking through the nose and ears was just a little head cold that would go away. Well it never did. I have my psychologist to thank for diagnosing the brain injury not my doc.