For the week of January 13, 1999   thru January 19, 1999  

Shake off that bell-ringer?

Injuries to the brain are always serious

Express Staff Writer

If the stories some dazed and confused concussion victims have told the Sun Valley Ski Patrol were true, Grover Cleveland would be president, Bald Mountain would be in Squaw Valley, and Anchorage would be the capitol of the United States.

"We see about four or five concussions a week," said Sun Valley Ski Patrolman Brian Dirksmeier.

Most of us have taken a spill, hit our head and felt a little out of whack. And most of the time we know we have a concussion, but we shake off the disorientation and accept that we ‘had our bell rung.’

If concussions were called brain injuries, though, which is what they are, they would probably not be taken so lightly, and we would report directly to a physician.

Information on concussions is readily available in books written for the layman and even on the Internet.

The word concussion comes from the Latin concutere, which means to strike together. That striking together, however minor, is a wound to the tissue of the brain, an organ very few of us, save for a few fanatical boxers, want to put at risk.

Concussions occur when the body is moving rapidly through space and suddenly stops. The brain is traveling at the same speed as the rest of the body, so when the body stops, the brain continues to move at the same speed in the same direction.

The brain then hits the skull and bounces back, hitting the opposite side of the skull until it loses momentum in the soup of neural-spinal fluid.

When it strikes the skull, a portion of the brain is damaged. That’s when things can get hazy for the victim. That’s also when it’s a good idea to check in with a doctor.

The bell-ringing is always serious if it is one of several occurrences, because the effects of repeated blows are cumulative. One blow is intensified by the effects of the previous one.

Thus, someone who has taken severe head blows in the past may experience concussion symptoms from only a mild bump. That can result in cumulative sensory and cognitive defects.

Consider the plight of ice hockey star Brett Lindros. In 1996, at the age of 21, the New York Islander had his promising career cut short because of his inventory of concussions. Doctors beseeched the left wing to call it quits in order to save his sanity. For Brett, whose brother Eric is the captain of the Philadelphia Flyers, successive blows—even minor ones—produced more severe symptoms. His disorientation sidelined him for longer and longer periods, causing him to miss a total of 64 games.

Management of head injuries of this sort is not an exact science. Doctors continue to debate classification and treatment approaches for concussions. Doctors also have a tricky time balancing their on-the-scene observations of the victim with the victim’s personal, often dazed account of what he or she is truly feeling.

Most doctors opt for a system that grades concussions from 1 to 3.

A Grade 1 concussion is the most common and the most difficult to recognize. With this mild bruising to brain tissue, there is no loss of consciousness or memory loss, but the victim may for a moment act stunned or dazed. Sensory difficulties usually clear within one minute.

The danger with those mild concussions is that, unnoticed, the victim may jump right back into action and risk a second head blow, which, cumulatively, could cause more severe damage. According to the American Academy of Neurology, anyone who suffers two blows to the head within a short time is at severe risk of sudden, irreversible, fatal brain swelling known as second-impact syndrome.

The difference between a Grade 2 and a Grade 1 concussion is the presence of memory loss. After sustaining the injury, the victim does not remember the events following the impact and may not be able to recall preceding events. Other symptoms include tinnitus (ringing in the ears), irritability and dizziness.

This is the most common concussion seen by the Sun Valley Ski Patrol. Patrolman Dirksmeier said most concussion victims treated by the patrol have no memory of the accident.

"Since their short-term memory is impaired, they keep asking, ‘What happened to me?’ You tell them, and they ask again a few minutes later, ‘What happened to me?’" Dirksmeier said.

Grade 3 concussions are easier to detect because of the presence of some lost consciousness. Victims of these head-bangers usually do—and should—take a ride on a stretcher to the nearest emergency room. A test for neck injuries should be performed.

Then, a neurological exam is performed, which includes checks for speech and vision impairment, memory loss and numbness. If the neurological exam is negative, the victim can usually go home, but only if there is someone who can check in to insure against swelling and loss of consciousness.

Dr. Dan Fairman, of Wood River Medical Center in Sun Valley, said that on a recent Monday, there were three concussion cases in the emergency room, all ski-related. He pointed out that skiers can substantially reduce their risk of concussions by wearing a helmet.

Fairman said he administers a basic neurological exam on concussion victims.

"I ask them who they are and time and place information," he said. "I also assess their memory. I might tell them my name and ask them again what it is a few minutes later."

One victim, a "highly functional lawyer," according to Fairman, could not recall three objects—a dog, tree and a car—minutes after Fairman asked him to do so.

After the bell rings, there is a chance that post-concussive syndrome may develop. It is characterized by headaches, inability to concentrate, irritability and fatigue. These symptoms usually appear within 48 hours and may last for weeks or months. There is no definitive treatment other than to control the symptoms and limit physical activities.

According to Fairman, it is a fallacy that concussion victims should not be allowed to sleep after the head trauma.

"They should just be checked after two to four hours to look for signs of swelling, which can lead to loss of consciousness," he said.

Symptoms to watch for include persistent vomiting, change in vision, confusion, motor impairment, or any type of unusual behavior.


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