Question: During the recent General Assembly session there was discussion of changing rules governing high school athletics. Specifically some legislators wanted to stipulate that a high school athlete can not come back onto the playing field after suffering a concussion until he or she been cleared by a physician. What exactly happens with a concussion? And is it dangerous for an athlete to reenter a game after he or she has suffered one?

Answer: A concussion occurs when there is a contact injury or sudden acceleration to the head. The brain normally floats in a small amount of fluid which is protected by layers of tissue and the skull. When a severe force causes the brain to move very quickly within the fluid it can become injured. Swelling within the brain alters the normal function of brain cells and their chemicals.

Concussions are graded by physicians depending on their severity. A Grade I concussion occurs when there is confusion but no loss of consciousness. In Grade II concussions there is also some degree of amnesia. If there is any loss of consciousness then it is considered Grade III.

Although confusion is the primary symptom, many others such as headache, dizziness, ringing in ears, blurred vision, nausea and light sensitivity often occur. In some severe cases seizures can also occur. In general the more severe the concussion the more symptoms will occur and the symptoms will last longer.

It is important to closely monitor someone who has had a concussion to make sure there is not a more severe brain injury resulting in bleeding within or around the brain. Bleeding can result in compression of the brain and potentially lead to death. For this reason you should make sure the injured individual is alert and can be aroused every hour for the first 24 hours.

The reason it is dangerous for an athlete to return to play after a concussion is because of the risk for a condition called second impact syndrome. With this condition a second, even minor, impact to the head can cause severe swelling of the brain and even lead to death. The risk of this condition is greatest when an athlete returns to play prior to all concussion symptoms disappearing or when multiple concussions occur.

Return-to-play guidelines are controversial, however they have become stricter in recent years for athletes of all ages. An athlete with even a mild concussion should not return to play the same day as the injury. For grade II and grade III concussions with loss of consciousness for only a few seconds the athlete can return to activity only after being symptom free for two weeks. The return to activity begins with some type of aerobic exercise. If they remain symptom free then they can resume practice. For more severe grade III concussions or after a second grade II in the same season, the athlete must remain out for 1 month after being symptom free.

In summary it is important to be very cautious when treating athletes with concussions.

Vic Goradia, MD
Sports Medicine Specialist
Go Orthopedics
www.GoOrtho.net

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