August is Neurosurgery Awareness Month and, coinciding with end of summer and start of a new academic school year, traumatic brain injury is a hot topic, especially in children and athletes. Traumatic brain injury (TBI) is a growing concern globally. Traumatic brain injuries are one of the leading causes of death and disability in young adults and especially in athletes. A traumatic brain injury is defined as either indirect or direct blunt trauma or penetrating trauma to the head. Traumatic brain injuries can be classified as mild, moderate or severe, depending on the individual’s symptoms.
According to the American Association of Neurological Surgeons: “About 1.5 million cases of TBI occur in the U.S. every year. Of those cases, approximately 80,000 to 90,000 people experience lifelong disability as a result of their TBI, with about 50,000 cases resulting in death … even mild traumatic brain injury, such as concussion, can cause brain damage, with clear signs of continued disruption of brain cells one year after the initial injury.”
A concussion is a mild form of a traumatic brain injury and is caused by either direct or indirect force to the head. Rotational or angular forces cause sheer stress to the brain tissue resulting in a functional injury rather than a structural injury. A person does not need to have a direct blow or impact to the head to have a concussion. Concussions are one of the most common and milder types of traumatic brain injuries.
A concussion is diagnosed strictly on history and clinical presentation; no lab test or imaging test is used to diagnose a concussion. Although a computed tomography scan is sometimes used to rule out a hemorrhage or a skull fracture since a head bleed can be life threatening, a computed tomography scan or magnetic resonance imaging will not aid in the diagnosis of a concussion.
Headache is the most common symptom, and some people may or may not lose consciousness at the time of the event. The loss of consciousness is not a diagnostic factor. The majority of the signs and symptoms of a concussion are nonspecific; therefore, a thorough history of the injury is crucial to aid in the diagnosis.
Numerous assessment tools aid diagnosis, including symptom checklists, neuropsychological tests, postural stability tests and sideline assessment tools. These same tools are also used to monitor recovery.
Physical and cognitive rest is one of the mainstays of treatment for concussions. There are no medications or specific therapy to treat this mild traumatic brain injury. The focus of recovery rests on managing symptoms associated with the concussion. Recovery is variable and, as a result, an individual approach to symptom recovery is important. The average recovery period is approximately seven to 10 days; however, again, this is individualized. Children, adolescents, and those with a history of concussions may require a longer recovery period. A stepwise, return-to-play protocol can be implemented once a patient has recovered physically and mentally.
Physical rest is important in the recovery of patients with concussion, and cognitive rest is equally important. Many teenagers are told not to participate in sports, yet they are able to return to school, which can bring on more cognitive stress. While the brain is recovering from an injury, the available energy and energy needed may not be in balance. Continuous cognitive stress, such as doing school work, going to work and using electronics, can increase that imbalance. This energy mismatch most often manifests as increased symptoms, such as headache, fatigue and concentration difficulties, while performing cognitive tasks. The optimal amount and duration of cognitive rest is unknown and different for each individual, so treatment is aimed by the individual’s symptoms and tolerance for cognitive work.
Can traumatic brain injuries lead to mental illness?
The link between traumatic brain injuries and mental illness is controversial. Many professionals mirror this relationship to “the chicken or the egg” analogy. There are not many concrete studies that specify whether or not mental illness can be caused by a TBI, but one study published in The American Journal of Psychiatry illustrated that the rate of psychiatric illness one year after a traumatic brain injury is significantly greater than that of the general population. According to the study, depression was about seven times higher in brain injury patients when compared to the general population. Panic disorder was more than 11 times more prevalent in the head-injury group versus the control group.
“Neurobehavioral symptoms are not uncommon after a traumatic brain injury,” according to an earlier study published in The American Journal of Psychiatry. “However, psychiatric syndromes per se have rarely been studied in patients with such injuries.” It is now more common for physicians to ask about prior head injuries in their patients who present with mental symptoms.
With the fall school year approaching and many children and adolescents participating in sports, it is important to stay educated on traumatic brain injuries and to seek medical help if you suspect your child may have a concussion or a more severe TBI. Although TBIs may or may lead to mental health disorders, risk of second impact syndrome and other complications should not be taken lightly.
Written by Kristen Fuller, M.D., Sovereign Health Group writer