House Calls / Dr. Michael Schwartz

Concussions are the most common type of head injury. Some studies report that as many as 4 million concussions occur each year, with almost 10 percent of young athletes reporting that they have experienced signs and symptoms. Over the past few years, doctors and coaches have spearheaded a campaign to spread awareness of the problem and its prevention.

A concussion is defined as any alteration in consciousness due to an impact to the head. Whereas it was once believed that a loss of consciousness was necessary to define a concussion, we now know that having your "bell rung" or "seeing stars" are actually concussions as well.

A concussion can occur when the head is either struck with an external force (e.g. a puck in ice hockey or a baseball) or from having a "whiplash" type collision (i.e. players running into each other at high speeds during a football game). During these events, the brain can be thrown around inside the skull resulting in a "brain bruise." When this occurs, it is common to develop headaches, dizziness and lethargy. However, additional symptoms such as nausea, vomiting, visual changes, confusion, problems with balance and coordination or loss of consciousness may indicate a more serious concussion. If this occurs, the patient must seek medical advice immediately.

Athletes who suffer multiple concussions may develop Chronic Traumatic Encephalopathy. CTE is a progressive brain disease caused by repetitive brain trauma. Long term complications of repeated concussions include memory loss, personality changes, depression, concentration problem, suicidal thoughts and dementia. This condition has be found in athletes as young as 17 years old but more commonly occur in older individuals decades after these athletes finished competing.

A 2010 Connecticut state law on concussions mandates that coaches must complete a head injury training course. In addition, coaches are required to immediately remove a student athlete diagnosed with a concussion or observed exhibiting signs, symptoms or behaviors consistent with a concussion. Finally, student athletes who are removed from play may not participate in supervised team activities without a written clearance from a licensed health care professional trained in the evaluation and management of concussions.

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One of the newer advances in concussion management is neuro-psychiatric testing. This exam, which assesses memory, language and cognitive function, is commonly administered to professional athletes before the start of a season. Fortunately, similar neuro-psychiatric exams are now being administered to athletes of all age groups with the goal of preventing long term, permanent brain damage. Sean Cunningham, head athletic trainer for the Miami Marlins, states, "We baseline test all of our players during spring training. If a play occurs, where a concussion is suspected, the athletic trainer will perform a concussion evaluation including assessing level of consciousness, memory, balance, eye tracking, pupil response and motor skills.

Comparative neuro-psychiatric testing is then performed 48 hours post injury." This follow-up examination is then matched to the initial baseline test. Once the results of the repeat exam are similar to the baseline and the player is cleared by a physician, the concussion is considered to be resolved and he/she may resume competition.

Advice if you suffer a concussion:

Rest is the most important treatment for a concussion. No reading, texting, playing video games or physical activities.

Drink plenty of fluids. Hydration may aid in the healing of the brain.

Avoid activities which increase the risk for another concussion. No contact sports.

Use Tylenol for headaches. Avoid aspirin or Advil -- these could increase the risk of bleeding

Return to activity only after all your symptoms have been resolved and you have visited your doctor for a complete neurologic evaluation. A second concussion before then can lead to more severe symptoms and even increase the risk of death.

If not taken seriously, concussions can lead to long term, chronic brain damage. If you suffer a concussion, consult your doctor. Also, be patient. A concussion may take days, weeks or months to completely heal. Respect your brain -- it is a magnificent organ.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at