Still more progress needed to manage brain injuries, says study

| March 8, 2018 | 0 Comments

Herman Bright speaks with Dr. Karen Wang, optometrist, with TAMC Optometry, about the impacts of concussions to a patient’s vision. (Photo by Ramee Opperude, U.S. Army Health Clinic-Schofield Barracks Public Affairs)

Dr. Chad Grills

Brain Injury program lead
U.S. Army Health Clinic-Schofield Barracks
SCHOFIELD BARRACKS — A recent research study published January in the journal Brain examined the brains of four male athletes aged 17-18 who had sustained recent sports-related concussions one day to 4.2 months prior to their deaths. It is rare that researchers have the opportunity to perform autopsies to examine the brains of recently concussed individuals.

While each case is potentially informative to our understanding of traumatic brain injury (TBI), two of the cases are particularly relevant to the Army and serve to underscore the importance of the Army’s approach to managing concussions.

One case involved an 18-year-old high school athlete who had four prior sports-related concussions. He had played football, rugby, soccer and hockey, and ultimately progressed to a semi-professional level of rugby. One month before he died, he sustained a concussion while playing rugby. His primary symptom post-injury was being very tired. He sustained a second rugby-related concussion two weeks later. He collapsed on the sidelines and was hospitalized for two days for observation.

Seven days later, after discharge from the hospital, he did some weightlifting. Later that day, he collapsed at home while eating dinner and was taken to the hospital, where he died from brain swelling.

The second case worth highlighting involved a 17-year-old high school football player who sustained multiple sports-related concussions in close proximity to each other. The first occurred 26 days prior to his death. The second occurred six days prior to his death. The third final and fatal concussion occurred during a football game wherein he landed on his helmet because of a tackle. He was rendered unresponsive and had a seizure. He was intubated and ventilated on the field and then taken to the hospital where he underwent emergency surgery to relieve brain swelling.

Despite the surgical intervention, his swelling progressed and he died one day later. The diagnosis was ‘second impact syndrome.’

Brain swelling can result in an individual’s death because the portions of the brain that support vital functions, such as breathing, are damaged by compression into the narrow opening at the base of the skull that marks the beginning of the spinal canal.
These are rare cases, not just because of their availability for brain autopsy but also because of their fatal outcomes. The good news is that these cases are rare, so much so that no one knows the number of cases per year.

The majority of individuals who sustain concussions do not die and resolve in a relatively short amount of time – days to weeks in most cases. Furthermore, most cases of repetitive concussions do not result in death, though the recovery times can be longer.

However, despite their rarity, such cases highlight the potential dangers and the importance of proper concussion management.

As a clinician-researcher who is devoted to excellence, I am proud of the DOD’s clinical practice guidelines for management of concussions. You should be too. The DOD has truly led the way in the development of concussion management protocols, which have received accolades in the peer-reviewed medical literature.

These clinical management protocols are further supported by OPORDS that require Soldiers to be medically evaluated within 12 hours after a potentially concussive event, both in theatre and in garrison. They further require 24 hours rest followed by medical re-evaluation. Individuals with multiple concussions within a 12-month period require more in depth evaluations and rest periods.

Unfortunately, many Soldiers are unaware of these requirements despite mandatory TBI training. And these mandatory rest periods often butt up against the prevailing ethos of the war fighter, which understandably would prefer to “shrug it off” and drive on.

Many Soldiers present to our brain injury clinic having jumped back in the ring while still symptomatic after sustaining a concussion during combatives (“I just wanted to finish the course!”) or after continuing PT despite a concussion from a fun game or two over the weekend (“I thought I was fine, but the headaches just got worse and worse”).

I have noted significant culture change over the past 10 years I have lead the TBI program at Schofield Barracks Health Clinic. This change is characterized by increasing acceptance of the importance of proper concussion management. More and more Soldiers seem to appreciate the importance of taking a knee so they can get back in the game later.

However, we still have a long way to go. If you have sustained a concussion, don’t risk it! Get it checked out.


Category: Health

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