Understanding Brain Injuries: Concussion, TBI, and CTE

Concussion is not a scientific term. What we commonly call a concussion actually IS a TBI. Doctors refer to any bump, blow, or jolt to the head that disrupts normal brain function as a TBI. That term encompasses everything from a sports collision that benches a youngster for a couple of games to severe head trauma requiring hospitalization and rehab. A TBI can occur at any age, and understanding more about these injuries can help ensure you get the treatment you need.

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The Glasgow Coma Scale (GCS)

The impact of a blow to the head causes the brain to move rapidly back and forth inside the skull. That movement may damage brain cells and create chemical changes in the brain. The severity of a brain injury is assessed according to the Glasgow Coma Scale (GCS), a clinical scoring system used to describe a person's level of consciousness immediately after a head injury. The GCS assesses vision and verbal and motor abilities, all of which can be impacted by a TBI:

• Mild traumatic brain injury (GCS score 13-15) is the type of injury people often refer to as "a concussion". It is associated with a brief loss of consciousness, lasting just minutes or even seconds. The person may appear dazed and mildly confused. A complete recovery can be expected between a week and three months of being injured.
• Moderate Traumatic Brain Injury (GCS score 9-12) involves a loss of consciousness that lasts from several minutes to as long as a few hours. Confusion may persist for days or weeks. Physical cognitive, and/or behavioral impairments may continue for months and are sometimes permanent. Treatment usually leads to a good recovery although some resulting deficits may remain.
• Severe Traumatic Brain Injury (GCS score not applied). Severe head injuries are the most life-threatening and usually involve physical damage to brain tissue. Treatment requires prolonged hospitalization and extensive rehabilitation. People rarely return to their pre-injury status. Severe TBI causes a wide range of short- or long-term changes affecting thinking, sensation, language, and/or emotions. TBI may also lead to progressive brain disorders such as Alzheimer's or Parkinson's.
• Chronic Traumatic Encephalopathy (CTE) is the result of repeated mild TBIs occurring over months or even years. The impact of these injuries is cumulative, causing the brain to progressively deteriorate. CTE has received a lot of attention lately because it has been diagnosed in several high-profile athletes who play contact sports, including Ken Stabler, Aaron Hernandez, and Frank Gifford. Common CTE symptoms include memory loss, erratic behavior, impaired judgment, extreme impulsiveness, aggression, depression, balance issues, and progressive dementia.

When to Seek Immediate Medical Attention

If an athlete suffers a suspected TBI, they should be benched and examined by a physician, nurse, specially trained coach, or athletic trainer. Evaluation often includes a standardized test called the Sideline Concussion Assessment Tool, 3rd version (SCAT3), used to assess TBIs in athletes ages 13 and older. While any head injury should be taken seriously, certain symptoms call for immediate medical attention. The symptoms below are red flags that warrant immediate evaluation and care.

Call 911 for an ambulance if the person:

• Has a seizure (uncontrolled jerking of arms/legs)
• Loses consciousness for more than a minute
• Can't be awakened/appears very drowsy
• Has blood/fluid draining from the ears or nose
• Loses bowel and/or bladder control
• Shows signs/symptoms of more severe injury

Call 911 or drive them to the nearest Emergency Department if they:

• Complain of a headache or a sensation of pressure in their head
• Can't recognize people or places
• Experience weakness or numbness of arms/legs
• Complain of nausea and vomit repeatedly
• Become increasingly irritable and/or confused
• Exhibit mood, behavior, or personality changes
• Develop balance issues
• Have double or blurred vision
• Have slow and/or slurred speech
• Are suddenly sensitive to light or noise
• Display concentration or memory problems
• Say they feel sluggish, groggy, or simply "not right"

If someone is determined to have a mild TBI or "concussion", it's critical to keep an eye on them for a couple of days. For the first 24 hours, a concussion is an evolving injury. The person may appear fine at first and develop symptoms and/or cognitive issues several hours after the initial event or even the following day. If that occurs, a trip to the Emergency Room is definitely necessary.

This article first appeared in the June 2023 edition of the HealthPerks newsletter.