Traumatic Brain Injury Blog

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Tagged with “concussion”

July 15, 2014

More Encouraging News Concerning the Recognition and Treatment of Concussion and Mild Traumatic Brain Injury

Several recent developments demonstrate increasing recognition of the serious potential consequences of concussion, and commitment to minimize those consequences through appropriate treatment of concussion:

  1. Physicians have an ethical obligation to become knowledgeable about concussion.

    On June 9, 2014 the American Academy of Neurology, the largest professional association of neurologists, released a position paper stating that doctors have an ethical obligation to educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, athletes and coaches. The statement declares that sports concussion “is a major issue in the world of health care” and requires more attention from physicians. Read More

May 27, 2014

Concussion as a Medical Diagnosis

Different symptom patterns of concussion depend on the precise nature of the damage to the brain

TBI-brain-image-150wMedical research is increasingly identifying the various ways a concussion can impact the brain and is providing explanations for why different symptoms persist in a subset of people diagnosed with concussion, based on the anatomy and physiology of the brain.

Much of this recent research has benefited from new techniques to “image” the brain, including various MRI techniques such as “diffusion tensor imaging” (“DTI”).  In a prior post, I discussed research concerning  the subset of concussed patients who experience persistent ocular (vision) and vestibular (balance) problems. A paper published online on April 15, 2014 in the journal Radiology reported that DTI imaging of patients with these symptoms revealed damage in the parts of the brain know to be associated with vision and balance. Read More

May 21, 2014

Neuroendocrine Dysfunction following Traumatic Brain Injury: Could This be a Key to More Successful Treatment?

Recent research has shown that traumatic brain injury, (TBI) including mild traumatic brain injury (mTBI),  can damage and cause dysfunction in the pituitary gland, a pea-sized gland located in the center of the skull that releases several essential hormones affecting such functions as growth and metabolism (part of the neuroendocrine system).  Researchers have found that a surprisingly high percentage of patients with persistent symptoms following a TBI show evidence of neuroendocrine dysfunction.

It turns out that the anatomy of this gland makes it particularly susceptible to the sheering injuries seen in TBI. The most common dysfunction found after TBI is deficiency in the Growth Hormone (GH), one of the key hormones released by the pituitary gland. The symptoms of GH deficiency overlap with many persistent TBI symptoms including fatigue, poor memory, depression, emotional lability, lack of concentration and attention difficulties. Read More

April 21, 2014

New Data Supports Importance of Cognitive Rest for Concussion Recovery

Most current guidelines recommend “cognitive rest” during the initial stages of recovery from concussion. “Cognitive rest” involves limiting activities that require attention and concentration such as reading, doing homework, text messaging, playing video games, working online, watching movies and television and listening to music.  Cognitive rest has been recommended in the past based on somewhat limited evidence suggesting that failing to minimize these activities in the early stages following a concussion could delay recovery. Read More

March 25, 2014

Visual Dysfunctions following Concussion and other Traumatic Brain Injuries

Recent literature has highlighted the prevalence of dysfunctions in vision following traumatic brain injuries of all levels of severity (including concussion.) Research published by the Veterans Administration (VA) in 2012 indicates that the percentage of TBI victims with vision problems could be as high as 60%.  They explain that this prevalence is not surprising, since over 50% of the brain is involved in visual processing. Alvarez et. al. explain how visual and other symptoms occur when the brain is subjected to  “acceleration/deceleration” forces: Read More

February 4, 2014

New Guidance for Patients and Clinicians on Managing Concussion Symptoms

Defense and Veterans Brain Injury Center logoOn January 23, 2014 the Defense and Veterans Brain Injury Center released new clinical recommendations with a standardized approach for concussion recovery.  Included in the recommendations for managing concussion symptoms is a first of its kind five-stage approach for return to activity following a concussion.  Detailed “do”s and “do not”s  are specified for each stage. Movement from stage to stage is determined by scores on a simple twenty-two item “neurobehavioral symptom inventory” included in the recommendations.  Read More

January 7, 2014

NFL and NCAA Under Increased Pressure to Manage the Long-Term Effects of Concussions

In August, 2013, the NFL announced that it had reached a $765 million dollar settlement of claims by more than 4,500 players alleging that they were suffering from long-term consequences of concussions that the NFL had known about for years, hid from players, and failed to minimize by establishing appropriate protocols for return to play.  The alleged cover-up by the NFL, with co-conspirators in the medical community, was recently the subject of an extensively researched PBS Frontline special titled “League of Denial.” 

By settling the players’ claims early in the litigation it appeared that the league would avoid further examination of what the league knew and when it knew about the long-term effects of concussion. However, several recent developments indicate that these issues will likely be examined further. The judge overseeing the litigation has appointed a “special master” to make recommendations concerning the settlement and the Brain Injury Association of America has  petitioned to intervene in the litigation to make sure that the settlement takes proper account of the

“progressive physical, psychiatric and cognitive disease processes that are caused and/or accelerated by brain injury, but may not  manifest in clinically significant symptoms on initial presentation.”

Read More

December 11, 2013

Functional Brain Imaging Helps Explain Post-Concussion Symptoms and Role of Exercise in Healing

Using functional brain imaging (fMRI) a multidisciplinary team of researchers at the University of Buffalo have documented metabolic and physiologic changes in the brains of patients experiencing post-concussion symptoms. They found improvements in both imaging findings and in patient symptoms following a  controlled, progressive aerobic exercise program. The results have been published in both the Journal of Head Trauma Rehabilitation   and in Current Sports Medicine Reports and are summarized in UB news releases. Read More

December 4, 2013

New Blood Biomarker Accurately Predicts Long-Term Disability Following Concussion

In a study published November 18, 2013 in Frontiers in Neurology, researchers from Penn and Baylor report that they have identified a blood biomarker – SNTF – that if found on the day of injury predicts with substantial accuracy both cognitive impairment persisting more than 3 months and the existence of abnormal brain imaging finding in the corpus callosum and uncinate fasciculus of the brain (using diffusion tensor imaging (DTI). Read More

November 25, 2013

American Academy of Neurology: Brain Shows Evidence of Injury Following Concussion after Acute Symptoms have Dissipated

There has been much debate over what happens to the brain following a concussion, much of it recently focused on concussions in sports. One side of the debate maintains that concussions, also referred to as “mild traumatic brain injuries,” involve only a very short term disruption of brain function with no damage to the brain.  As discussed in previous posts, this view has been discounted by a growing body of research  involving advanced imaging technologies as well as post-mortem  pathological studies showing that in a minority of cases concussions can cause lasting damage to the brain as well as persistent symptoms.

On November 20, 2013 the medical journal of the American Academy of Neurology, a professional organization representing 21,000 neurologists and neuroscientists, published findings that after a “mild” concussion, brain scans using diffuse tensor imaging technology, showed grey matter abnormalities on both sides of the frontal cortex. Read More