Concussions: Cause for concern

Concussions: Cause for concern

Anna Bratulic | Hockey sticks are designed for puck handling, but some over-zealous players use them to wallop opponents on the head.

When Boston Bruins defenseman Marty McSorley did that to Vancouver Canucks winger Donald Brashear two years ago, hockey fans were aghast at the brutality that knocked Brashear, who spent weeks recovering from the resulting Grade 3 concussion, out cold while his legs quivered out of control.

This and similar incidents are prompting neurologists and neurosurgeons to start public awareness campaigns in the hopes of reversing flippant attitudes about brain and spinal injuries. Some 9,400 Quebecers sustain brain or spinal injuries every year, costing Quebec's health care system an estimated $285 million annually to treat them.

Dr Charles Tator, professor of neurosurgery at the University of Toronto and president of Think First Canada, an organization that encourages chilDren to take up safe activity habits, estimates that 90 percent of concussion cases are preventable.

He recently spoke about concussions and their undeserved reputation as being relatively benign injuries as part of the Montreal Neurological Institute's Neuro at Night lecture series.

"Concussions used to be considered minor head injuries because we were taught in medical school that a concussion had only a temporary effect. It's true that some of the symptoms are temporary, but the effects on the brain are often permanent," he said.

We can't really speak any longer of a minor concussion. There is no concussion that is truly minor."

Over a two-year period, Tator had personally examined some 25 hockey players for severe post-concussion problems. He found that most received their injuries either from stick contact to the face or head, fighting or elbowing, all avoidable circumstances.

"We just have to eliminate fighting from hockey. Why do we tolerate that? The macho approach of people like Don Cherry, who encourage this type of aggressive behaviour, should be eliminated," he said, adding that Think First has lobbied for stricter enforcement of hockey rules such as no checking from behind.

The brains swims in spinal fluid that acts like a cushion between it and the fixed, rigid walls of the skull. When the head is struck or violently jerked, the brain crashes into the skull and then rebounds, like a ball, and collides with the opposite end of the skull, effectively injuring it in two spots.

A concussion is defined as any trauma that induces an alteration in one's mental state, whether or not there was loss of consciousness. Confusion and amnesia, occurring either immediately or shortly after he impact, are considered hallmarks of the synDrome.

Recent research has pointed to the serious nature of all brain injuries even in cases where loss of consciousness did not occur. In the past, many concussions went unrecognized because the symptoms weren't all that Dramatic initially.

Recognizing when a concussion has taken place is essential because one such injury leaves the brain more vulnerable to subsequent blows. Second Impact SynDrome usually occurs when a second concussion is sustained while a person has not fully recovered from the first. "We really don't understand the exact mechanism of it, but one of the theories is that it does lead to a rise in pressure inside the head which can be fatal," said Tator.

It is the cumulative effects of several concussions that doctors especially worried. Some long term, and even permanent, effects include memory loss, frequent headaches, ringing in the ears, poor concentration, increased irritability and other personality changes. Concussion in Sport, a group chaired by Dr Karen Johnson, director of neurotrauma at the McGill University Health Centre, recently published guidelines in the British Journal of Sport Medicine, the Clinical Journal of Sport Medicine, and Physician and Sport Medicine, outlining a highly structured rehabilitation plan for athletes who have suffered concussions.

Among other things, the guidelines strongly recommend that the athlete be completely symptom free before returning to any form of rigorous training.