BRAIN CONCUSSIONS

There are two sporting professions where brain concussions are prominent. They are boxing and football.

Boxing

Knocking a person unconscious or even causing a concussion may cause permanent brain damage. There is no clear division between the force required to knock a person out and the force likely to kill a person. From 1980 to 2007, more than 200 amateur boxers, professional boxers and other fighters died during a professional fight or during training. The American Medical Association has called for a ban on boxing. That certainly isn’t going to happen as long as professional nd amateur boxing are popular.

Supporters of the ban state that boxing is the only sport where hurting the other athlete is the goal. Dr. Bill O'Neill, boxing spokesman for the British Medical Association, has supported the BMA's proposed ban on boxing. He said, "It is the only sport where the intention is to inflict serious injury on your opponent, and we feel that we must have a total ban on boxing.

 Opponents respond by saying that such a position is a misguided opinion, stating that amateur boxing is scored solely according to total connecting blows with no award for "injury". They observe that many skilled professional boxers have had rewarding careers without inflicting injury on opponents by accumulating scoring blows and avoiding punches winning rounds scored 10-9 by the 10-point must system, and they note that there are many other sports where concussions are much more prevalent. I am not convinced that is true. I think the truth is that many sports face the same kinds of concussions but not as often as boxing.

In 2007, one study of amateur boxers showed that protective headgear did not prevent brain damage, and another found that amateur boxers faced a high risk of brain damage. The Gothenburg study analyzed temporary levels of neurofiliment light in cerebral spinal fluid which they conclude is evidence of damage, even though the levels soon subside. More comprehensive studies of neurologiocal function on larger samples performed by Johns Hopkins University and accident rates analyzed by the National Safety Council show amateur boxing is a comparatively safe sport. I don’t see how that is possible.

Professional boxing is forbidden in Iceland,  Iran,  Saudi  Arabia  and North Korea. It was banned in Sweden until 2007 when the ban was lifted but strict restrictions, including four three-minute rounds for fights, were imposed. It was banned in Albania from 1965 till the fall of Communism in 1991; it is now legal there. Norway legalized professional boxing in December 2014.

Here is a frightening statistic: nearly 90-percent of boxers suffer a brain injury of some extent during their career, according to the Association of Neurological Surgeons. The repeated hits to the head on a daily basis are terrible on boxers, and causes them to be prone to Parkinson’s or Alzheimer’s disease later in their lives.

It is just repetitive trauma to the head.  It is  like getting a whiplash on a daily basis. The brain has very little space to move inside the skull. It is never good to have repetitive trauma on an incased organ. Even if a boxer has strong neck muscles, the punches will take its toll.

One of the best ways to help reduce the number of brain injuries in boxers is also one of the most obvious. Helmets cut down on injuries, and amateur boxing requires them, but professional boxers don’t always wear headgear. “Similar measures to amateur boxing can also be used in professional boxing, but may decrease the thrill, which does appeal to many supporters,” said Dr. Hans Forstl in “Boxing – Acute Complications and Late Sequallae”.

None of this is exactly news, but it shows just how common the injuries really are. Every day, athletes destroy their brains for the glory of the championship and the money and yet, the general public continues to romanticize and aggrandize the sport. 

A concussion is a sudden trauma-induced alteration of the alert state. The person may be unable to concentrate or be confused for a few seconds, or completely lose consciousness and fall down. The brain is capable of recovering from a concussion.

How much force is necessary to cause permanent brain damage is under study, and hence still unclear. Over the years, professional boxers suffer permanent brain damage. The force of a professional boxer's fist is equivalent to being hit with a 13 pound bowling ball traveling 20 miles per hour, about 52 g's. Plopping down into an easy chair can generate up to 10 g's. So, it seems that somewhere between 10 and 50 g's is the threshold to permanent brain injury. This does not mean that accelerations over 50 g's have to cause permanent brain damage. Football players are subjected to 200 g's.

Football players and race car drivers also protect their heads from being whiplashed. Whiplash seems to be particularly damaging to the brain. Woodpeckers smack their heads against trees with 1200 g's of force without suffering brain damage. Part of the reason is that they keep their heads in the plane of their body; the head does not rotate in a "yes-no" manner during the pecking. If there were some way to stabilize the head when driving. more people would walk away from automobile accidents without serious brain injury.

The brain is vulnerable to traumatic damage in two ways. The cerebral cortex can become bruised - contused - when the head strikes a hard object (or a hard objects strikes the head). Or, the deep white matter can suffer diffuse axon injury when the head is whiplashed without hitting a hard object (or being hit by one). In serious whiplash injuries, the axons are stretched so much that they are damaged.

Cerebral contusions tend to occur at the tips of the frontal and temporal lobes where they bang up against the interior of the skull. Diffuse axonal injury occurs more toward the center of the brain where axons are subjected to maximal stretching.

Signs and symptoms of a concussion may include:

·        Headache or a feeling of pressure in the head

·        Temporary loss of consciousness

·        Confusion or feeling as if in a fog

·        Amnesia surrounding the traumatic event

·        Dizziness or "seeing stars"

·        Ringing in the ears

·        Nausea

·        Vomiting

·        Slurred speech

·        Delayed response to questions

·        Appearing dazed

·        Fatigue                                                 

Some symptoms of concussions may be immediate or delayed in onset by hours or days after injury, such as:

·        Concentration and memory complaints

·        Irritability and other personality changes

·        Sensitivity to light and noise

·        Sleep disturbances

·        Psychological adjustment problems and depression

·        Disorders of taste and smell

·         

Seek emergency care for an adult or child who experiences a head injury and symptoms such as:

·        Repeated vomiting

·        A loss of consciousness lasting longer than 30 seconds

·        A headache that gets worse over time

·        Changes in his or her behavior, such as irritability

·        Changes in physical coordination, such as stumbling or clumsiness

·        Confusion or disorientation, such as difficulty recognizing people or places

·        Slurred speech or other changes in speech                                Vision or eye disturbances, such as pupils that are bigger  than normal (dilated pupils) or pupils of unequal sizes. Lasting or recurrent dizziness.                                                         

        

Causes of Subdural hematoma

Subdural hematoma is usually caused by a head injury, such as from a fall, motor vehicle collision, or an assault. The sudden blow to the head tears blood vessels that run along the surface of the brain. This is referred to as an acute subdural hematoma.

Chronic subdural hematomas develop due to a minor head injury. A blood clot on the surface of the brain is also called a subdural hematoma.

In a subdural hematoma, blood collects between the layers of tissue that surround the brain. The outermost layer is called the dura. In a subdural hematoma, bleeding occurs between the dura and the next layer, the arachnoid.

The bleeding in a subdural hematoma is under the skull and outside the brain, not in the brain itself. As blood accumulates, however, pressure on the brain increases. The pressure on the brain causes a subdural hematoma's symptoms. If pressure inside the skull rises to very high level, a subdural hematoma can lead to unconsciousness and death.

Symptoms of Subdural Hematoma

·        Headache.

·        Confusion.

·        Change in behavior.

·        Dizziness.

·        Nausea and vomiting.

·        Lethargy or excessive drowsiness.

                                            

 A concussion resulting from a bump, blow, or jolt to the head can happen to both men and women, not just -athletes. In fact, rates of emergency room visits related to traumatic brain injury (including concussions) among women almost doubled from 2001 to 2010, according to the Centers for Disease Control and Prevention (CDC). These injuries can be caused by not only sports but also falls, car crashes, blunt trauma (getting hit on the head by an object), and assaults. An alarming report published this year in Family & Community Health found that at least 60 percent of abused women have had a traumatic brain injury due to domestic violence.       

Studies have shown that women are more prone to concussions than men. “When we compare men and women playing the same sport, we find that female rates of concussion are significantly higher than those for males,” says Jeffrey Bazarian, MD, a concussion specialist and professor of emergency medicine and physical medicine and rehabilitation at the University of Rochester in New York. Women also tend to have longer-lasting symptoms and take longer to recover overall, research shows.     

These risks matter because the potential long-term health consequences of concussions are serious. People who have had multiple concussions are at higher risk of developing a condition called chronic traumatic encephalopathy (CTE), a progressive degenerative disease found in the brains of former athletes and others who have experienced repetitive brain trauma like concussion.

When you bang your head, the hard shell of your skull helps protect your brain’s soft tissue from direct impact, while fluid around the brain acts as a shock absorber. But a violent-enough jolt can fling your brain against the inside of your skull, triggering bruising as well as blood vessel and nerve damage.

Concussions can’t be spotted from the outside, nor can they be seen with imaging tools like MRIs or CT scans, which is why doctors rely on symptoms (such as nausea, headache, confusion, dizziness, memory problems, and loss of consciousness), as well as neurological exams, cognitive testing and other forms of assessment, to make the diagnosis. 

Compared with men, women have about 1.5 times greater risk of concussion in soccer and 1.4 times greater risk in basketball, and women playing softball have nearly twice the risk of men playing baseball, per the National Collegiate Athletic Association Injury Surveillance Program. “For a long time, we assumed that women were simply more likely to report concussion symptoms than men, but research now shows that’s not the case,” says James Borchers, MD, a sports medicine specialist at the Ohio State University.

Women may even sustain more severe concussions than men: In a recent study of 207 male and female athletes at a concussion specialty clinic in Ontario, the clinic’s medical director, Shannon Bauman, MD, found that women didn’t just report more symptoms of concussion post-injury but also had more objective signs (according to a physical exam and their medical histories), such as migraine headaches and trouble maintaining their  balance.

What is not so clear is why? One theory is that women, even athletes, tend to have less neck strength than men. The weaker their neck, the more vulnerable they are to a concussion; Very few women work on neck strengthening, either because it doesn’t occur to them or because they worry about developing a more muscular neck. But the weaker a person’s neck, the more likely it is that that person’s head will get whiplashed, which increases the rate at which our brains move around in our skulls. As a result, we can suffer a more serious concussion.  

Research also suggests that women are more apt to get post-concussion syndrome, in which symptoms like headaches and dizziness last for weeks, even months, after an injury. In Dr. Bauman’s study, only 12 percent of women had recovered completely after two months, compared with about a third of the men, and 35 percent of women still had symptoms six months later.

This slower healing may be related in part to hormones. Women injured during the two weeks before their period had a slower recovery and poorer health one month after injury than those who either got hurt in the two weeks post-period or were taking birth control pills (which smooth out monthly hormonal ups and downs), according to a 2013 study authored by Dr. Bazarian. When a woman gets a concussion, her pituitary gland—a pea-size gland attached to the base of the brain—may get shaken up a bit and stop making the hormone that stimulates estrogen and progesterone. If a woman gets hit at a point in her cycle when progesterone is high, usually the two weeks before her period, the pituitary shuts down, and progesterone—which promotes brain cell growth and has a calming effect on the brain—drops very quickly, causing a sort of withdrawal effect that worsens post-concussion symptoms. Girls who haven’t started menstruating yet and postmenopausal women have outcomes similar to men.

The good news is that if you had a couple of concussions playing sports in high school or college, or suffered one as an adult, the risk of severe lingering or permanent damage is low, The key is to make sure you don’t get a second concussion while still recovering from the first. It is known from data that if concussions happen close together, it can cause longer-lasting impairments, but if the concussions are spread far enough from the earlier one, you may very well recover completely

Unfortunately, some women and men seem to suffer concussions one after the other, a phenomenon that concerns and mystifies researchers. Katherine Price Snedaker, executive director of the nonprofit Pink Concussions, has suffered more than 20 of these head injuries over the last 35 years. She said, “I got my first one playing field hockey at age 16 and started getting one every couple of years after that, One time it was a car accident; another time I fainted and banged my head against the wall; another time I hit my head on my car door.”

Getting multiple concussions is probably due to more than just terrible coincidence: One JAMA study found that having three or more concussions triples a person’s risk of future ones. It could be due to genetic factors, or simply to the fact that these people tend to be more active or have more risk-taking behaviors, like acting aggressively during competitive sports.

 While the cause is unknown, the phenomenon is particularly worrisome because women who suffer repeat concussions may also be susceptible to CTE—the same disease that’s grabbed so many headlines lately in relation to professional football players. “CTE makes the brain tissue progressively degenerate and also leads to the buildup of abnormal proteins called tau, which can result in memory loss, confusion and, long-term, conditions such as depression and dementia. The disease was originally identified in male boxers (it used to be known as dementia pugilistica); In the early 2000s, post-mortem examinations of pro football players revealed CTE in their brains, too. Now experts realize it can happen to anyone who has had repeated brain trauma.

Women are most likely to get a concussion playing team contact sports, such as soccer, basketball, and softball, found a 2013 study published by Dr. Giza in the journal Neurology. According to the University of Pittsburgh’s Brain Trauma Research Center, the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19 percent per year of play.

For certain activities such as bicycling, skiing, in-line skating, rock climbing, and horseback riding, to name a few, a helmet is a must. Helmets can’t prevent a concussion, but “since a helmet is designed to absorb some of the energy of an impact, they do slow the rate at which your head decelerates, which can potentially lessen the effects of a concussion, You should wear a helmet that meets the specific safety standards for your sport or activity. Children should always wear a helmet when participating in contact sports.  

 Anytime you hit your head, be on high alert for signs of a concussion. These include headache, dizziness, nausea or vomiting, difficulty thinking clearly, fuzzy or blurry vision, mood changes (like feeling sad or irritable), trouble remembering new information, sudden and unexplained fatigue, sleeping more or less than usual, or feeling slowed down. If you or those around you notice any of these symptoms, call your primary care physician, who can help make the decision whether you can safely monitor your symptoms at home or need to come in immediately such as going to the emergency room of your local hospital. While a concussion itself isn’t necessarily life-threatening, it’s important to get it properly diagnosed.

The worst thing you can do is ignore a concussion and carry on as if nothing is amiss.  You’ll just worsen the damage, and it will take longer to recover.

There is no one-size-fits-all treatment plan, but in general, as long as you’ve got symptoms, avoid physical activity and limit using computers, texting, reading and doing anything that requires concentration. You don’t actually need to lie in a quiet, dark room for days. There’s actually evidence now that it creates more mental distress, anxiety and a longer recovery period. Once symptoms start improving, you can begin resuming regular activities but, again, don’t overdo it. Plan on working a reduced schedule, and if you can.  perform light exercise, like walking, before jumping back into your old workout routine. If your symptoms return, that’s a sign you need to scale back again and give yourself more time to heal. If the symptoms continue to drag on, you had better see your doctor.  

Fortunately, most people recover with minimal aftereffects. What’s crucial: doing everything in your power to avoid getting injured again, especially soon afterward.  something  Snedaker learned the hard way. After years of having her repeat concussions downplayed by doctors, she’s now on ADHD medication to help manage the cumulative effects, including short-term memory loss and distractibility. She says, “It’s like everything is in the filing cabinet, but it’s not filed correctly.”

As more doctors become aware of the role gender plays in concussion, and as more research is done, stories like Snedaker’s will hopefully become rarer. But while it’s reassuring to know that scientists are studying the issue, you still need to be proactive about your own health. Treatment starts with education, which means not ignoring symptoms. Our brains do a great job of healing themselves, as long as we let them.

Former New England Patriots player Aaron Hernandez suffered substantial damage to parts of his brain that affected memory, judgment and behavior from the most severe case of a degenerative disease linked to head blows he received.

In Hernandez's brain, there was evidence of previous small hemorrhages, which is associated with head impacts. Other parts, like the hippocampus, had begun to shrink and large holes were found in his brain's membrane.

Mohammad Ali was diagnosed with Parkinson's syndrome, which his doctors attributed to boxing-related brain injuries.

Canadian boxer George Chuvalo is at the time of this writing,  under a court-ordered legal protection of the Office of the Public Guardian and Trustee because he is unable to instruct his lawyer. A court considered opinions from geriatric experts who assessed Chuvalo in 2017. They were Dr. Richard Shulman, a geriatric psychiatrist, and Dr. Heather Gilley, a geriatrician. In my respectful opinion, I believe that he is suffering from brain injuries as a result of his boxing career.  

I met this great Canadian boxer three times in my life. The first time I met him, he invited me to join him for supper in his home. I then met him again when we were both individually being interviewed on a radio show. The third time I met him was when his first wife died and I went to his home to offer my condolences. He seemed OK then in all those three times I met him but as we all know, our health can get worse as we get older.

I believe that there are a great many boxers and football players suffering even to this day from concussions they had years ago when they were active in their sports.

I have two daughters but if I had a son, I would try very hard to talk him out of playing football or going into a boxing career.