A high definition visualization of a million brain fibers. The non-invasive imaging technology can pinpoint where neural fiber breaks have occurred due to traumatic brain injury, something that can’t be seen in CT and MRI scans. Image courtesy of Walt Schneider, University of Pittsburgh Schools of Health Sciences.
Any blow to the head can cause brain trauma. It’s a question of degree.
For most folks, falling down and banging the noggin on the floor may prove sufficiently concussive, damaging enough to result in lingering headaches or worse. Conversely, for a boxer a full day of sparring with countless jabs and uppercuts to the head could be just another day at work.
“They can come to the gym the next day feeling wonderful,” said Dr. Paul Wallace, a member of the California State Athletic Commission and licensed ringside physician for more than 24 years. “In terms of their ability to withstand blows to the head, boxers are clearly a subset of people.”
Of course, the real and permanent harm of concussions and associated brain trauma is often not immediately apparent. For that reason and many others, the American Academy of Neurology recently issued new guidelines for when to remove possibly injured athletes from games.
The new headline: If you suspect injury, take them out. Period.
The AAN guidelines replace 15-year-old rules deemed outdated and inadequate. The Academy noted that old standards for detecting a concussion (symptoms like mental confusion, memory loss or glassy eyes) had become confusing and insufficient. Even the best tests for mild traumatic brain injury can miss up to 20 percent of concussions (later documented through medical imaging), so it’s easy to imagine a coach or doctor at a game making a poor decision. And old, playing field rules like “three concussions and you’re out of the game” didn’t help. They were simply dangerous.
The best and safest course of treatment, according to the AAN and the Centers for Disease Control is immediate removal from play, followed by a thorough medical evaluation and time away from the game.
Athletes (and everybody else) are at highest risk of further brain injury – a second concussion – in the week or so after the first blow. Multiple concussions can worsen symptoms, slow recovery and increase the likelihood of long-term or permanent brain damage, such as chronic traumatic encephalopathy.