“The brain…” a second look at what we know to be true

“The brain, which resides in a jacket of water inside the rigid skull, keeps moving, and rotates forward and backward on the fulcrum of the brain stem.” Jane Brody
NY Times article Feb 13, 2007
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Boxer Mike Trowell died in a Glasgow Scotland hospital after sustaining a blow to the head in the first round of a match in 2016
WESTBOROUGH, MA February 5, 2017 This blog was first posted in 2013 and has received little comment. I think it remains important 3 years later because it reveals my understanding of concussion that holds true today.  No athlete should return to play before his or her brain is fully healed AND he has been able to successfully undergo the standardized return-to-play protocol established by the CDC in Atlanta nearly 10 years ago.  In late 2016, Irish Boxer Mike Trowell died shortly after a fight in Glasgow on September 30.  He was knocked down in the first round and visibly injured.  After a standing 8 count he was allowed to continue his match when he was again knocked down in the fifth round. At this point he became unresponsive and was transported to the trauma center where he died after being pulled from life support. He had been having severe headaches for days before his final fight.
Our knowledge of the risk of second impact syndrome (SIS) is grounded in the science that has emerged from autopsy studies of the brains of athletes who have died after years of playing contact sports. The incidence of second impact syndrome is quite rare but it occurs with regularity.  When the brain is not fully healed it can be highly susceptible to a second trauma that results in rapid swelling of the cerebral cortex and the loss of cellular transport that allows for autoregulation of cerebral pressure and normal perfusion.  Read the information below that I first published in 2013.

The quote in the heading of this piece is a quote that was taken from an article written by Jane Brody of the NY Times entitled Hard-Knock Lessons From the Concussion Files. In it, Ms. Brody reviews a published article in the New England Journal of Medicine by  Allan Roper, M.D. and Kenneth Gorson, M.D., neurologists from Saint Elizabeth’s Medical Center in Boston.  As we know, concussion is a serious public health problem and is especially hard on younger athletes.  Female athletes are particularly vulnerable to concussion and tend to have longer recover times. Concussion is sometimes considered an invisible injury largely due to the absence of frank signs of injury on the outside of the head.  It is now the standard of care that athletes not return to play until entirely symptom free.  This can take a week or longer and requires rest.  People sometimes fail to appreciate the cognitive demand of school and work.  Over taxing this system may prolong symptoms of concussion and extend an athlete’s down time.  If an athlete returns to play before he or she is fully healed there is a substantially higher risk of having a second concussion before the first is fully healed.  This can result in a protracted course and months of being on the sideline.  What is worse is the possibility of second impact syndrome, a life threatening condition that results from the brain’s inability to autoregulate perfusion pressure while injured.  It is rare but occurs more frequently than one might think.
Michael Sefton – October 2013
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