Talking heads

There is no such thing as a minor concussion

Concussion is very much in the news these days and those who followed the Rugby World Cup in the autumn will have seen it up close and personal, with slow motion replays of the head impacts involved. It will also have been clear, from the way the players involved were led off the field, that the condition is taken very seriously by the medical community.

Concussion, or mild traumatic brain injury (mTBI) to give it its more scientific name, is much more prevalent than generally realised. A relatively small impact to the head with no loss of consciousness can cause concussion: a fall from a tree, a horse, or a bicycle, scooter, or skateboard; an inadvertent head strike on a low object, a trip up and head strike, never mind contact sports, can induce concussion. Concussions are often not reported and may show only non-specific symptoms, sometimes even days or weeks later.

Head first

Concussion’s clinical definition from the American Association of Neurological Surgeons is: ‘a clinical syndrome characterised by immediate and transient alteration of brain functions, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma.’

The fact that this definition is limited to changes in the brain function and mental status, and does not describe physical or biochemical changes in the brain, is indicative of the status of current concussion knowledge. It also highlights the primary issue when it is necessary to identify potential concussions in the field. In sport, paramedics and athletic trainers may ask