When is a CAT scan appropriate for a concussion patient?

Staten Island Advance By Staten Island Advance Staten Island Advance
on December 13, 2010 at 5:30 AM, updated December 13, 2010 at 5:32 AM

STATEN ISLAND, N.Y. — In last week’s column we defined concussion and discussed cognitive problems, headaches and functional decline after multiple head traumas have occurred. We also looked at the possible accumulative effect in disability. Today, we will focus on symptoms, medications and when it may or may not be appropriate to have a CAT scan or an MRI performed.

Common symptoms that occur after head trauma include headache and dizziness. Roughly 90 percent of those injured report experiencing these symptoms within the first month; approximately 25 percent have symptoms one year after the trauma.

Memory loss varies widely, with up to 40 percent of people experiencing it for weeks to months after significant head trauma. Anxiety and depression also can be seen in up to one-third of those with persistent post-concussive symptoms. Imbalance and poor equilibrium often reflects a problem with the vestibular system because of the rapid acceleration and deceleration injury. Physical therapy and balance therapy may be helpful in improving some of these symptoms.

Medications for concussions should be tailored to the severity of these symptoms. It is important to try to avoid the use of strong analgesics such as narcotics in people who have had concussions because that clouds the examination and makes people feel lethargic and nauseated. Medications for dizziness, nausea, and drugs such as acetaminophen (Tylenol) are helpful in the acute post-concussive time frame.

Patients and their families often ask when a CAT scan is appropriate for those who have had a concussion. The answer is that multiple guidelines exist. One that I feel is reasonable is if the patient is older than 60, experiences a persistent headache for more than 24 hours, and is nauseous and vomiting. For people with significant memory loss of the event itself and obvious trauma around the neck, an imaging study such as a CAT scan should also be performed.

The appearance of focal neurological deficits, such as one-sided weakness, double vision and seizures, require a complete neurological workup.

The field of sports medicine has grown exponentially over the last few years. Studies from both the National Football League and the National Collegiate Athletic Association have pointed out the importance of observation and treating people with significant head trauma. It is no longer acceptable to tell an athlete (whether they are a little leaguer or professional) to “shake it off and go back in.” There is nothing brave about compromising one’s health after having a head trauma.

Recent studies show that football injuries at the college level actually occur during practices and not during the game itself. This is because practices are so frequent and intense. It is, therefore, crucial that guidelines for athletic trainers, physicians and coaches be carefully monitored for the safety of these athletes.

Enhancements in technology clearly have improved the long-term prognosis and reduced the frequency of concussions. Baseball helmets and football helmets have become much more sophisticated. However, with the size, speed and improved athleticism of participants in sports, high-speed impacts have lead to more severe trauma. There is actually a technology used in football helmets called an accelerometer that monitors the speed of impacts.

Rules in sports to prevent helmet-to-helmet contact are crucial in reducing the incidents of head trauma in football. Chris Nowinski, a former Harvard lineman and co-founder of the Sports Legacy Institute, which pursues research in head trauma in sports, particularly football, was quoted as saying sarcastically that more brain trauma is not correlated to success in football. Practice rules and rules of the game should be modified to try and reduce repetitive brain trauma in athletes.

Recognizing the signs of concussion is crucial for parents, coaches, trainers and doctors dealing with the Staten Island community where athletics is such an integral part of our life. Organized sports provide our children with the benefits of fresh air, cooperation, team spirit and a love for the game. I hope to see you on the baseball and football fields this weekend.