How many times have you or someone you loved fallen down stairs, hit their head on ice, had something fall off a shelf on to their head or neck, had a toddler sitting in their lap who decided to throw an unexpected tantrum and thrash their heavy head into your face and forehead, crashed your bike, caught an
unexpected mogul while skiing/snowboarding that tossed you up into the air and down on your
back/neck/head, stood up under an open kitchen cabinet, a beam in your attic, a counter..(you fill in the
blank)? I think we have all been there. You look around, you laugh (or cry if no one else is present), then
you brush yourself off and keep going. It is not until a few days later, you're stiff, you're sore, you're achy, and you have an unrelenting headache or dizziness. You start not thinking straight and then you just let it go, or pop some over the counter medication thinking that it will get better and so you decide to “push through” and continue to “shake it off”.

All these things are common and shouldn't be enough to cause a “concussion” or “brain injury” … right?

Wrong. Believe it or not, it is these every day, silly occurrences of slips and falls, recreational accidents,
and at home injuries that can lead to a sequela of symptoms including headache, nausea, dizziness,
vertigo, imbalance, brain fog, changes in mood, depression, anxiety, trouble speaking, trouble thinking to
name a few. So, what do you do? What if you went in to be checked and your doctor says that there is no
visible evidence for concern, your CT scan and/or MRI are clear, you have no bleeding or injury, and all
systems appear “healthy”. Can you still have a concussion then? The answer is an emphatic, YES!

The reason for this is that Concussion is defined as, “A subtype of mild Traumatic Brain Injury
(mTBI)…A reversible neurological dysfunction caused by a direct blow to the head or indirectly through
forces transmitted to the head by the neck or elsewhere on the body.” It is a metabolic, physiological,
microstructural injury to the brain. It is the absence of gross lesions or structural changes in the brain and
the clinical signs which can otherwise not be explained by drugs, alcohol, medication use or other injuries
or co-morbidities. The force of the head and neck being jarred forward and back (and in some incidences
which also include rotational forces) cause a shearing of the white and gray matter in the brain (which are
different densities) and can lead to injury of the axons and nerve transmission pathways. This then causes
disruption to the function of the pathways in the brain, or “messaging highways” that allow our brains and
bodies to coordinate certain functions such as balance, vision, hearing, moving, and so forth, leaving you
to feel symptoms either physically, emotionally, cognitively, or even affecting sleep and wake cycles.

So, in other words, although there is structural injury to the axons, these are unable to be picked up by
imaging and current technology or lab work (at this time there is no adequate concussion blood marker)
and the damage causes a disruption in the function. That is why concussions are often referred to as the
“invisible injury”. However, the good news is, as stated in the definition, these injuries are reversible with
appropriate identification and care!

Unfortunately, the above scenario of being told “you’re fine” due to no presence of findings on imaging,
can lead a patient to not receiving further care or care only after they continue to worsen and then persist
in self-advocating knowing deep down that “something is wrong”. Although 70-80% of concussions
“resolve” within 10-14 days (which the absence of symptoms does NOT mean the brain is healed and
ready to return to regular activities), 20-30% of patients who do not obtain appropriate diagnosis or care
after the injury, end up experiencing further decline leading to persistent post-concussion symptoms. This
is termed post-concussion syndrome (or more recently known as “Persistent Post Concussion Symptoms”
or “PPCS”) and can also have long term health consequences. However, because the conversation has not
quite evolved enough around the topic of concussion to educate fast enough, and research being done is
still relatively new in the field, many people are going undiagnosed and untreated.

With that being said, my purpose in writing this article today is to first and foremost let you know that
There is hope! Concussions are real consequences to falls and injuries and they are treatable brain
injuries! Secondly, it is my intention to start furthering the conversation on Concussion and mild
Traumatic Brain Injury. If you are a patient, or a provider, I am happy to chat with you and share what I
know. There are resources available. Seeking proper assessment and treatment by a qualified health care
professional who is up to date on the latest research and rehab modalities is imperative. Early assessment
and treatment of concussion can expedite your healing time. NH Concussion Center focuses on
individualized programs for patients experiencing mild traumatic brain injury. For more information on
Concussions, call my office, visit my website at www.nhconcussioncenter.com, view my Instagram
@dr.denise.pickowicz, or check out the office Facebook page: NH Concussion Center, or bianh.com. I
am here for you!

References:

1. Leddy JJ, Baker JG, Willer B. Active Rehabilitation of Concussion and Post-concussion Syndrome. Phys Med Rehabil Clin N Am. 2016 May;27(2):437-54. doi: 10.1016/j.pmr.2015.12.003. PMID: 27154855.
2. Leddy JJ, Haider MN, Noble JM, Rieger B, Flanagan S, McPherson JI, Shubin-Stein K, Saleem GT,
   Corsaro L, Willer B. Management of Concussion and Persistent Post-Concussive Symptoms for
   Neurologists. Curr Neurol Neurosci Rep. 2021 Nov 24;21(12):72. doi: 10.1007/s11910-021-01160-9.
   PMID: 34817719.
3. Ken, TK, Neary JP. Cerebrovascular Pathophysiology following mild traumatic brain injury, Clin.
   Physiol. Funct. Imaging (2011) 31 pp85-93. Doi:10.1111/j.1475-097X.2010.00990.
4. McCrory P, et al Consensus statement on concussion in sport-the 5 th  international
   conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017 Jun;51(11):838-847. doi: 10.1136/bjsports-2017-097699. Epub 2017 Apr 26. PMID: 28446457.