Concussion: General Comments

2018-04-10 updated 2018-04-17 • SEND FEEDBACK •
Related: concussion, health, James G

Legal disclaimer: Since we are not doctors, never follow anything based on health-related topics on this or related sites without first consulting with your doctor or other trusted health professional. OTOH, the study of brain injuries is at best in its infancy, like studying outer space with primitive telescopes.

This page contains general observations and reader comments.

See the concussion pages for more info.

Reader comments, more discussion

The following is personal and yet not so: I relate my experience as is my wont as possibly being helpful to others, as I have done for years in my cycling health articles. And doing so usually results in useful feedback for myself, which I often like to include (please state in any comments if you do not want to be quoted).

My body is stronger than it has been in many years, for example, my lungs are functioning superbly* helping me outpace everyone by far, except teamed-up paceliners. So I am hoping that core functionality will support rapid recovery—a strong base at least cannot hurt.

* “Huge” lungs according to today's XRay nurse, I had to be repositioned exactly right for the XRay to cover both lungs. Or maybe she made it up. I dunno.

HBOT

Several readers have suggested hyperbaric oxygen treatment (HBOT). Aside from the fact that my insurance is highly unlikely to cover it (and I therefore cannot afford it, today's ER was $2850 for example), it is not FDA approved. Still, I’d bet it would be helpful.

Still, I *can* go to Death Valley below sea level and drive to 7000 feet to Dante’s View and back all in a short while. Maybe some below-sea-level time could be slightly helpful, along with a bit of appropriate lazy time basking in the sun. Since I am going right through that area with my daughter on a trip already planned next week, I may see how I respond at below sea level (Badwater). I’m going to take it easy which will be a difficult challenge (for me!), but I’m taking this very seriously. And she can drive when needed, and I’ll pass on the hiking and shoot from the roadside and nap in the back of my van whenever I feel the need.

No assumptions

One reader suffered a similar injury and is still suffering months later. My empathy goes out to that person. The point is noted: I am taking things seriously. But that does not mean no riding (easy and short perhaps in a few days, TBD)—the ER doctor approves and I believe strongly based on years of personal observation that exercise and blood flow are highly beneficial to health and healing.

Direct head hits are not the only cause of concussion

My first ER visit on Saturday March 17, I told the doctor that I did not think I had hit my head. But actually, I don’t know whether I did or did not hit my head.

In retrospect, I was exhibiting all the classic signs of concussion, so I can only say that this was not very good evaluation there down in Solvang. I don’t blame them, but no doctor should take a wobbly half-coherent patient’s statement as a working assumption.

Anyway, I have no recollection of hitting my head (but I cannot say I did not, either). Still, the brain sloshes within the skull with sudden deceleration, and I flew through the air at 25 mph into a soft soil/grass embankment, skidding a few feet perhaps. That’s a rapid deceleration and so even without a direct impact to my skull, my brain experienced similar deceleration forces as with my body upon impact.

So: do not assume that a concussion has to occur with direct head impact.

James G writes:

I am an ophthalmologist and we deal with sometimes VERY SUBTLE eye movement disorders. I also have a brother who is a programmer and suffered a concussion from being hit from behind in a motor vehicle accident about ten years ago.

I can tell you that the NIH’s “7 to 10 days” comment and the comments you will read in the papers from the ER and internet sources will all say about the same thing: that recovery is a few days to a few weeks. From family and professional experience I do not believe this is always true. The comments are based on observations of the concussed by others, not by the concussed themselves.

My brother was pretty much back to normal after a month except for very subtle cognitive abilities. I couldn’t tell and he seemed normal to me, but he could relate that his coding was slower and more difficult. And he couldn’t do it for the extended periods of time that he could pre-injury. This got better with time but I still don’t think he’s completely back to normal after ten years.

And as for vision, if there are very subtle induced oculomotor difficulties (usually brainstem and incredibly subtle), the patient may notice it but they are otherwise so minuscule that it would take the most diligent and determined motility specialist to detect the problems that the patient is trying to complain about.

For some people, they never use their brain to an extent that would disclose an injury if they had one. For the detailed thinkers like Stephen Hawking and the like, or those who depend on fine motor control like a surgeon or a professional diamond splitter, those folks are going to be the ones to notice their impairment, however subtle. And I put you in that category. Again, our technical and analytic ability to recognize these injuries in others is just not granular enough. Your personal experience will be your guide.

DIGLLOYD: indeed, this is of great concern. I have to be very cautious going forward with high-speed descents, where I have counted on intense concentration and high-speed visual processing for safety. The pothole that I hit was nearly invisible in a parsing sense (its depth and shape and orientation along with a very nearby shadow that made it look as if part of the shadow)—my perceptual system failed me at the wrong moment.