This is the 2nd part of our Q&A on Traumatic Brain Injury (TBI) and the role your local eye doctor can play in helping you assess and treat a TBI.
Q. - If I think I (my child) have had a concussion, is a brain scan necessary?
A. – If there is obvious structural damage, or if certain symptoms are present or progressive, an MRI/CT may be indicated. In the majority of concussions, however, no abnormality will be identified. This doesn’t mean there’s nothing wrong, or that no other care is necessary, just that the scan is not sensitive enough to see the problem. CTs and MRIs primarily look at the gross structure of the brain, whereas mTBIs usually affect biochemical and neural communication within and between different brain areas. During 2018 a new blood test was approved (the Banyan Brain Trauma Indicator – BTI) that can help determine who will most benefit from a scan. Patients with mTBI but low biomarker findings are very unlikely to have structural damage, and so can avoid the costs and risks of a scan. Those whose findings are high, however, will be well served with additional tests. As there are more than 20 million scans performed each year, this can save many millions of dollars and reduce exposure to radiation.
Q. - What can I do to prevent a concussion?
A. - Only so much, but a lot! To start, do whatever you can to avoid ever having an initial concussion. The greatest risk factor for experiencing a concussion is having had one previously. To prevent that first one, consider an “APP” – in this case Awareness, Precaution and Preparation. Being aware of what behaviors, activities and kind of sports plays are highest risk, can help you avoid them, or at least reduce the risk. For example, in football, kickoffs account for about 5% of plays, but 20% of concussions. A 2016 Ivy League rule change moved kickoffs from the 35 to the 40-yard line, reducing returns. Also reduced were concussions on kickoffs, by 80%. Taking appropriate precautions can also pay dividends: for instance, reducing risk exposure when fatigued; maintaining good hydration and nutrition; and doing things as simple as wearing a seat-belt and not fussing with your phone while driving. Finally, being prepared when risks are present, can’t be overstated. In sports, particularly, this means being in shape, well trained, and using the most appropriate equipment.
Q. – You talk about equipment in sports. Can protective headgear prevent, or protect against concussion?
A. – The correct and properly maintained equipment certainly helps protect against injury. It cannot, however, prevent concussion. Any jarring blow, not only one to the head, can “rattle” the brain enough to result in concussion. There is also concern that athletes, believing they are protected, may feel freer to take risks, counteracting potential benefits. Some equipment is being evaluated to reduce the likelihood of damage even when impact isn’t reduced. One fascinating possibility is called a Q-collar. This plastic device, currently being tested in high school soccer players, is worn around the neck and exerts gentle pressure to decrease blood flow out of the brain. It is believed this better cushions the brain when an impact occurs, thereby reducing damage.
Q. – Are all concussions similar to one another?
A. – They say, “if you’ve seen one concussion – you’ve seen one concussion”. All concussions are similar in that they involve a “rattling” of the brain, but beyond that, no two are quite the same as far as symptom specifics, severity or duration. One person may sustain a powerful blow and recover quickly and all but completely, while someone involved in a “fender-bender” may never be the same. Despite each concussion’s uniqueness, experts may categorize them by symptom cluster, such as visual, vestibular, post-concussion migraine, cognitive/fatigue, anxiety/mood, and cervical. This can assist in determining prognosis and specific treatment approaches. Even when multiple symptoms exist, one cluster often predominates and can guide care.
If you live in Virginia and have questions or concerns about TBI- please feel free to contact Dr. Jacobs to arrange an appointment