Awareness of concussion injury exploded with the movie Concussion in 2015. The correlation between multiple concussions and neurodegenerative conditions was brought to the big screen. The common analogy of concussion being a “brain bruise” suggests that it is a minor injury that should recover in a few days without any permanent consequences. However, this is not true.
Our brains are uniquely designed and complex, more sophisticated than any computer. Every activity is a function of networks in the brain. The brain tissue injury that occurs as the result of concussion is complex and disruptive. Concussion is the result of many kinds of trauma that cause the brain to be shaken around inside the skull, causing diffuse axonal injury (DAI).
DAI creates lesions all throughout the brain, damaging the myelin (the fatty coating around axons), and may cause damage to deeper axonal structures. Diffuse injury disturbs network communication in the brain. Synapses—where one brain cell or neuron uses neurotransmitters to communicate with another brain cell—can be pulled apart, therefore disrupting cell-to-cell communication. The microenvironment of electrolytes and other brain-specific chemicals around the brain cells, glia and other support cells is disrupted and may effect electrical conductivity and functioning of cells.
Even a minor concussion may cause breaches in the blood brain barrier (BBB). A breach in the BBB allows chemicals, toxins and infections access to the brain when they would otherwise be blocked. The microtubular structure that internally organizes the neuron and allows transport of neurotransmitters to the synapse may be disrupted and disable cellular function.
Brain cells that are damaged and not restored to function begin a process of degeneration; this dying back of the cell leads to cell death and brain atrophy. This is the definition of a neurodegenerative process. Neurodegenerative processes include dementia, Parkinson’s disease and ALS.
Functional recovery—restoring the ability to read, sleep and balance, visual function and depth perception, cognitive activities and more—can be addressed by therapy, where some re-wiring and re-networking of the brain may occur. However, decline may still occur because functional recovery is different from biologically and physiologically healing the brain.
Military veterans, first responders and athletes in contact sports are at great risk for concussion and recurrent concussion, which causes cumulative injury and a high risk for neurodegenerative conditions. Traditional Brain MRI sequences, even with contrast, do not aid in diagnosing concussion because they do not highlight the disconnections. Brain MRI – DTI (diffusion tensor imaging) sequencing and/or Brain Quality SPECT scanning are the imaging tools of choice. Objective computer-based functional testing, including the RightEyeQ test (a standardized objective test of visual fixation and follow), reaction time testing and formalized balance testing, are objective and predictive, which is a good way to establish a baseline.
Take brain health seriously and pursue meaningful testing and active treatment for concussion.
Carol L. Henricks, M.D. is a neurologist specializing in the use of hyperbaric oxygen therapy (HBOT) and PEMF at NorthStar Hyperbaric, in Tucson. (HBOT) saturates the body with oxygen, reducing inflammation and enhancing recovery from central nervous system injury. Connect at 520-229-1238 or NorthStarHBOT.com.