How many concussions can lead to death ?

Concussions suffered during Karate

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A question most parents ask me when they walk in to my clinic to have their child assessed after a head injury: “Can concussions cause death?” if yes “how many before it’s fatal ?”.

A few days before the assessment, Brian and his mom had spent time at the ER after Brian mentioned the feeling like “blood was gushing to his brain” and he couldn’t make sense of anything that ever occurred after that. 

According to the Centers for Disease Control and Prevention, about 4 million sports related concussions occur each year. 

Every day, 153 citizens in the United States die from injuries that include the diagnosis of Traumatic Brain Injury (TBI) 

The most vulnerable age groups include, 

Children aged 0 to 4 years, adolescents aged 15 to 19 years, and older adults aged 65 years and older. 

In 2012, an estimated 329,290 children (age 19 or younger) were treated in U.S. Emergency Departments for sports related diagnosis of concussion or Traumatic Brain Injury (TBI)  

 Going back to questions, often the other less intimidating questions asked are, 

  • Is my child going to be ok? 
  • Will he/she return to playing his sport? Will it be dangerous for him to return to play? 
  • Will my child be able to cope up at school with academics? 
  • And so on… 

Attributing concussion to death can most definitely make you nauseatingly sick with fear. 

 But you can’t blame some of these parents who have seen their kids collapse, some lose their consciousness, others lose their attention span and train of thought after a vicious hit to the head for asking these questions. 

 An analogy I often use to stress about mental health: 

What is the minimum permissible level of lead in drinking water? The answer is ZERO.

The Centers for Disease control and Prevention (CDC) states there isn’t a safe level of lead in a child’s blood. Even at its minimum, lead is harmful for their health. The same is true with a head injury.  

 Hence, the number of concussions you need to sustain in order for them to be fatal is ZERO+ 

Lets consider football. Helmet to helmet collision is the number one injury mechanism leading to some massive shearing forces in the brain leading to functional inabilities. 

The average defensive back (DB) can produce up to 1600 pounds of tackling force when his speed and body mass are combined.

Imagine two speeding trains with the same number of cars and load speeding towards each other head on.

The force of the impact would be distributed along the length of the trains. Now imagine both trains having passengers.

 The passengers would be thrown about freely within the cars due to the impact. The player’s brains are those passengers, and those first cars that strike are the player’s helmets. 

 

This is just one example of one of the many ways we can traumatically induce alterations to the mental status of the brain. 

THE ONE THING TO KEEP IN MIND BEOFRE WE PROCEED,   

IF A CHILD DURING PLAY IS SUSPECTED OF A CONCUSSION, YOU MUST PULL HIM/HER OUT. 

IN THE PROCESS OF FAILING TO DO SO, THE CONSEQUENCES COULD BE FATAL.  

Why? Let’s find out. 

So, what is a concussion? 

It is a mild traumatic brain injury, a widely diffused brain injury causing alterations to the mental status of the brain. 

Concussion being a functional and not a structural injury, does not always lead to loss of consciousness and hence is often left “unnoticed” or “undiagnosed” by the coaches, players or physicians alike.

That being said, not all structures are spared. There is some disruption of structures due to the brain sloshing around in a vast empty skull, depending on the intensity and force of impact.

As the brain is soft, irregularly shaped, and has a variety of parts with different densities, it doesn’t move as one whole unit in response to a sudden head impact.

Rather, different parts of it will move at different speeds, causing sheering injuries inside the brain tissue.

The resulting distortions in the brain can cause damage to the nerve fibers (known as axons) and rupture of the blood vessels.  

When axons have been damaged throughout the brain, it’s known as diffuse axonal injury – a common finding in concussion and more severe head injuries. I

f a knock to the head causes the brain tissue to become relatively mildly deformed, it’s likely to result in brief functional changes in the brain; changes that are too subtle to see on head CT scans,

but that cause disruption to the way the cells function. Whereas in an injury causing more severe brain deformation,

we may see permanent changes to the structure of the brain which could have fatal consequences.

In the event, your child does not recover completely from one such concussion and sustains a second one, that leads to what is defined as a “second impact syndrome” the results of which can often be catastrophic.  

So why might I die if I had a concussion? 

CAUSES OF DEATH DUE TO TRAUMATIC BRAIN INJURY: 

1) ACUTE CEREBRAL OEDEMA – This usually occurs with more severe cases leading to structural damage and increased pressure in the brain leading to decline in neurocognitive status. 

2) DEPRESSION / SUICIDE – One of the leading causes amongst high school athletes. Case studies suggest suicide was common mostly in the acute and subacute phases of the injury ie early stages. 

3) PATHOLOGIES ASSOCIATED WITH CTE – CTE ie chronic traumatic encephalopathy is a condition that results from repeated blows to the head leading to neurodegenerative changes that ultimately leads to death. 

4) SECOND IMPACT SYNDROME– Systemic failure of the brain resulting from exertion ie incomplete recovery from a previous injury,

ultimately resulting in longer recovery time sometimes incomplete/poor recovery leading to a decline in health status and death. 

You do not want to take away the semblance of normal life from your kid, no matter how old they get. 

In order to ensure that, it is important to always closely watch for any signs or symptoms, even if they don’t seem alarming. 

Take proper safety measures and most importantly educate yourselves. 

Awareness is the new prevention. 

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