Doc, many QBs, like Troy Aikman and Chris Miller (who suffered 5 concussions in a span of 14 months), suffer "multiple" concussions. From what you're saying, that is different than "recurrent" concussions, is that right?
Once again, my disclaimer:
I do NOT claim to give out medical advice nor am I claiming to diagnose, cure or treat ANYONE over the internet. Anyone who makes those claims are either much more skilled than I, or completely and hopelessly RECKLESS. In any medical emergency, contact your family physician/emergency medical treatment center, not the INTERNET.
As for the specific instances you quoted, without knowing more about the case, I can't make a definitive statement either way. What I can do is reiterate what I said originally. Concussions are the result of trauma and don't have long lasting effects unless PERMANENT damage has occurred. In that case, the person's dura and surrounding tissue that was MEANT to cushion the brain and PREVENT concussions isn't doing it's job as well.
But that's not a "recurrent concussion". That's permanent damage to the brain's surrounding tissue.
Isn't that what lay people innocently mean when they say "recurrent" concussions?
They are tying independent trauma's together under the name "concussion" when a CONCUSSION is the RESULT of the trauma, not a cause of the subsequent traumas (unless the person's reflexes are dulled or impaired by blacking out or dizziness).
Little known fact: THe brain itself doesn't have massive pain receptors. Most of the pain you feel in a headache comes from the pain receptors on the blood vessels in and around the brain. Those vessels detect waste (as in toxins or metabolites - it would take WAYYY too long to go into depth here) and contract/dilate to increase/decrease blood flow...that is another source of the pain you may feel. Trauma can cause contraction, causing other things, causing bad metabolites leading to pain in all ways listed.
The dizziness/syncope comes from the decreased blood flow to certain areas AND getting you vestibulocochlear "bell" rung...(nerves are located in middle/inner/brain, all effected by the trauma).
Not to be understated, trauma causing the brain to slam against any part of the cranium can cause brain damage in the form of lesions...but not to worry, the brain re-wires small portions fairly easily. Larger ones result in a loss of function or prolonged symptoms.
This is a GROSS over-simplification of the neuroanatomy/neuropathophysiology of concussions and the resulting altered mental states. There is no way I could give you all of the info I've learned about this subject here, nor do I think anyone wants to know more than this.
Also, when boxers like Jerry Quarry suffer repeated blows to the head causing dementia, what are those considered?
Dementia (that you are talking about here) is from permanent damage to the brain itself. Sorry but the concussion is just the immediate symptoms following trauma, not a cause of any subsequent (far after the concussive symptoms subside) or previous (damage before the previous concussive symptoms subsided) permanent damage.
Trauma to the head caused his symptoms by causing damage (irreversible after repetition). That DAMAGE slowed his reflexes and predisposed him to further trauma.
No "concussion" lasted continuously over that time...and if it did, his trainers are responsible for letting him fight in that state.
Didn't Max Baer kill a boxer because his brain got detached from the dura? Or was that mythical and the guy died from hemorrhaging?
Max Baer was a MONSTER!!! From the reports, his punches were EXTRAORDINARY, akin to getting hit in the head with a frozen 20lb slab of MEAT over and over again...
I'm surprised he didn't kill MANY, MANY more people with that.
But again, it wasn't the "concussion". It was detachment of the dura. There are blood vessels running all thru the dura, sometimes anastomosed (connected) with vessels in the brain. A person who gets hit the wrong way with that connection CAN rupture the anastomosed vessel(s) and bleed into the brain. The brain space is pretty tight. There's fluid in there but it's regulated by production, ventricles and connection to the spinal cord. Anyone with a blood pressure of 120/80 (or higher, in the case of a boxer with adrenaline pumping, fight-or-flight in full effect) will bleed into their brain fairly quickly with the subsequent pressure forcing the brain (mostly the cerebellum) into the foramen that normally holds the much smaller brainstem...
Needless to say, that leads to death...compression of the brainstem causes catastrophic damage, breathing cessation, loss of consciousness, many more...
What kind of MDs are you and Mrs. Doc?
My wife wants me to specialize in Anesthesia (she's a Nurse Anesthetist) so we can bill double but I'm either going to stay straight Peds or skip the end for Surgery.
Edited by GCMD, January 29, 2009 - 07:10 PM.