Q: What is traumatic brain injury? Is it different from a concussion?

A: Traumatic brain injury is any broad term used to describe any brain injury caused by trauma. It is a spectrum of injuries occurring in the brain ranging from either structural damage to the brain, bleeding in the brain or inflammation of the brain. TBI causes a wide spectrum of symptoms, including but not limited to mental changes, seizures, focal muscle weakness, paralysis, coma and death. TBI is often categorized by the severity of the injury, mechanism of the injury (for instance – is it a penetrating injury or a closed head injury) or location of the brain injury.

Glasgow Coma Scale is one of the standard assessment tools doctors use to determine the severity of the brain injury even before any brain imaging such as CT scan of the brain is done. A brain CT scan is used to confirm or diagnose most TBIs. Concussion is at the extremely low end of mild TBI. It is a traumatic brain injury causing a very mild inflammation and metabolic abnormalities in cellular level of the brain. Unlike other types of traumatic brain injuries which can be diagnosed or confirmed by brain CT scan, concussion is not diagnosed with CT scan or MRI. It is diagnosed clinically by patient symptoms. Brain imaging such as CT scan or MRI is used to rule out other injuries in the brain. A brain CT scan or MRI should be normal for a patient who suffered a concussion. If any abnormality is seen in a brain imaging such as CT scan or MRI, it means the injury is beyond concussion.

It is very important to know the impact that causes a concussion is not only limited to the head; in other words, you can get hit anywhere in the body and develop concussion.

Q: What causes a TBI?

A: TBI can be caused by any high velocity impact to the head. This includes both penetrating and non-penetrating head injury. However, concussion is caused by any impact that causes sudden acceleration and deceleration of the head which often cause ricochet movement of the brain within the skull leading to the brain hitting one end of the skull, then bouncing and hitting the opposite end of the skull. It is the impact of the brain's impact in the skull that leads to micro inflammation (swelling on the cellular level) of the brain which manifests as concussion symptoms. Any forceful blow or trauma either to the head or anywhere in the body can cause concussion. This is the reason why anyone can get suffer concussion, including someone who just slipped and fell or someone involved in an accident.

Q: What are the symptoms and treatment of TBI?

A: There are many signs and symptoms to look out for when you suspect concussion. It is imperative to know some of the common signs and symptoms when you suspect you, your loved one or athlete may have just suffered a concussion. Some common symptoms for a concussion include: headache/ head pressure; nausea and vomiting; balance problems; vision changes; confusion; difficulty with concentration or remembering; sensitivity to light or noise; neck pain and numbness or tingling.

Some of the signs to watch out for in someone who may have suffered from a concussion include: loss of consciousness; weakness; confusion or forgetfulness; irritability; more emotional; drowsiness and slowed reaction times.

Some people, especially athletes, have the tendency of not reporting their symptoms, either purposefully or just because they do not know they just suffered a concussion. So, be vigilant because concussion can be life threatening in some cases.

Q: Are there any long term effects? What are they?

A: Most concussions can resolve without any complications within two to four weeks. However, some may linger for a prolonged period of time. It is especially important to stop doing strenuous physical activities and cognitive exertion while you still have active concussion symptoms. As a matter of fact, the cornerstone of concussion treatment is physical and cognitive rest.

Some of the documented long-term effects of concussion include:

* Post concussive syndrome: this is when concussion symptoms persist for months.

* Post traumatic seizures: seizure starting days or months after concussion.

* Depression

* Mild cognitive impairment: what we know so far now is people who suffered multiple concussions may have a higher risk of developing mild cognitive impairment as they get older.

* Chronic traumatic encephalopathy

* Chronic traumatic encephalomyopathy

Q: What can be done to prevent TBI?

A: Using protective gear such as a helmet and mouth guard can prevent or minimize certain types of TBI. However, a helmet has not been shown to absolutely prevent concussion. It is important to take all possible precautions to minimize any chance of suffering brain traumas by doing the following:

* Wear a helmet or properly fitted protective equipment when riding a bicycle, bike, horse or playing any sports such as football, baseball, skating/skateboard, skiing or any other high impact sports.

* Wear a seat belt every time you are driving or riding in vehicle.

* Buckle your child in an age/weight appropriate car seat.

* Make play/living areas safe for your children and the elderly

* Never drive under the influence of alcohol or drugs (even some prescription drugs).

* Most important, follow the safety rules and all the rules of each game or sport you are playing.

Q: Is there any group of people more likely to suffer from traumatic brain injury?

A: While anyone can suffer TBI, historically it is more prevalent in men than women in this country. Children newborn to four years old, adolescents 15 to 19 years and elderly 65 and above are at the greatest risk of sustaining TBI. Falls are one of the highest leading causes of TBI in the general population. Concussion accounts for up to 15 percent of all sports related injuries.

While an athlete can suffer concussion in any sports, football, ice hockey and lacrosse have the highest risk of concussion for boys while girls soccer, lacrosse and basketball have the highest risk of concussion for girls.

Celestine Nnaeto, MD, FACP, CAQSM is the associate program director for St. Luke's Primary Care Sports Medicine Fellowship. The St. Luke's University Sports Medicine Program has a multidisciplinary team of sports medicine doctors, physical therapists and neurologists.