April 24, 2012
12:00 p.m. – 1:00 p.m. (EST)
Cleveland_Clinic_Host: Welcome to our Online Health Chat "Concussion" with John O'Connell, MD. We are thrilled to have him here today for this chat. Let’s begin with the questions.
FlRugby: What are the tell tale symptoms of a concussion?
Dr_O_Connell: Concussion has several grades of severity. The symptoms include loss of consciousness, confusion, and the inability to answer simple questions. Afterwards, patients may exhibit depression, dizziness, sleepiness, irritability, feeling "in a fog", headache, memory problems, nausea, nervousness, poor balance and concentration, ringing in the ears, sensitivity to light and noise, and difficulty sleeping.
FlRugby: Do the symptoms become visible immediately or do they get worse over several days?
Dr_O_Connell: The confusion, loss of consciousness and the inability to answer questions are immediate, the others may occur immediately or manifest hours to days afterwards.
lindaRell: Is a consistent severe headache a sign of a concussion?
Dr_O_Connell: Yes it is, and it indicates further evaluation is necessary.
lindyhop: My nephew (14 years old) had a concussion playing soccer about a month ago. He still gets headaches, is this normal for these headaches to last this long?
Dr_O_Connell: How bad was his concussion? Did he lose consciousness? What was done afterwards to treat him?
playharddoit: How long do the symptoms last for a concussion?
Dr_O_Connell: They are variable and are related to the severity of the concussion.
Coachmph: Can you tell me about ImPACT?
Dr_O_Connell: It is a computer based testing program to assess athletes following a concussion. It allows a thorough and reliable evaluation by a trained individual which can be stored and shared. Benefits are increased reliability of testing and data and accurate evaluation.
TedDeeb: What is the probability of seizures after a concussion – is this a sign of a more serious concussion injury?
Dr_O_Connell: Posttraumatic seizures occur following more severe head injury and indicate aggressive workup, these patients require immediate evaluation by a physician.
SportFanatic: Seems like teens get more concussion injuries, are they more prone?
Dr_O_Connell: Teens are more likely to be in a situation where a concussion would likely occur, most brain injury related fatalities occur among American football players, but in terms of injuries per 100,000 participants, horseback riding and motorsports produce more injuries.
Dr_O_Connell: @ playharddoit, to elaborate on my answer, symptoms vary and length of symptoms determines the degree of concussion. Mild concussions have symptoms lasting less than 30 minutes, moderate concussions have symptoms for up to 7 days and severe concussions have symptoms greater than 7 days.
SoccerMom: What are the guidelines for a student athlete to return to play after a concussion injury?
Dr_O_Connell: They vary based on grade and number. For a first time mild concussion with no loss of consciousness, the athlete may return to play after 1 week of no symptoms. For a second time mild concussion, return to play in two weeks if asymptomatic for a week, and after a third mild concussion terminate the season, return next season if asymptomatic. For grade 2 concussions, where there is loss of consciousness for less than 1 minute, return if asymptomatic after 1 week for the first, 1 month for the second if asymptomatic and terminate season for the third with return next season if asymptomatic. For grade 3 concussions, with greater than 1 minute loss of consciousness, minimum of one month after the first, return to play if asymptomatic, terminate the season after the second, return next season if asymptomatic.
AlWalker: What is post concussion syndrome? What tips would you give to be able to continue your daily life?
Dr_O_Connell: Post concussion syndrome is headache, dizziness, fatigue, irritability and impaired memory following a concussion. This is due to altered function of the chemicals in the brain that transmit nerve impulses and I recommend seeing your doctor for further workup if not already done. Do not return to competition until all symptoms have resolved and your testing is all negative.
AmberL: Should you treat a female athlete differently compared to a male for a concussion injury?
Dr_O_Connell: Good question! I'm not aware of any differences in the guidelines for treating male versus female athletes. The guidelines do not specify gender.
Dr_O_Connell: @ AmberL While the guidelines do not differ, you may be interested to know the incidence of concussions per 1,000 exposures in sports without helmets is greatest in soccer, with men's soccer showing almost identical numbers to women's soccer. In sports with helmets, Ice Hockey and Football are the most common sports with concussions.
Cleveland_Clinic_Host: For those now joining us, we are currently chatting with John O'Connell, MD, who is taking your questions about Concussion. To ask a question, type in the box below and then click 'Ask'
SuzyQ: What is the status of the Florida legislation on concussion assessments etc?
Dr_O_Connell: Legislation regarding informing athletes about concussion risks and symptoms was passed unanimously by the state legislature and is awaiting signature by Governor Scott.
RobLevine: My son got a concussion playing lacrosse and he was wearing a helmet, what are the guidelines for the fit of helmet to prevent this from happening again??
Dr_O_Connell: It should be a NOCSAE certified helmet with a face mask, chin strap, chin pad and mouth guard, turning the helmet should result in only slight movement.
PeteW: Has there been any research to show a correlation between adolescent depression and concussions??
Dr_O_Connell: Yes, I've attached a link for you to the consensus statement on concussion in sports.
CoachK: What pain medications are good/appropriate for a concussion?
Dr_O_Connell: Ideally medications that don't cause any cognitive side effects such as over the counter acetaminophen.
Cleveland_Clinic_Host: We have approximately 10 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.
JayBird: I read that there is research being done about a concussion medication? Is this true and is it on the market?
Dr_O_Connell: I am not aware of any medication specifically for concussion on the market. Antidepressants are sometimes used to manage the symptoms that occur following concussion.
DannyB: Is bed rest and demobilization of the head the best remedy?
Dr_O_Connell: Ideally, activity as tolerated, avoiding any activities that may result in a second impact is best.
JBird5: Does increased neck strength give you an extra edge in protecting against a concussion?
Dr_O_Connell: Theoretically, increased neck strength can help against trauma from indirect impact, such as a blow to the chest or back moving the body, but practically, proper well fitted protective equipment is more effective.
SteveD: Can wrestlers (Greco-Roman) get concussions?
Dr_O_Connell: Absolutely! As I mentioned in the previous answer, indirect trauma can also lead to concussions.
Dr_O_Connell: Thanks for your questions; I had a great time answering them.
Cleveland_Clinic_Host: I'm sorry to say that our time with John O'Connell, MD is now over. Thank you again, Dr. O'Connell, for taking the time to answer our questions today about Concussion. To make an appointment with Dr. O'Connell, or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org
Future Web Chats
Cleveland Clinic offers free online health chats throughout the year. It's easy to be part of our live chat events, led by Cleveland Clinic physicians and health educators. Register for one today!