Post-concussion symptoms, see concussion symptoms


I was brain injured in 2003 while cycling in Victoria, BC. Concussions are also known as mild traumatic brain injuries and while what I sustained was a coma-inducing severe traumatic brain injury, from what I hear, and what makes sense to me, there seem to be many overlapping symptoms. I read about how Marc Savard has “post-concussion” symptoms and I’m really wondering why they call them post-concussion symptoms and why I always say ‘I was brain injured’. I guess the major traumatic blow to my head  is a thing of the past, so, on a technicality, I can get away with saying “was brain injured”, but plain logic is enough to tell you that you don’t have symptoms from an injury that doesn’t exist. I still have major symptoms and even though you can’t see my injury just by looking at me today, doesn’t mean that my brain has completely healed. Some parts of my brain seem unaffected, but obviously, some parts are still affected. My brain injury is not a thing of the past, my brain is still injured, or at least changed enough from what it was, so as to make the distinction meaningless. My problem with double vision and balance are obvious to people who know me, but I have symptoms that, from what I’ve read, many with concussions experience as well.

From a non-medical point of view, I think saying someone has “post-concussion symptoms” is a misnomer. The hit is not the concussion, the injury to the person’s brain is the concussion. If ‘John’ was knocked down, landed hard, broke his leg and was using crutches, it wouldn’t be said that John has post-broken leg symptoms, it would be said that John’s leg is broken. So why say “post-concussion symptoms”? Saying you are or were brain injured has such a negative connotation that it’s easy to for me to understand. Not long ago, when someone asked, I would try to avoid saying it, now I try to make sure I tell people that I was brain injured – not gloss over it – but I still tend to be reticent about the severity of my injury (but not all the time).

I mentioned some of my more major symptoms; double vision and balance issues (the amount to which they are intertwined is a difficult issue to resolve, since I’ve never had one without the other); but I think some of the other daily issues I face are some that people who have concussions face as well. When I stand up after I’ve been sitting down for a while (probably 20min or more), I’ve got to take a second to re-orient myself. This is usually very quick and it probably has a lot to do with my balance issue, but I feel it predominately in my head – not dizzy or spinning, just needing literally a second to get re-adjusted. If I’ve been lying down, I need more time and that’s when dizziness can kick in for a few seconds. It really helps if I go from lying down to sitting up and then take a second when I stand. It sounds basic enough and it only takes a couple of seconds, but it’s something I do with more of a conscious effort.

Quickly turning my head when I’m lying, sitting or standing can often cause a second or two of dizziness. Not enough to knock me off my feet or anything, but enough that I notice and am bothered by it. The most intense moment of dizziness I seem to get is when I’m sitting up and I feel the need to push my arms up over my head and stretch them up and stretch my body (usually in the morning sometime). It’s a stretch that everyone does (brain injured or not) in the morning (usually standing, right after they get up). I’ve done it standing next to my bed, but the dizziness it causes always knocks me back on my bed, so I also do it, usually mid-morning, sitting in a chair. Those ‘spins’ can last a few seconds and my head feels weird for a few more seconds after that too.

For some strange reason, I’ve never had to deal with headaches. I had one long, intense headache after the doctors replaced the bone flap in my skull that was removed to release pressure on my brain just after I was injured, but other than that, I seem to have avoided them (that said, my head doesn’t always feel 100%). Another important issue that I share with people with concussions is fatigue. It’s not something that’s easy to relate because it’s not like being sleepy or tired after a long day’s work. It’s also something I’ve – perhaps unwisely – ignored at times because I wanted to do something or go somewhere. I wrote a post in January about Sidney Crosby and his then-newly sustained concussion (check out the video). I wrote in that post that “To anyone who has had a concussion or another type of brain injury, his description makes sense” and unfortunately it’s a difficult feeling to convey. I like his description at 4:55 of the clip when he compares it to feeling a little sick (I took this to mean something like having a cold or flu, not stomach sick) or ‘off’. I think that’s about as apt a description as I can think of. Just like anybody in life, you don’t feel the same everyday, but this feeling is always lurking. You may not consciously feel ‘off’ that day, but it’s usually not far away. I’d like there to be a more universal description, but I don’t think one will ever exist because everybody’s brain is different; different thought processes, different neural pathways, it’s so complex that it’s extremely rare, if not impossible, for even two to be exactly the same.

The Boston Bruins should be commended and congratulated for understanding the issue and expecting Marc Savard to miss the entire season. It’s good to see this issue being addressed, at least for one player!

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5 thoughts on “Post-concussion symptoms, see concussion symptoms

  1. Don Brady, PhD, PsyD, NCSP, LMFT September 7, 2011 / 11:22

    Sorry to hear of your concussion-related struggles. Great insightful article…

    I agree with you that the term post concussion symptom is very misleading. Please see below excerpts for additional comments.

    Perhaps some excerpts from my 2004 Dissertation (…NFL Players’ Knowledge of Concussions) will assist you along with also reading a 1994 (yup 1994 !) article written by neurologist R. W. Evans, MD who was a trailblazer in the field of concussions. A brief list of some of his concussion- related writings follow:

    Evans, R.W. (1987). Postconcussive syndrome: An overview. Texas Medicine, 83, 49-53.
    Evans, R.W. (1994). The postconcussive syndrome: 130 years of controversy. Seminars in
    Neurology, 14, 32-39.
    Evans, R.W. (1996). Neurology and Trauma. Philadelphia: W.B. Saunders Company.
    Evans, R.W. (2000). Postconcussion syndrome. In R.W. Evans, D.S.Baskin, & F.M. Yatsu
    (Eds.), Prognosis of neurological disorders (pp. 366-380). New York: Oxford Press.
    Evans, R.W., Evans, R. I., & Sharp, M. J. (1994). The physician survey on the post-concussion
    and whiplash syndrome. Headache, 34, 268-274.

    I had the privilege of conversing with Dr. Evans during the completion of my PhD studies. Dr. Evan’s article that appeared in Seminars in Neurology is entitled The Postconcussion Syndrome: 130 years of Controversy. Upon reading the journal article you will find that many of today’s issues were being discussed during the 1800’s: substitute trains for sports.

    Several Dissertation excerpts now follow and I trust this info will assist in making more sense of your insights while also providing new/expanded info to readers of this blog.

    Don Brady, PhD, PsyD, NCSP, LMFT
    Licensed Clinical Psychologist
    Nationally & NY State Certified School Psychologist
    —————————————————————————————————–:
    Strauss and Savitsky (1934) are credited with coining the phrase postconcussion syndrome (Evans, 1994), and they posited that not only may a concussion occur without a loss of consciousness, but that it has an organic basis. In their extensive 63-page review of the topic, they emphasized the importance of documenting clinical observations and of not quickly attributing vague or unusual findings to functional/psychological origins. The value of the clinical judgment was also highlighted in the following statement: “Results of tests and exact quotients cannot take the place of the opinion of an experienced clinician” (p. 912).
    ============================================================================
    The term postconcussion evolved from early conceptions of a concussion as an entirely reversible syndrome without detectable neural pathology. As such, the prefix post literally meant after [the event] (Gasquoine, 1997). Agreement does not exist on how to conceptualize the concept of post concussion syndrome or even if the syndrome exists. According to Evans (1987), symptoms attributed to the effects of a concussion may also be called postconcussion syndrome. Rutherford (1989) advocated for the dropping of the prefix post, and thus called the collection of presenting symptoms the concussion syndrome. The author also argued and pointed out that since fractured ribs-related pain is not labeled “post rib fracture” pain, concussion-related symptoms should not be perceived as postconcussion symptoms. Furthermore, since some symptoms of a concussion and post concussion are similar, it is not easy to recognize when a concussion ends and the postconcussion syndrome begins (Wills & Leathem, 2001).
    ============================================================================
    Evans (1989, 1994) and Roberts (1988) elaborated on the notion of the PCS construct being entrenched in controversy for several hundred years. Evans also stated that current controversies pertaining to concussions are comparable to injuries and their respective symptoms that persons reportedly sustained in railroad-related accidents during the mid to late 1800s in the United States and Europe (Caplan, 1995; Erichsen, 1997; Keller, 1995). Reflected in the numerous terms utilized since the mid-1800s to describe the present day postconcussion construct, these controversies range from acknowledging to disputing the existence of the syndrome, and they include a debate as to whether its etiology is organic or psychological/functional. Evans also pointed out that the physiological basis of the postconcussive syndrome is becoming increasingly well-documented by abnormalities found in pathologic, neurophysiological, neuroimaging, and neuropsychological studies. (1994, p. 5).
    ====================================================================
    From R W Evans, 1987

    Postconcussion Symptoms

    Headaches

    Muscle contraction type

    Migraine

    Occipital neuralgia

    Secondary to neck injury

    Secondary to temporomandibular joint syndrome

    Due to scalp lacerations or local trauma

    Mixed

    Dizziness

    Vertigo

    Tinnitus

    Blurry vision

    Diplopia

    Memory dysfunction

    Impaired concentration

    Personality change

    Anxiety

    Depression

    Sleep disturbance

    Decreased libido

    Irritability
    Noise and light sensitivity

    Fatigue

    Slowed information processing

    (R. W. Evans, 1987)

    • Nick Mercer September 7, 2011 / 14:36

      Thank you for all of the valuable info and studies.

      • Don Brady, PhD, PsyD, NCSP, LMFT September 7, 2011 / 22:21

        My pleasure, Nick.

        May I also suggest you read 2 recent articles published in June 2011 by NASP (National Association of School Psychologists) re SRCs that my wife, Flo, and I wrote. The articles are entitled: 1- Sport Related Concussions (suggest you read the comments re emotional, physical and cognitive rest; and also functional recovery) and 2- Sport Related Concussions: Myths and Facts.

        Google our names, NASP and sport related concussions & links to the 2 articles will emerge. Feedback would be appreciated when convenient.

        From my perspective, a concussion is, not was, a brain injury, and there exists ample evidence that the brain does not completely heal after a concussion….and thus an individual DOES NOT fully recover but may functionally recover from the brain injury.

        Best wishes.

    • Don Brady, PhD, PsyD, NCSP, LMFT September 11, 2011 / 04:28

      Re: R. W. Evans, MD, Neurologist

      The neurologist has a website that readers of this blog might find very informative. Some of his articles are available directly from his website.

      rwevansmd.com

      I was pleasantly surprised to find the doctor”s site as I mistakenly thought he had died.

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