Friday, November 27, 2009


by Richard Crews
In a typical "Western" movie, the cowboy hero is whacked on the head with a pistol butt and falls unconscious. In a few minutes, as soon as it is dramatically appropriate, he recovers consciousness and immediately resumes his pursuit of the bad guys.

There are several things wrong with this picture. First, our hero has no post-concussive amnesia--immediately on awakening he recalls all the events leading up to the injury such as the appearance of the guy who hit him and the sounds of the attack. In real life, the memory banks of the concussed person are wiped clean for the minute or two prior to the concussion; someone, for example, driving down the street who is involved in a concussive head injury does not recall the last few blocks of driving before the accident.

Second, there are typically post-concussive symptoms of disorientation, confusion, and forgetfulness. The typical victim appears dazed; cannot identify the time, date, or place; and cannot respond appropriately to simple commands (such as "hold up two fingers"). General headache as well as pain associated with the local trauma (the painful lump on the head) are always present.

Third, there are usually symptoms of cognitive impairment hours to days after the injury. Even after the person is no longer confused or disoriented, the individual typically has headaches and experiences difficulty concentrating, learning, and solving simple problems for many hours, even days. (The memory loss is permanent--the lost memories for the events immediately preceding the head trauma are never recovered.)

Another important result of concussion which is missing from the typical cowboy picture is that the individual has increased susceptibility to receiving another concussion--the so-called "second-impact syndrome." This can persist for days--even weeks--during which even a milder blow to the head can cause a significant concussion.

It has also appeared in recent years that athletes who suffer repeated head trauma, for example in boxing or football, have an increased likelihood of brain deterioration later in life--for example, of Parkinson's Disease (like the boxer Muhammad Ali) or Alzheimer's (for example, the football Hall-of-Famer, Mike Webster)--even if there was apparent complete recovery from the original trauma.

Changes in equipment design, especially helmets, and in laws requiring their use have helped reduce traumatic brain injuries in athletes in recent years. There have also been useful changes in professional football rules--such as penalties against "spearing" or helmet-to-helmet contact. In boxing, the worldwide outrage at the violence (boxing is the only professional sport in which the official goal is to inflict injury) have spawned efforts to make boxing illegal, efforts that have been ongoing for decades, though they are met with considerable fan objections and monetary incentives for the boxers. Since there is now a law in the U.S. requiring that a doctor be present at every professional boxing match, the last best hope for outlawing the sport would be that all sports physicians agree to boycott boxing matches, perhaps under threat from medical associations of losing their medical licenses.