Tearful, tired...can't think clearly? You could have concussion... and, like so many other victims, not realise just how serious it is

Abigail Butcher, 39, a freelance journalist has written about her own experience of concussion which was only diagnosed months after falling 4ft.

Article sourced from Daily Mail, 03 March 2015. When a friend hoisted me on to his shoulders at a concert last July, I could hardly have anticipated that, for months afterwards, this simple action would leave me struggling to concentrate or hold a conversation, let alone work or drive. For, as my friend stood up, I toppled forward and fell about 4ft, landing squarely on the top of my head. I saw a burst of bright light as I hit the ground, then it all went black for around 30 seconds, although I wasn't knocked out. I stood up slowly, clutched the wall for about five minutes while the stars cleared, and soon felt fine again, though my neck hurt a little. I didn't think any more of it. But two days later I started to feel a bit odd — sick and dazed. I was also struggling to concentrate on my work as a writer, and felt inexplicably tearful. However, I was most concerned about my now painful neck, so took myself to A&E.

Concussion can be easily missed

An X-ray came back clear, however, and I was sent home with an advice sheet to read on head injuries. I later discovered I'd actually suffered concussion, though no mention was made of it then — I was only diagnosed months later when I used my private health insurance to see a specialist. The problem is that concussion can be missed, leaving patients struggling with daily life and dealing with bewildering and debilitating symptoms, when what they need is to take it easy. And older people as well as those who've suffered from depression may be even more affected by symptoms. Concussion, or mild traumatic brain injury (TBI), is a sudden but temporary impairment of consciousness — you don't have to black out to have it — caused by a blow to the head or a sudden, violent movement. The force of the blow causes the brain, which has the consistency of jelly, to move inside the skull, explains Professor Tony Belli, a traumatic brain injury specialist at Queen Elizabeth Hospital, Birmingham. 'This stretches, deforms and sometimes severs the long, delicate fibres — called axons — that connect nerve cells in the brain. 'This interrupts the communication between different parts of the brain. The immediate result is usually someone "seeing stars", stumbling or briefly losing consciousness. 'Communication between the parts of the brain is usually quickly restored, but the cabling needs repairing afterwards. This explains why people develop post-concussional symptoms,' he adds. These include headache, fatigue, dizziness, trouble falling asleep, feeling unusually sleepy, as well as difficulty concentrating and problems with memory and multi-tasking.
'Most day-to-day tasks are still possible on a low level, but the brain has no reserve to deal with strenuous mental and physical exertion, prolonged stimulation, stress or illness,' explains Professor Belli. 'The whole thing is a bit like the lights going out during a powerful storm: electricity may be restored quite quickly afterwards, but if everyone switches on their appliances at once, the grid won't cope as many of the cables are still down.' So the advice is to take things easy to help speed up recovery. The problem is that diagnosing concussion is not an exact science — there is no specific test, nor can it be picked up by X-ray or MRI. Doctors will base a diagnosis on someone having symptoms and having had an 'alteration of consciousness'. Yet this moment is often so brief many people think nothing of it — as I did — especially when there can be a time lag of up to 48 hours between the head injury and symptoms. But that's not the only reason many people's concussion gets missed, says Dr Mark Wotherspoon, a sports physician at The Spire hospital in Southampton, who I saw two months after my fall.

Poor understanding in A&E

'There's a poor understanding of concussion in A&E departments and among GPs in general,' he says. Each year, 1.4 million people in the UK suffer from head injuries. In about 85-90 per cent of cases any concussion will recede within two to three weeks, but in a small number, the problem will be persistent, continuing for three months or longer. And between two and four per cent of people never completely recover, and live with a feeling of permanent 'brain fog'. The confusing thing is concussion can be hard to detect in yourself, partly because of the reduced brain function that comes with it. Twenty-four hours after I first went to A & E I went back, but only because I was still concerned about the pain in my neck. I had another neck X-ray that came back fine and even though I was sick on the way home — a key symptom of concussion — all I thought about was my neck pain.
Within a week, I was sleeping for around 16 hours a day and was very confused, and I started to feel sick and dizzy again, so called my GP. He rang an ambulance and I returned to A&E, this time for a CT scan to check for bleeding on the brain. As there wasn't any, I was sent home again.

Speeding up recovery

It was only a month later when, complaining of my difficulty working, constant dizziness and fatigue to a knee surgeon (I was interviewing him for Good Health) that it was suggested I had concussion. My GP referred me to Dr Wotherspoon, who often treats those with brain injuries. After listening to my symptoms, and assessing my balance and cognitive function, Dr Wotherspoon confirmed it was concussion. For the best chance of recovering, he said I had to completely avoid any taxing mental or physical activity — I was unable to work, read or even go for a walk. There is no medication for concussion, but symptoms such as headaches and low mood — another effect of concussion — can be treated. Correct management — which as well as taking it easy includes avoiding alcohol — can help speed up recovery time. 'People need to know what to expect — that they will be dizzy, low in mood, suffer sleep disruption and that they must rest from mental and physical work,' says Dr Wotherspoon. He says my symptoms lingered because I tried to continue as normal. But people like me could be predisposed to prolonged symptoms from a concussion anyway. With a history of serious depression throughout my 20s and into my 30s (I am now 39), I was on anti-depressants for years — fortunately, while I do still occasionally get 'the blues', I kicked the worst of it five years ago. However, doctors think any chemical imbalance in the brain of someone affected by a mood disorder may make them more prone to the effects of concussion.
It's not just mood disorders that predispose you. Age plays a huge part too — the older a person is when they are concussed, the longer they will take to recover from it and women recover more slowly than men. Exactly why is not known, says Professor Belli. Some people are genetically predisposed to concussion. 'Those who have the variant of the gene APOE, which is linked to dementia, recover more slowly from TBI but we don't know why,' says Professor Belli. Six months on, I have gradually returned to work and exercise but still suffer occasional dizziness if I've been concentrating hard or pushing it a bit far in the gym — and continue to need nine or ten hours' sleep a night. If you have suffered a bump on the head and still feel dizzy, emotional, have trouble concentrating or simply 'not quite right' after six to eight weeks, seek help.
Ask your GP to refer you to a brain injury clinic — or a specialist injury clinic. I still curse the fact that I didn't get the right advice from the outset. You can find out more about Abigail here.
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