Concussion chat captures thousands of views

Linda Mansfield, MD, and Nikhil Patankar, MD, MBA, shared their knowledge and expertise about concussions on Wednesday in a live chat on Twitter.

Dr. Mansfield serves as director of Beacon Medical Group Sports Medicine and co-director of South Bend-Notre Dame Sports Medicine Fellowship.

Dr. Patankar is director for quality at the Pediatric Intensive Care Unit, Beacon Children’s Hospital.

And talk about reach.

Their tweets had been viewed nearly 6,000 times, as of Thursday afternoon, according to a Twitter analytics report.

Here’s the edited version of their chat transcript.

Q: What are the most common signs of concussion?

Patankar: Headache, nausea, vomiting, difficulty seeing and maintaining balance and feeling stunned. Other symptoms like confusion, forgetfulness and poor concentration are also commonly seen.

Mansfield: Initially we see headache, dizziness, balance problems and confusion. Later these can evolve into fatigue, irritability and emotional lability.

Q: Does every concussion patient exhibit all these symptoms?

Patankar: Not necessarily. Headache is usually the most common symptom reported. Other symptoms depend on the severity of the concussion.

Mansfield: It is imperative to seek medical evaluation so to avoid returning to play and being at risk of suffering a second head injury.

Q: What is standard medical treatment? How does it differ based on severity of injury?

Mansfield: Physical and cognitive rest, meaning no physical activity as well as avoiding any academic activities that exacerbate symptoms. Treatment initially does not differ based on severity, but length of treatment and progression back to activity does.

Patankar: Usually supportive care. No medications are proven to help. Duration of treatment depends on the severity of symptoms.

Q: If you don’t take rest seriously, can you lengthen time it takes to heal?

Mansfield: Length of treatment varies widely, although 90 percent of patients have symptom resolution within one- to two-weeks. Some patients have prolonged symptoms and can develop what is referred to as post-concussion syndrome lasting weeks to years. Symptoms sometimes last longer in younger children, most likely because their brains are still developing.

Q: In what sports are athletes more prone to concussions?

Mansfield: Football is the sport with the most concussions, simply because it is the sport with the most collisions. Girls soccer is also a sport where concussions are prevalent.

Patankar: Football is the number one sport, followed by girls soccer and then boys lacrosse.

Q: But people can suffer concussions from injuries outside of sports, correct?

Patankar: Absolutely! Fall from height, motor vehicle or workplace accidents, or assault can also cause concussions. An assault could be domestic abuse, including child abuse.

Mansfield: In addition, a motion not involving collision but causing rapid head movement can also lead to a concussion. Motor vehicle accidents are another common cause of concussion, as well as falls.

Q: What are the dangers of playing through pain?

Mansfield: Symptoms persisting for several hours wold be an indication to seek medical attention.

Patankar: Continued headache or mental fogginess should prompt you to see your doctor.

Q: How many concussions are too many? 

Mansfield: Suffering a second impact to the head, which in rare but catastrophic cases have led to immediate brain swelling and death. Also discussed earlier is the risk of second impact to the head, leading to prolonged symptoms.

Patankar: Common long-term effects of repeated concussions are short-term memory loss, difficulty in performing daily tasks, as well as issues with decision-making and problem-solving skills.

Q: What are your thoughts about research being conducted in football about repeated concussions linked to possible CTE diagnosis?

Patankar: A recent article published in JAMA, July 2017, reports that CTE was diagnosed in the brain autopsies of 87 percent of football players at all levels.

Mansfield: That is not to say that 87 percent of football players have CTE, but that athletes with symptoms of CTE are likely to have brain changes. There needs to be studies done on risk factors for prolonged symptoms. Also continued studies on brain changes and CTE.

Q: Does research steer us toward a “magic number” of concussions to avoid?

Mansfield: There has been no number proven to be the “magic” number to disqualify an athlete from sports. It’s an individual decision. But there have been some findings to suggest there are changes in the brain in athletes that have suffered repeated head trauma.

Q: Any other advice for those who suffer a blow to the head or experience concussion symptoms?

Mansfield: Again, seek medical attention and do not return to sports activity until the possibility of concussion is ruled out.

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