Polite Dissent

Stormwatch P.H.D. #11 “Family Matters”
Christos Gage, writer
Andy Smith, penciler

A concussion is a type of mild diffuse brain injury — this means that the injury is spread over a large portion of the brain as opposed to a focal brain injury such as penetrating trauma or a bleed. Concussions are most commonly caused by a direct blow, though acceleration/deceleration injuries can also cause them. Common symptoms include amnesia, headache, confusion, vomiting, visual disturbances, and a loss of consciousness. The amnesia can be retrograde (loss of memory from the period before the injury) or anterograde (loss of memory from the period after the injury).

There have multiple systems devised to classify concussions, but none have been completely satisfactory because they aren’t very good at what we as doctors (and you as patients) are most interested in: predicting outcomes. One of the more common of these systems divides concussions into five grades. Grade I is a concussion where the patient experiences confusion, but no loss of consciousness. Grade II includes anterograde amnesia in addition to the symptoms of a Grade I concussion. Grade III concussion have the symptoms of Grade II concussions, but also include retrograde amnesia and unconsciousness of less than 5 minutes. Grade IV is similar, but has a loss of consciousness of five to ten minutes. Grade V describes a patient with a concussion who remains unconscious more than ten minutes.

Two concerns in patients who suffer concussions are Post-Concussion Syndrome and Second Injury Syndrome.

As the brain is healing after a concussion, neurological symptoms including headache, dizziness, clumsiness, memory problems and light sensitivity can persist. These symptoms are known as Post-concussion Syndrome and can last for days, weeks, or even years (Jackson King is being a little overly optimistic when he tells Gorgeous that it will only last “a couple of days.” But then maybe he can predict the outcome better because of his telepathy — sure would be nice). Post-concussion syndrome can make returning to work, school, or sports a real challenge. For example, Steve Park was once a top tier NASCAR racer who suffered a severe concussion in a crash. He had a protracted post-concussion syndrome and was never able to race successfully at the highest level again. Patients who are experiencing post-concussion symptoms should not return to sports (or crime-fighting) until all the symptoms have resolved. (We generally recommend waiting an extra week after the symptoms have resolved just to be safe). Returning to full activity too early is a bad idea because 1) patients with post-concussion symptoms are apt to injure themselves, or at the very least, embarrass themselves by being very bad at sports (or crime fighting); and 2) the potential for Second Injury Syndrome.

If a person receives a second concussion while they are still recovering from a first concussion, they are at risk if developing a serious condition known as Second Injury Syndrome. Not much is known about this rare condition (less than 50 recorded cases) except that it seems to occur in young patients who sustain two mild head injuries within a fairly short period of time. Second Injury Syndrome is nearly always fatal, and even if the patient survives, they are likely to be severely impaired. There is no effective treatment or cure for Second Injury Syndrome.