Brief Answer:
Jarring of the brain

Detailed Answer:
Good morning. My name if Dr. Dariush Saghafi. I'm a neurologist from the XXXXXXX Ohio region. I see concussions through the XXXXXXX VA system.

Think of a concussion as the act of "jarring" the brain. It happens in a number of different ways, sports injuries, car accidents, sports, falls, etc. Whatever causes the head to come to a sudden stop after it's been in motion will generally cause the brain to jar around inside the cranium. What happens afterward could be thought of as the after effects of the concussion. Symptoms vary by individual as well as their severity but there is almost universally some degree of the following:

Confusion, dazed feeling, loss of consciousness, headaches, nausea, vomiting, dizziness, numbness, tingling, blurriness of vision, double vision, fatigue, tiredness

There can be short as well as long term or "late" effects as well which would include personality changes, impetuous or even inappropriate behaviors in public or otherwise. Poor decision making which is completely incongruous with what the patient was like before that concussion. Ringing in the ears, loss of hearing, loss of smell, loss of taste are also possible symptoms.

I hope this explanation gets you a bit closer to what you wanted or needed to know. If this meets with your approval then, I'd very much appreciate some written feedback and a STAR RATING on the response to know how well you've been helped.

And at the same time if there are no further questions or comments on what I've written I would appreciate CLOSING THE QUERY from your end which will indicate to the network that I've satisfactorily met the needs of this particular question and that it can be filed.

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Brief Answer:
Examination by neurologist

Detailed Answer:
Good evening. The most qualified physician for assessing a patient for concussion is a neurologist. Clinical examination with an appropriate history is extremely sensitive in order to make an accurate diagnosis.

It is possible that an imaging study could be ordered, however, at this time there are no tests or scans of the brain that can determine the presence or absence of a concussion.

We are close though to getting a scan which will be able to detect concussions for up to several months afterward but this test is not ready for prime time just yet.

If this information was considered helpful then, I would very much appreciate your written feedback and STAR RATING to let me know how well I targeted your questions.

I would also be thankful if you would CLOSE THE QUERY from your end so that the network will credit this consultation appropriately and archive for future reference.

All the best to you.

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Brief Answer:
Special Sequence MRI looking for free radicals

Detailed Answer:
Good morning. Thank you for your follow-up question.

At this time there is information that special sequences are under development using MRI technology which can detect certain brain tissue changes related to traumatic head injuries which can be detected for at least several months from the time of a concussion. The sequences look for what are called FREE RADICALS which are released by the brain at the time of a concussion and can then, disperse and lead to further damage and problems over time. This may be an explanation as to why changes can occur in people even well after a concussion has occurred.

Here are a couple of links to cool articles on the subject:

http://www.technologyreview.com/news/411201/detecting-subtle-brain-injuries/
http://www.technologyreview.com/news/523306/inexpensive-brain-scans-could-catch-concussions/

I should warn you that there is nothing CURRENTLY AVAILABLE (whether offered by imaging companies or techno advanced experimental research protocols) which has been proven and accepted by the medical community at large in the acute or chronic detection of concussion based ENTIRELY upon an imaging study in the absence of standard radiographic signs of trauma such as bleeding, skull fractures, lacerations, penetrating wounds to the skull or brain, etc.

Similar imaging is being done for people who have had strokes. Whereas, before patients could only be told they had suffered TIA's (mini-strokes) and sent home now, there are now ways to image them so that we can tell if they've actually incurred very subtle strokes due to changes in the flow and accumulation of water in the area of the brain associated with the TIA.

I'm not saying that is exactly how the concussion imaging is going to work but rather that the stroke technology is running along the same lines. As to exactly when that type of imaging will be perfected and ready for prime time I don't have an idea. Furthermore, there has to be FDA approval for any type of study like that to be released to the general public so I doubt we are going to see anything on this available for a while yet.

I keep telling my patients that though it's nice to say that we live in a world where all this technology is on the brink of exploding the truth is that none of the really REALLY awesome stuff that is likely to be curable in the future or detectable such as Parkinson's Disease, Brain transplants following stroke, Alzheimer's dementia, XXXXXXX Gehrig's Disease (ALS) is going to be ready for US to be able to use when we need it and probably not even in our children....maybe our grandchildren! Oh well, we're still pretty well off with video games and YOUTUBE/FACEBOOK and of course, BLUE TOOTH rules! LOL!

As to the other part of your question- certainly, an emergency room physician is quite qualified to check a person over to tell whether they've suffered a concussion or not. And they can do the preliminary imaging studies such as a CT scan, etc. When I mentioned that a neurologist would be the most appropriate or best specialist that was based on wanting to give you who I felt would be the MOST QUALIFIED to assess a person since concussions can cause all sorts of very subtle neurological symptoms and signs that other physicians are simply not looking for (including ER personnel).

Clinically speaking the time for when a concussion occurred would be taken to be when the accident or blow to the head occurred. If what you're asking is whether or not there are easy ways to forensically detect EXACTLY when a blow to the head occurred then, the answer is, it depends on what's there in or on the head to help in the analysis. For example, if there were no witnesses to the accident and the person themselves lost consciousness during the incident and may even be suffering from some form of amnesia for events that occurred immediately before and after then, obviously valuable information may be lost or at least difficult to obtain.

Is there blood from a skull fracture accumulated under the skin or around the orbits for instance (raccoon eyes) or is there imaging evidence of a contusion on the brain itself (bruise). Is the person displaying odd behavior or did they have a convulsion which often occurs within a week of an index event if a person was actually knocked unconscious? Are they complaining of odd or severe headaches which is unusual for that individual? Are they having problems with seeing or reading?

Things like that might help a doctor pin down more precise timing if it's not obvious from the history when the blow to the head occurred.

I hope these responses help you and if so I'd very much appreciate your feedback along with a STAR RATING to help me know how well I answered your questions.

Also, I'd be very thankful if there are no further questions or comments if you would CLOSE THE QUERY on your end which will indicate to the network that they may process and properly credit this conversation for future reference.

Hoping the best for you or whomever may have suffered a concussion.

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Brief Answer:
Needs neurological examination and had imaging study.

Detailed Answer:
Good afternoon and thank you very much for your return question.

As I had stated previously the most sensitive and specific testing for your friends concussion at this point in time would be a neurological examination by a trained doctor who would likely order at least an imaging study of his head such a CAT scan or MRI. in my opinion, the most appropriate position for this type of patient would be a neurologist although you had asked about an emergency room physician as well in a previous email.

An emergency room physician although trained to examine people for head trauma will do so only under the most acute of circumstances in order to determine if there has been significant penetration or other rather obvious types of injuries for immediate rectification buy a neurosurgeon or the like. They do not have the same training to look for subtle types of symptoms that your friend may be demonstrating such as death perception problems, headaches, and other things that may be going on relative to the Concussion.

Also, as I explained earlier we do not have diagnostic studies or blood tests that have the capability of looking 15 years into the past to determine the nature of any Concussion then. The neurologist, however, may be able to piece together a history and any changes in neurological functioning at that time to be able to come up with something.

In conclusion, I believe the best chance of your friend obtaining the most information regarding his current Concussion and it's aftereffects would be to see a neurologist and follow their suggestions for any testing that may be appropriate and available to perform.

Another alternative to that scenario would be if you wanted to offer your friend a chance at a real time WebCam interview and neurological examination; you may find me on the HealthTap network at www.HealthTap/drsaghafi. you can find me on this network from Wednesday-Saturday at 3AM-6 AM(Eastern standard time; New York City time zone)

Of course, an in person examination by a neurologist in my opinion is preferable and much more likely to yield complete results as opposed to a WebCam interview but I'm sure we can do some manner of pertinent examination if you would like to try that.

I wish your friend well and hope he experiences a full recovery.

If these answers have helped with information you were seeking I would greatly appreciate a written note of feedback as well as a star rating. In addition, I would also greatly appreciate your closing the query on your end which will signal the network to archive and credit this transaction for future reference.

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