Concussions are scary, the more you learn about them.  I like the way Brian Adler summarizes the underlying message:  “All concussions are brain injuries, and all brain injuries are serious.”  (Adler is an attorney who represents accident victims, not a doctor, but he seemed to get a lot of nodding heads at a  sports medicine conference in Seattle.)

The biggest danger is getting a second injury.

There’s been a lot of discussion among scientists and neurologists about concussions and athletics.  The most common system for many years makes a distinction between people who lose consciousness and people who don’t.  But, the latest guidelines, published this month as the “Zurich concussion statement,” says you don’t have to lose consciousness to have a serious concussion.  (I can’t find a free accessible version online.)

The new guidelines say youth athletes should never return to action on the same day as the injury (and adults should only take that risk after a medical evaluation).

Washington’s new youth concussion law (reported on KPLU) is perhaps the most advanced in the world, because one of its architects also served on the Zurich panel.  That’s Dr. Stan Herring of the UW/Harborview.  One big change is simply recognizing that each individual and each injury is different.  You can’t simplify by saying, it’s only minor because he never lost consciousness.  Instead, someone trained to evaluate head injuries needs to run the  victim through a series of tests, similar to a neurological exam.  If there are any problems with balance or coordination, for example, then the brain needs time to heal.

Technically, a concussion is less severe than a “mild traumatic brain injury.” But it can be hard to tell where one stops and the other starts.  A head injury can lead to internal bleeding, which damages brain cells by creating pressure inside the skull.  And a lot of damage happens when the “wiring” of the brain, the long axons that connect one brain cell to another, get severed.  There are bundles of axons, and a jolt to the head can rip them in clusters.  Such damage may not show up in x-rays.

Helmets?  Surprisingly, the international panel can’t agree on whether they’re a good thing in many sports, since they may encourage athletes to take bigger risks and hit things with their heads.  Helmets are definitely recommended for bicycling, skiing and snowboarding.

Oh yeah, one bit of good news.  Most concussions heal within a week and leave no lasting damage.