Mild traumatic brain injury (MTBI), commonly known as concussion, is defined as a head injury with a temporary loss of brain function causing a variety of physical, cognitive, and emotional symptoms. There is no overt physical evidence of trauma, and the victim may immediately appear to be confused, disoriented, dazed or even experience a brief loss of consciousness. These symptoms often resolve within a brief period of time or may last for days, weeks, months and even years after the incident. Clinical experience shows that fatigue becomes a notable factor over time with reports of decreased performance and needing more rest.
Current diagnosis of MTBI include observation and behavioral checklists. Long-term symptoms may be examined with a CT scan or MRI and neuropsychological testing. Presently the quantitative EEG (qEEG) is one of few techniques to accurately diagnose MTBI as other methods do not pick up bruising or microscopic tears within the brain. Concussions consequences can vary from mild to fatal. Historically, the brain was thought to be “hardwired” with each area of the brain responsible for certain functions. For example, the occipital lobe of the brain is involved in visual perception. We now know the brain is flexible and able to heal and change although is sometimes requires help.
Skull Brain InterfaceMTBI occurs when the brain hits the inside of the skull. This happens when a body (skull) stops suddenly, changes direction suddenly, or is repeatedly exposed to micro traumas. The brain is enclosed in cerebral spinal fluid, which acts to cushion the brain from hitting the skull. If the change in direction or force is too great, the brain will collide with the skull.The sinus cavity is at the front of the skull; above, around and below the eyes and along the sides of the skull towards the ears. These structures are jagged and sharp. When these structures impact the brain, they tear and causing micro bleeding. The areas most commonly affected are the prefrontal, frontal and temporal lobes. The back of the skull is quite smooth and curved and collisions with it will instead cause extensive bruising. Injuries caused by hitting the sinus cavities are usually quite discrete (specific as to effect), whereas injuries caused by hitting the back of the skull are quite diffuse.
Physiological Effects of ConcussionAs the skull stops moving, the brain continues to move subject to the laws of physics. The sudden change(s) in direction and the impact upon the inside of the skull lead to several potentially traumatic events occurring. Based upon the physics, verified by MRIs we know that:
- 1. Brain cells communicate through a cascade of electrical charges down a long stem, called an axon. Axons contain pumps and channels that allow ions, such as sodium and calcium, to go in and out of the cell when needed. The forceful impact of a concussion causes diffuse damage occurs in ionic channels, resulting in a reduction of general intelligence, information processing and slowness of thought.