Sports and head injuries—when is it serious?

The 17-year-old high-school soccer player who came to my office a few months ago had experienced a head-to-head collision with a teammate several days earlier that left him with 10 stitches. Immediately after the injury he had a headache and dizziness and was taken to the emergency room. His examination and CT scan were normal, and after getting stitched up, he was discharged. He felt much better by the next morning and decided to drive to school and stay for soccer practice. But he became dizzy and was driven home by two friends, who left him at his doorstep, parking his car in the driveway.

Instead of going inside his house, he got in his car, backed it down the driveway, and continued to back down the street until his car hit a telephone pole and flipped over. His friends heard the crash and pulled him out of the car. When he arrived at the emergency room for the second day in a row, his doctors were amazed that he seemed to have no apparent injuries. After yet another CT scan of the head, they allowed him to go home with his parents with strict instructions for observation.

Every year more than 1 million people suffer head trauma that, like this 17-year-old, is serious enough for an emergency-room visit. And about 235,000 people are hospitalized. Eighty-five percent of head injuries are concussions, which can happen when a moving object such as a soccer ball hits the head, or from direct strikes to the head from sports injuries, falls, assaults, or motor-vehicle accidents. Normally our soft, gelatin-like brain tissue is cushioned by spinal fluid within the hard, bony skull. But an abrupt blow to the head can cause the brain to bounce against the inner wall of the skull and result in a concussion.

People who've had concussions may or may not lose consciousness and may not remember events immediately before or after an accident. Like my soccer player, they may be confused and experience headaches and dizziness. They may also complain of nausea and vomiting, ringing in their ears, blurred vision, light sensitivity, and balance disturbance. Although most mild post-concussive symptoms usually improve spontaneously within three to four days without treatment, if they are severe, they could last for several weeks or even months. Lingering symptoms are called a post-concussion syndrome.

My patient was extremely lucky. Within a few days, he had recovered completely. But concussions can be dangerous for athletes who return to play while still experiencing symptoms. Because of widespread criticism for allowing players with concussions to return to the field too soon, last December the National Football League issued stricter guidelines about when pros can go back to the game following head injuries: Formerly, players were allowed to get back in the game if they hadn't lost consciousness, but now they have to stay on the sidelines if they are having memory problems, dizziness, or a headache.

This is good advice for all of us, and especially for children and teens involved in school sports.

To avoid serious consequences after an injury:

• See a doctor or go to an emergency room if you've had a worrisome blow to the head, a loss of consciousness, or if you have a headache that won't go away, confusion, one-sided weakness, persistent dizziness, imbalance, difficulty with language or speech, hearing loss, vision loss, or double vision.
• After a concussion, family members should observe patients for any change in behavior or new neurological complaints.
• In order to prevent a second injury, avoid activities that may lead to falls or repeated head injury.
• Don't drink alcohol or use sedative drugs after a blow to the head.
• Wear a properly fitted helmet when biking, skateboarding, skating, skiing, or sledding.
• Be careful when you engage in sports that have high numbers of reported head injuries, including basketball, football, ice hockey, skiing, and soccer.
• Make your home as fall-proof* as possible. Remove throw rugs, keep the floor and stairs clear of clutter, and coil or tape wires to walls so you don't trip on them.

—Orly Avitzur, M.D., Consumer Reports medical adviser

For more on preventing sports-related injuries, take a look at a Q&A with pediatric sports medicine specialist Aaron Provance, M.D. on the Babies & Kids Blog.

*links to PDF