Mind your head
Posted on 22 March 2016
Dr Roger Melvill, a neurosurgeon at Mediclinic Constantiaberg, explains why it’s so important to seek treatment after a bump to the brain – even if you think you haven’t hit your head hard.
Head injuries can range from mild bumps to catastrophic, diffuse brain injuries. The spectrum of change depends on the force applied. Compare someone in a car accident to someone who falls over on a rugby field – clearly the effect of these traumas will be very different.
Generally speaking, sport concussion falls into the less severe category of cerebral injury. Still, if you’ve suffered a head injury – even a minor one – you should seek medical help. The danger of not doing so is that symptoms may become increasingly severe.
A classic example is, say, when someone gets a knock to the head on the temple area just in front of the ear. If a skull fracture takes place the person might be concussed but then seem to recover. Say it’s a schoolboy, he might walk home after his rugby match. Within hours he’s developed an increasingly severe headache, so his mother tells him to go and lie down. When he doesn’t appear for supper she goes to check on him, to find he has slipped into a coma due to pressure from a blood clot in his brain that developed as a delayed phenomenon. This is what we call a ‘lucid interval’, which occurs with an extradural haemorrhage (bleeding on the outside of the brain).
Most patients who suffer a head injury while participating in sport are expected to make a good recovery – even if they are unconscious for a few moments. However, if someone has had a concussion, they should not return to sporting activities until they have recovered fully. They should not be exposed to the risk of another concussion for at least three weeks after their concussion.
There’s a good reason for this. One concussion superimposed on another has an additive effect (named Spät-Apoplexie by German pathologist Otto Bollinger), and can result in catastrophic brain injury. In other words, when a brain is recovering from a mild concussion and is subjected to a second impact within a short period of time, the second impact can be catastrophic. People have been known to die from the second one, even if it is fairly minor.