Concussion Risk Factors for Long Term Problems
Why did this Person have a Bad Result?
- Age Over 40
- Prior History of Brain Injury
- Extraordinary Demands on Brain
- High Achiever
Far too much of the focus in the study of what the researchers always call “mild” brain injury, is trying to predict how serious a brain injury will become, based upon the way in which the patient interacts with medical professionals in the acute stage. * Personally, I think this misses the point. Certainly, if there was no concussion, there isn’t likely to be a brain injury. But once there has been a concussion, the focus should not be on categorizing how serious the concussion and the concussion risk factors was, but on what deficits the person is left with, after a healing period, and what we can do to minimize the disruption of those deficits upon this person’s life.
But as initially the focus of this page has been devoted to explaining why concussion can cause permanent brain damage, a discussion of why some people have apparent full recoveries, while others, are profoundly effected by a similar injury, is tantamount. To begin this discussion, we must again summarize our theory of the pathology of subtle brain injury.
Diffuse Axonal Injury.
Concussion risk factors results in organic injury to the brain, in most cases, by the mechanism of diffuse axonal injury.
Process not an Event.
This injury is more likely as a result of strain to axons than actual tearing, which over a period of 12-72 hours results in a cascade of events which can disrupt a significant number of neural connections, either because of the death or damage to the axons which connect the neuron bodies.
Regeneration isn’t Total Recovery.
Our current research into neuropathology indicates that significant regeneration of these neural connections can occur, but that the extent of such regeneration falls off considerably with age (with over 40 being a meaningful line of demarcation) and that the regenerated neural connections are less efficient than premorbid.
High Achiever Problems.
For this reason, individuals in professions which place a high demand on processing speed, are more likely to experience deficits than others, and that most people who have suffered more than a Grade I concussion, will have some measurable deficits, if sufficient demands are made upon their brains.
*(The sport and concussion risk factor guidelines must address the issue of prognostication in the acute stage as their central purpose is to guide the decision as to when a person is allowed to return to action.)
Attorney Gordon Johnson
Past Chair Traumatic Brain Injury Litigation Group, American Association of Justice
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