OT - Concussion Protocol
On Tuesday, my 13 year old daughter fainted while performing for a class of third graders as King George. She was wearing a giant red puffy crown, the kind you used to see in the Imperial Margarine commercials. I think it broke her fall. In any event, she did hit her head on a bookcase on the way down and sustained a concussion. Today, she still has a bit of a headache and is dizzy, with sensitivity to light and sound. She's laying low, not going to school or participating in sports. Anything else I need to know? First concussion in my family.
February 10th, 2017 at 11:12 AM ^
Not a doctor, but are you fairly positive the initial fainting was just from being on stage and all that kind of stuff?
February 10th, 2017 at 11:20 AM ^
The room was hot, she was wearing a lot of clothes (and yes, a crown), she was on a stool, and there was a crowd of people in the room. Doctor assumed it was lack of hydration and overheating (and possibly being overwhelmed from all the people. My daughter has a bit of social anxiety).
February 10th, 2017 at 11:35 AM ^
February 10th, 2017 at 11:41 AM ^
We're going back to the doc today, so I imagine she'll order a CT scan. She hit the back of her head but there's no bump. This happened on Tuesday, and I woke her Tuesday night a couple times to make sure she was with it, and her pupils were normal. She's showing no signs of confusion, just headache, a little dizziness, and sensitivty to light and sound, but it seems better today.
February 10th, 2017 at 2:11 PM ^
Yes. Just had a recheck with her regular doc (first doc was an old guy, in his 70's. No offense to old guys but I prefer younger doctors) and she pointed out that my daughter's blood pressure runs low, which could account for the fainting as my daughter was standing for a while in a hot room with lots of clothes on. Second neuro exam was normal, so she said continue no activity, no sports, no gym and return to school when headache subsides, half day to start. If anything brings back the headache, stop doing it. If symptoms get worse, return for CT scan. Seems reasonable. My daughter is up and around and in good spirits. Thanks for your diagnosis -- my daughter said that's exactly what happened.
February 11th, 2017 at 12:50 AM ^
No concussion has ever been diagnosed by CT scans. These headscans pose additional risk to youth and potential long term negative impacts to IQ. If your doctor doesn't know about that... find one who does before listening to her.
If it is a bleeder...they should have caught that already...but yeah ... everything is on table.
That is not to say CT scans should never happen. My daughter had two concussions with huge hematomas and we were pressured into getting CT scans. In retrospect I would have had her admitted and stayed with her instead.
You are the best person on the planet to help here. You know her favorite book, food, the way she walks, talks, bats her eyes... you'll know if something is up.
Best to you and your daughter.
February 11th, 2017 at 12:51 PM ^
Yes, the doctor told me that concussions are not seen on scans, but that brings up a good question -- would they have seen any bleeding at this point through symptoms? I'm assuming if her symptoms worsen, that's what they'd look for.
February 13th, 2017 at 9:44 AM ^
...read your discharge order. Each, some or all of those symptoms is/are going to point to some possible cause.
Telling what that might be...it's difficult and that is on your doctor. A hemorrhage at this point, however, is not your main concern unless there is some reason to suspect an issue with your daughter. Little humans are tricky. Any and every concern you feel...call your doctor (or even better their nurse.) They will add it up and get it right. Trust yourself. You know what is normal. The nurse will listen. My heart goes out to you.
That said our brains can and do have mircobleeds often enough without serious issue. The blood brain barrier (BBB) is as complex as any neural component of the brain. It is incredibly fast and efficient in function and repair. Every concussion involves some aspect of bleeding. That is why people are touting blood test detection for central nervous system specific proteins that have escaped through the BBB and into the bloodstream post trauma. When a hemorrhage is a primary issue it's mostly in the first hours post trauma that you're going to see it symptomatically. Since our brains are incased - we get in trouble when there is a rupture that overwhelms the BBB's capacity to fix itself. A severe local bleed can cause pressure on the entire brain.
The brain is a name for several different regions that have specific purpose. Where the actual trauma occured - that is were your going to see the symptoms. Watch tell and then listen to what/how your medical people respond.
There's no need to dig deeper than your discharge paperwork. It's generic enough to capture almost all areas of concern. Concussion - if that is what she has - normally take 7-10 days to resolve. Let us know how she is doing. This is bringing it all back to me ... and it hurts. Good luck.
February 10th, 2017 at 11:12 AM ^
I assume you have gotten actual medical advice from a doctor who has seen her in person, and you are not relying on the opinions of a sports message board.
February 10th, 2017 at 11:18 AM ^
Yes, we went to our doctor right after it happened. The neuro exam was normal. He said to not return to normal activities until the headache subsided. But he made it seem like that would be in a day or two, so I'm just wondering if anyone else has gone through this.
February 10th, 2017 at 11:42 AM ^
from h.s. football and college rugby. My only advice is... seriously, MGoBlog isn't a good place for this kind of advice unless it's pointing out resources for where to go to get better advice. In this case, if you feel your physician is being dismissive or isn't answering your concerns, you may need to find another one.
For what it's worth, and hopefully it's not much, I recall my symptoms typically lasted a few days.
February 10th, 2017 at 11:43 AM ^
With you on serious advice. I find comfort in others' experience since I have no experience with concussions myself.
February 10th, 2017 at 11:13 AM ^
You want to keep exertion down until well after the symptoms subside. The brain takes a long time to heal and any additional injury to the area will slow the recovery., Remember that the brain is not attached the skull and just floats around inside. This can cause a reoccurrence from something as simple as a sneeze. I would recommend seeing a doctor so they can evaluate and help track progress. If you are in the Grand Rapids area, Mary Free Bed has a good post-concussion program.
February 10th, 2017 at 11:49 AM ^
and do what the doc said, keep her quiet for now, advance activity slowly (physical and mental), and monitor how she's doing.
February 10th, 2017 at 11:47 AM ^
Competent medical advice on a sports message board.
#TheMichiganDifference
I hope your daughter feels better soon.
February 10th, 2017 at 12:04 PM ^
I dealt wiith a fairly brutal concussion a little more than 2 years ago when I got drilled in the head with a softball. I'm not capable of giving of medical but I can speak to the symptoms I suffered through. I dealt with headaches, dizziness and nausia to varying degrees for the first 3-4 days. The simplest of activities (ie. walking up/down the stairs) can cause you to become very light-headed and dizzy. I tried to return to work 4 days later and simply looking at computer caused severe headaches. All I can say from the experience and don't take feeling better as being able to return to regular activities. Until she feels 100% symptom free she should avoid any strenuous activites. Lastly, I found that even weeks and months later the slightest contact to the head caused immediate headache. Taking it easy is the best cure!!
February 10th, 2017 at 12:05 PM ^
As a new dad, this is the stuff I have nightmares about. I hope she's ok.
February 10th, 2017 at 1:35 PM ^
As a father of four, my advice is don't worry. Your kids are going to get hurt. You can't stop it. They also tend to "get over" things pretty quickly.
February 10th, 2017 at 2:30 PM ^
There was this one time when my son, then age 7, fell backwards and his head hit my daughter, then 4, in the mouth. She sat up and blood literally started pouring out of her mouth. I hate the sight of blood, so I screamed and ran out of the room. My son got scared and hid in a closet. My husband ran in there and while looking to see where the wound was, found what he thought was a hunk of her tongue in her mouth. Eventually he realized it was a bloodied piece of bread that she had been chewing on. Good times.
February 10th, 2017 at 12:32 PM ^
Depends. What are your daughter's political leanings?
February 10th, 2017 at 12:53 PM ^
Neo-Jacobite democratic fascism, so you can take your Parliamentarian Marxism right outta here.
February 10th, 2017 at 2:15 PM ^
Kanye in 2020.
February 10th, 2017 at 12:38 PM ^
if you can keep her in a dark and quiet room as much as possible. It can be difficult to know when the brain has healed, it's not like a sprain or broken bone. Her brain is still developing so don't feel you are ever being over protective when it comes to letting her heal.
February 10th, 2017 at 12:39 PM ^
February 10th, 2017 at 1:39 PM ^
Typical neurologist; besides TPA in some situations, migraines (barf), they just diagnose but don't treat (/s, kinda sorta).
Don't need a neurologist to hear that the kiddo is experiencing post-concussive sequelae (photophobia, vertigo, others to look for are problems concentrating, mood swings/depressive symptoms, sedation).
Limiting visual stimuli (TV in front of you, music in the background, laptop in front of you) in addition to restriction from any sports until symptoms resolve recommended.
PS go see a real doctor
PPS was part of the "headbonk" consult team at Mott. Blech.
February 10th, 2017 at 2:28 PM ^
For the work with "headbonk".
February 10th, 2017 at 1:14 PM ^
Have her see Jeff Kutcher--by far the best in area, probably country for concussion. Was the M guy until about a year ago. Believe he is now in Brighton or Plymouth. Sports Neurology Clinic I think is name of his place.
February 11th, 2017 at 8:55 AM ^
February 11th, 2017 at 8:32 PM ^
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February 10th, 2017 at 1:32 PM ^
The dangerous part of a concussion is the second impact syndrom. That is when the brain receives another impact before being recovered. CDC has good info. Even after she is recovered if any symptoms return she needs to go back to resting it. There is a five step process for "return to play". Again, check out what the CDC has on its website.
February 10th, 2017 at 2:05 PM ^
February 10th, 2017 at 2:14 PM ^
He told me to chck her pupils, too, for symmetrical dilation. I didn't do that; I can't imagine subjecting someone with light sensitivity to a bright light after sleeping for a few hours to check their pupils.
February 10th, 2017 at 2:16 PM ^
The link below is to the Mayo Clinic's page on post concussion care. Having suffered several myself, I recommend sleep, staying off of electronics, and lots of water/protein. The brain needs to heal and as long as she is allowed to stimulate it with phones/iPads/Computers or difficult homework, she will prolong her recovery. Have her lay low, put on her favorite children's film (not on the device, but on the T.V.) and have her lay low and rest for a couple days. If her symptoms get worse, demand a neurology consultation.
http://www.mayoclinic.org/diseases-conditions/concussion/basics/treatment/con-20019272
February 10th, 2017 at 10:20 PM ^
February 11th, 2017 at 12:30 PM ^
February 13th, 2017 at 4:18 AM ^
I was looking through the forums in the middle of the night between cases. My first time commenting after lurking on these forums for a long time. I thought I could provide some input since I'm a neurosurgeon, but actually see that there's already a lot of great advice already on the board already. Maybe a summary:
1) A CT scan is warranted if your daughter lost consciousness for over a minute, has a skull fracture or has really bad vomiting or focal neurlogical symptoms. Peds doctors don't always like to radiate kids if they can avoid it.
2) The CT scan would show a hemorrhage, but a concussion, almost by definition, will not show up on a CT scan or an MRI for that matter
3) Concussions can take a variable amount of time to recover from, until then can have headache, irritability, even personality changes. Stay away from contact sports or excessive stimulation. Keep hydrated.
4) Super impressed with the level headed advice from this thread. Most of above has already been said by others.