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Concussion: A amnesia to remember!

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Right in the action, you take a blow to the head. You are "sounded" a few seconds. Think you can continue as you have not lost consciousness. Error ! Dr. Chermann neurologist sport, explains the dangers of concussion.
By Dr. Stéphane Cascua, sports doctor
After the shock, ask him, "Who is our enemy? What's the score ? "He can not answer: it is a shock!
The accumulation of concussions can cause "early dementia" within 45 years.
In March 2005, Christophe Dominici, the famous rugby player, playing against Italy in the Six Nations tournament. At the 37th minute, it is necktie by an opponent and his head violently rocking: concussion and loss of consciousness. The doctor assures Chermann neurological monitoring of the player. Despite the pressure, he will announce in a press conference its inability to play the next game with lestade French in Europeprévu cut two weeks later. Remember also to Chris Waddle, another famous cranial trauma. In 1991, during a match against OM AC MILAN, he suffered a nasty elbow to the head. He did not vanish but ended the competition completely in the fog. As an "automaton", almost by accident, he scored the winning goal! Back in the locker room, he vomited and dozing. It should be hospitalized and never remember his match!
Admittedly the commotion!
Concussions are common in team sports and even skiing where it represents 16% of the listed injuries. If one of your teammates, one of your children or a sport that you frame suffers a concussion, it is imperative to stop the session! Typically the injured is hit on the head. It may also be responsible neck trauma of a violent oscillation of the head. In these circumstances, the brain is carried by inertia and has just hit the inside of the skull. In 10% of these accidents, the victim loses consciousness but in the vast majority of cases, it keeps a partial consciousness. However, it is "sounded"! He staggers and balance is precarious. Talk about it and ask, "Where are we? Who is our enemy? What's the score ? "He can not answer! It presents a "traumatic amnesia pre". Often, it is he who asks these questions ... every 3 minutes ... because it is unable to memorize the answers: it also suffers from "post-traumatic amnesia." If you are not careful, his behavior is misleading: he kept his player reflexes. Automatic actions are normally scheduled, its "procedural memory" whose connections networks seem protected brain center is said to have kept. If we look closer, his personality seems changed. From time to time, it is aggressive and filthy! Sometimes it is surprisingly sad and burst into tears! Above all, his game is irrelevant! Logic, it only engages in behavior rehashed without adapting them to the information collected in the field ... since he has already forgotten them! If WADLE scored reflexively, many concussed players joining the bench ... for today, according to the coach, they are bad and lack of lucidity!
What happened in the brain?
To the naked eye: nothing to report! It is far from the dreaded hematoma after loss of consciousness, one that crushes the brain and causes the death of the victim. Even with MRI (magnetic resonance imaging) conventional, one does not detect anything! More than a lesion of the nerve tissue, it is more impaired functioning. On the occasion of the commotion, the transmission of information between neurons is disordered by disturbance of the secretion of chemical messengers. Inflammatory substances are discharged and the brain swells slightly. The pressure within the skull increases a little, that's sufficient to cause headache, nausea and drowsiness. "Functional MRI" used exclusively in research show that to solve a problem, the brain uses more "automatic" areas as areas of "reflection". Recordings of the electrical activity of the brain show the decrease in certain types of streams that reappear when the symptoms subside.
What are the risks ?
The day of trauma and as the symptoms have not disappeared, we must fear the "second impact syndrome". Due to impaired psychomotor skills, this second shock of chance to occur if the sport is not suspended! It is more severe, it causes a surge in inflammatory processes and a major brain swelling. In the young under 20 years, it sometimes causes a compression of the base of the brain. This area oversees vital functions such as breathing and heartbeat. Indeed, as a hematoma that big edema is sometimes responsible for the death of the injured! Later, the shock may cause accumulation of "dementia." There is talk of "post traumatic encephalopathy." Typically, it is a mixture of Alzheimer's disease and Parkinson's. The most famous victim is Mohamed Ali but there are a large number of patients among boxers, hockey and American football players. Everything happens as if repeating inflammationsenclenchait a degenerative process. protein clumps accumulate and crush the filaments joining neurons. Symptoms often appear early, from 45 years. These are memory problems, mood and behavior. Many news items relate the erosion of professional, social and family of former boxers become aggressive and violent.
SHOULD CONSULT A DOCTOR!
Go to the emergency, in case of fainting! Call the fire department, if after waking, the victim vomits or dozing. This may be a intracranial hematoma that grows! It can crush the brain!
If concussion without loss of consciousness, be monitored by your doctor injured or better by a neurologist. If headache, nausea, fatigue, concentration problems, mood or coordination subside in less than a week, there is a slight concussion.
If the memories are still not set after 24 hours, if the symptoms are intensified whenever attempting to light physical activity, if they persist more than 7 days, we are facing a severe concussion, the patient should always be followed by a neurologistawareness of the concussion the athlete.
After any concussion, it is preferable that a neurologist who know the sport can give its approval before the resumption of traumatic activities.
How to treat? When return to sport?
After a concussion sports and intellectual rest is mandatory! The injured must leave the field and medical monitoring is necessary. Conventionally, the resumption of training takes place in stages, each of which lasts for 24 hours. As soon as the symptoms disappeared in everyday life, we try the bike room in respiratory ease then jogging then a slight technical work without contact and then resume group training. If discomfort reappears at any stage, we must return to the previous. Traditionally, this evaluation is done in the absence of drug. Sometimes the neurologist prescribed anti-inflammatory effective on headaches and irritation of the brain. Traditional painkillers and sleeping pills are not recommended. If severe concussion, this natural evolution takes about 3 weeks. This is the time you spend healing a sprained ankle. It's finally just enough to keep the brain in good condition!
By Dr. Stéphane Cascua, sports doctor

. - 18 mai 2011.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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