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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. St├ęphane 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 Europepr├ęvu 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.
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. St├ęphane Cascua, sports doctor

Doctor St├ęphane CASCUA. - 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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The Iroman lack of iron, the other sports too!

Doctor St├ęphane CASCUA.

Iron is essential to your health and performance. It is a central component of hemoglobin. The latter is contained in red blood cells and gives it color. It is the iron that captures oxygen when blood passes through the lungs. It carries the precious gas to muscles. When they arrived, it drops its cargo which then allows the burning of energy substances and muscle contraction.

When you run or when you jump, your heels hit the ground and the fat pad of the foot of the plant is crushed. It is through many blood vessels. These red blood cells burst and release their hemoglobin. Iron is released into the blood and pass into urine.

Muscle contains a twin sister of hemoglobin, myoglobin. The latter also contains a lot of iron which sets some oxygen. This small local reserve allows starting the contraction before the blood vessels do not provide the necessary complement. When you experience aches, your muscle membranes are victims of micro-fissures. Myoglobin and iron leaves the muscle and gaining the blood. The precious metal is eliminated in the urine.

When you make an effort, the majority of blood flow is directed towards your muscles. There remains very little to the digestive tract and the bladder wall. These organs suffer from lack of oxygen and are shaken with every stride. Small areas are damaged and start to bleed. Red blood cells and iron are lost in the feces and in urine.

You enter the assiduous why athletes often lack iron, especially if they do not take care to concoct "menus and recipes" adapted. Sports are even more concerned since all these iron losses are added the massive elimination of blood during menstruation!

That is why it is good to occasionally perform a blood test to assess the stock in body iron. This levy is necessary when it comes to review a state of fatigue. It unnecessary to dose iron in the blood because the body is able to keep within the limits of normal while the reserves are at their lowest! It is necessary to measure levels of "serum ferritin" because this structure is the storage form of iron.

The bone is strengthened or crack in contact sports

Doctor St├ęphane CASCUA.

Each sports movement constitutes a solicitation for the bone structure. At each reception process, the tibia runner undergoes vibratory impacts. Unrolling not, the hiker twists slightly small bone in his foot. Even the body-builders, powerfully contracting its muscles, pulls on his bone.

Each strain injures a little bone of sports. Fortunately, during the rest period, the bone trying to rebuild. If time allows, if they bring him the necessary food, it is repaired! It reconstructs even louder than before as if to prepare for new mechanical attacks. This phenomenon is called by coaches cycle decompensation / overcompensation. This process has been described in many body organs and functions: muscle, stock energy, hormones, etc. It is a key driver of growth.

Thus, it was shown that the well-trained marathoner had stronger bones than sedentary. Indeed, its more dense bone structure, higher in fiber and calcium. In addition, the microscopic architecture of the bone is perfectly oriented along the axis of mechanical stresses.

Indeed, the chemical structure of the bone is comparable to reinforced concrete. The protein network is the steel rods. Calcium is comparable to concrete mired these metal axes. At the hip and pelvis direction of the bone structure is very characteristic. On a radiograph, it is found that the fibers leave the femur, the thigh bone, tilt in, come from hip to withstand the weight of the body resting on the hips. The lines of force from the right leg and left leg meet in the middle of the basin and support each other in the manner of the nave of a church.

Physical activity associated with a sufficiently high protein diet, vitamin D and calcium is a great engine of bone construction. This cocktail is particularly useful to hinge periods of life. During growth, it is necessary to eat 4-5 dairy products every day to build strong bones. It should also move: it is essential to practice a sport requiring the running and jumping at least 3 times a week for 30 minutes. In the absence of impact, bones harden less. It has been shown that a young competitive swimmer had lower bone density than sedentary because he was deprived of gravity during those long hours of pool training. In addition, bone densification stops 25 years. At this age you have made up your bone capital for life!

In adulthood, sport reinforces very hard bone and the amount of calcium necessary for the maintenance of bone is still debated. In case of fracture, the rest of the broken area needed a few weeks to allow to "ensnare" the broken area. In addition, gradually increasing mechanical stress are indispensable to "mechanize" the callus. Again, they help to guide the fabric of the bone in the center of the constraints to prepare him for his mission. An increase in calcium intake in consolidation period is proposed by some doctors without that interest has been really shown.

After menopause, the bone structure is gradually degraded to make the brittle bones is osteoporosis. Ladies, remember, your resistance to hip fracture depends on your diet and your sport for 25 years! If physical activity after menopause can no longer denser bones, reduces the loss of bone tissue. So it is advisable to go see jumping around or jog. It is also good to make the soft gym to maintain bone strength to strength. To make the most of this stimulation, it is again necessary to take 4-5 dairy products daily. It should also go out every day to enjoy the sun and make the vitamin D essential for the absorption and calcium binding. Fresh coordinating sports such as Thai Chi or "balance workshops" have proven effective in reducing the risk of falls and fractures.

If the sporting activity is excessive, the micro-cracks caused by impacts on the bones fail to consolidate over the rest. Rather, these lesions worsen in the next workout. Finally the splits right through bone, it breaks without any violent trauma. It is the stress fracture. In a postmenopausal woman, it was demonstrated that 6 hours of sport load per week may be sufficient to break insidiously bones. Among younger adults, this type of injury is favored by dietary deficiencies and hormonal disorders. Lack of calcium, vitamin D and protein alters the rebuild bone victim of microcracks in the exercise. Insufficiency sex hormones reduces the stimulation microscopic chemical plants be responsible for the synthesis of bone tissue. Functional changes occur when the deep depletion of the body. That kind of burnout is most often diagnosed in women because it causes menstrual irregularities and a cessation of menses. The victim is found in a state of "early menopause". In humans this hormone suffering is more insidious but it exists and its effects on bone density are comparable. The sports overwork cocktail, dietary deficiencies and disappearance of rules typically found in young women anorexic. Faced with a stress fracture, the sports physician must remain vigilant. It should not simply treat a "bone". It has an obligation to support a whole person, he is responsible for seeking overtraining or behavioral disorders.

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