A concussion injury is caused by violent shaking of the brain and is a complex injury causing injury to blood vessels, structural intra-neuronal microtubules and the myelin (the fatty coating around brain cells) and other changes.

   

Imaging that depends on the MRI changes seen in myelin (diffusivity of water which reflects post-traumatic changes) are the most useful in demonstrating post-concussion changes. A brain MRI-DTI with tractograms is a good choice. Supportive diagnostic data/functional testing can come from the RightEye test of visual information processing and objective balance assessment can be done with sophisticated vestibular balance testing.

   

Residual injury to the frontal lobe of the brain may cause the person to make poor decisions or have emotional instability. Residual injury to the temporal lobe of the brain can affect memory. Parietal lobe damage can cause problems with reality testing. Occipital lobe injury affects visual information processing. Concussion in children and adults carries a risk for future dementia, Parkinson’s disease and other neurodegenerative conditions. A neurologist is trained to ask all patients, “Have you ever had a concussion?” rather than “Have you recently had a concussion?”

   

Hyperbaric oxygen therapy is the only treatment that has ever been demonstrated to create healing of a brain injury condition. Nutrient optimization, energy therapies and retraining exercises are all supportive adjunctive modalities.

   

Return to play is a serious decision; the long-term consequences can be life changing.