Concussions, And What You're Wrong About

Concussions have received a lot of attention in the media lately, and those of us who ride motorcycles are no stranger to this form of mild traumatic brain injury. All of us have known someone who’s injured themselves this way (or worse) while riding, and since March is National Brain Injury Awareness Month, I thought now would be a good time to debunk some common misinformation riders share about the most common form of mild traumatic brain injury.

Though you may be familiar with my dazzling wit and bike-related candor as a writer, my day-gig is in medicine. Mild-mannered neuroscience nurse practitioner with a doctoral degree and clinical residency in neurosurgery from Columbia University by day...female moto-journalist by night. I’ve also experienced the joy of a concussion firsthand, after being rear-ended by a guy who was reaching down for his cell phone when he plowed into the back of me on the freeway in 2011. Totaling my car and kicking me to my couch for two months.

Seriously. This is stuff I know. And since I know what a discriminating readership we have, I’ve provided you with the best, not-wikipedia-references I could find.

The CT scan was negative, so you’re good.

When it comes to CT scans (or any other diagnostic medical imaging), no news is good news, but guess what: concussions don’t show up on a CT scan, or any other routine imaging studies(1). A concussion is not a radiographic diagnosis. “Woah; get a load of this concussion!” – said no radiologist ever.

The diagnosis of concussion is a clinical one, meaning it’s based on observed signs and symptoms after a known mechanism of injury. Tests like CTs and MRIs are ordered to make sure there’s not a more serious injury, like a hemorrhage or diffuse axonal injury. Normal findings do not rule out the presence of concussion.

Interestingly, the radiologist who read my own CT dictated the specific phrase, “No evidence of concussion”.

“Like what?” I asked opposing counsel, when he asked me about the radiologist’s report at my deposition. It did not come up again.

Your head never actually hit anything, so you can’t have a concussion.

Wrong! Though the most common cause of any brain injury is a physical blow to the head, a concussion (or worse) can happen when it just gets bounced around in the skull too hard. Think about that time you bought that tropical fish at the pet store. They put it in a plastic bag full of water, tied a knot in it, and you put it on the front seat of your car. You got home, reached for the bag, and there was your fish, floating upside down and lifeless. Why? You jiggled it to death. The same thing can happen to your brain as it floats around in a cushion of fluid in your skull. Sudden changes in acceleration and deceleration, like whiplash or being thrown from side to side on a roller coaster, can slam your gray matter against one side of the skull and back to the other. Blast waves are another common cause of jiggling that thing around to the point of injury. Just because your head doesn’t hit the ground, doesn’t mean it can’t get hurt.

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