The 'Visible' Injury No One Sees

Abstract

The diagnosis of concussion/mTBI has become a symptom only diagnosis and symptom only treatment injury over the years. This seems an inappropriate course of therapy for this common and worldwide injury. Concussion/mTBI is underestimated by not only the patients sustaining this injury, but the physicians, therapists, trainers, family members and athletes in the chain of evaluation and those self-reporting symptoms, but also every child athlete, parents of those child athletes and their ‘coaches’. The ‘coaches’ may also be parents and have an inappropriate need to see their child athlete succeed at all costs, even to the detriment of the child’s future. This urge to excel at the cost of future health and our young athletes and soldier’s future functionality and potential societal contributions needs to be muted and the right thing done for our future as well. It is fact and simple truth that when the symptoms resolve, there may still be an injured brain that has not healed. The injury is simply not visible, and must be made to be visible. Injury visibility is done by common CT and MRI for most other wounds or injuries, but it is also fact that common CT scan and MRI do NOT make concussion/ mTBI visible. CT and MRI however make other skull injuries visible, such as bleeds, fractures, and brain infrastructure injuries. When the patient with concussion/mTBI is sent back to prior to injury activity based on regular CT or MRI with symptom resolution he/she may still have an injured brain, and when back at ‘usual’ violent or athletic activity may sustain a re-injury of a partially healed prior brain injury, or a new injury on top of the older unhealed injury. This can be devastating to the patient, and doubly so for our children athletes. In concussion/mTBI, normal medical practice and standard of care seems swept aside, and the patient may be sent back to activity before objective proof of brain healing. Those patients with continued symptoms (post-concussive syndrome) are usually kept safely from activity until symptoms are resolved, but again sent to ‘action’ sans objective proof of brain healing.