Concussion Recovery

[oldschoolskier]

So, the story she told him was that I was showing her something in the bumps when someone out of control hit me from behind. She said his ski hit my helmet. (There’s no obvious damage.) We both were on the ground unconscious. He for around a minute, me for “5-10 minutes” on the ground, and I was twitching. After “I was different”, kept asking their names, and wedged turned the whole way back to the meeting area.

Re-reading the thread I realized, this is the same thread I referenced my bad.

My big concern is the twitching....think seizure.....so far in your care givers have not addressed this.

All in all, a lot of members are concerned, and rightly so. In this case better safe than sorry.

 

[SkiNurse]

Afaik. And really only one. Somebody came along, but I may have been getting up and they were unaware of the seriousness of the collision. I have no idea.

Ironically, that was part of the decision to go that way. It’s not a crowded trail. The alternatives were very crowded at that time and I avoid them if the group is capable. Had there been more snow this year we might have done something different with a few other options. Likely.

Yes, I saw an er doctor Sun am. His comments on the CAT scan were it shows swelling, bleeding, skull fracture, and frankly I’d be dead by now or showing severe symptoms at nearly 48 hrs post injury. It doesn’t “show” a concussion. He offered to do it for “peace of mind”. This is in line with the two other docs I talked to, though I did not talk to a neurologist or neuro surgeon.

Several years ago a family member got a concussion, had only the normal non serious symptoms right away, then 6 weeks later started having headaches and pain in the neck. Went to primary care doc, “it’s nothing”.

Within 48 hrs they’re being flown to emergency neuro surgery to have a holed drilled in the skull. A CAT scan at the first er showed the brain pushed over some 20mm by fluid, thus the flight. The neuro surgeon eventually reviewed the original CAT scan 1day post injury and said it was normal and nothing was missed.

If people have different info on imaging I’m listening.

Damn it, James!

GET A CAT SCAN!!! There are many different types of concussions and brain injuries. It all depends on impact, signs & symptoms and in what area(s) of the brain is injured. Some are immediately damaging and fatal, others are slow bleeders and the effects aren't seen for a while. What concerns me the most is that you lost consciousness, have no recall AND had what seems to be like a seizure.

 

[TheArchitect]

Damn it, James!

GET A CAT SCAN!!! There are many different types of concussions and brain injuries. It all depends on impact, signs & symptoms and in what area(s) of the brain is injured. Some are immediately damaging and fatal, others are slow bleeders and the effects aren't seen for a while. What concerns me the most is that you lost consciousness, have no recall AND had what seems to be like a seizure.

I can't stress my agreement with this enough. Being knocked out is a red flag. The very first question I was asked was if I lost consciousness and my doctor said it was a very good sign that I had not.

 

[raytseng]

Agree that should've been the emergency protocol with extended loss of consciousness and memory loss, thats what they did for me and i did have a hemmorage.
But if hes really stable and a few days out, even if they still see a bleed, I don't think in practice they're going to do anything vs let the brain/body do its own repair unless he becomes unstable. And only save the scan as a comparison should that arise.
Unfortunately cost is a factor. Its 3000 to your insurance and for me a 500 copay for very little utility.
For me, they didn't scan again at checkout or to see if my hemmorage stopped, just based on that i didnt turn into a vegetable overnight and a full cognitive test (30min) was indication enough plus whatever they saw in blood draws. Nor at my subsequent checkup at +1 week. They did give me keppra to take for 4days but again that window has passed.

At least please inform whoever is looking after you, if you suddenly have an issue, for them to get help. If your doctor didn't perform a thorough cognitive test, you may want to request that at a subsequent visit.

 

[James]

If your doctor didn't perform a thorough cognitive test, you may want to request that at a subsequent visit.

What's the test look like? Mine was pretty basic. Part of it I think is just going through intake and talking with the nurse before and then doctor.

 

[raytseng]

The basic test they gave me throughout the night to make sure I was OK and only took a few min. Who are you Why are you here, What happened, Where are you, who's the president. plus some basic physical commands (lift hands out, press up press down, etc) and looking into my pupils and so on. That's probably what you got.


The comprehensive cognitive test from a RN from the neruo dept.
I think it's probably a standard test they give to seniors to test for alzheimer or other cognitive disorders and took about 30min.

First they did the basic question set.
Then down to business with new stuff like:
remember these 3words, and i'll ask about them later.
name as many animals in a 30seconds.
They would have a sequence that are related in a category and then you have to add another, like motorcycle, bicycle, car... and one with colors.
or you need to identify the category.
Some simple math like you have 3cats and 2 dogs how many animals.
then trickier math like 10 nickels and 5dimes, how much money do you have. ( I needed 2 tries as the units versus qty are swapped).
Some time math like 1:45pm + 30minutes is .

Written, some of the similar but written responses or fill in the blanks.
Then there was a section with sentence instructions, like circle all the 'e's in this sentence, underline all the capitals etc.
Then spatial, it had the draw a clock and a particular time, and some other shape instructions.


Some of these I was slower or didn't give as quick as I would be today; but in retrospect as long as I was still lucid and not get confused and say "Who are you, what am I doing here," or "When are we landing" or gibberish like "hotdog toast jelly" to the animal sequence then it's still a pass for this purposes.

This is probably a standard test that they could use to track scores over time for those with degenerative diseases.

 

[James]

It wouldn't be surprising if a lot of cashiers these days got 10 nickels plus 5 dimes wrong or took forever without the computer.

Well, I had none of those more detailed but essentially passed most just by normal interaction over 2 days.

My big concern is the twitching....think seizure.....so far in your care givers have not addressed this.

Apparently that's pretty normal. I was surprised.

 

[raytseng]

yes, you probably are fit enough to hold the nuclear codes

The President Can Draw a Clock

The cognitive test that Trump passed was neither thorough nor difficult.

www.theatlantic.com

 

[Prosper]

Agree that should've been the emergency protocol with extended loss of consciousness and memory loss, thats what they did for me and i did have a hemmorage.
But if hes really stable and a few days out, even if they still see a bleed, I don't think in practice they're going to do anything vs let the brain/body do its own repair unless he becomes unstable. And only save the scan as a comparison should that arise.
Unfortunately cost is a factor. Its 3000 to your insurance and for me a 500 copay for very little utility.
For me, they didn't scan again at checkout or to see if my hemmorage stopped, just based on that i didnt turn into a vegetable overnight and a full cognitive test (30min) was indication enough plus whatever they saw in blood draws. Nor at my subsequent checkup at +1 week. They did give me keppra to take for 4days but again that window has passed.

At least please inform whoever is looking after you, if you suddenly have an issue, for them to get help. If your doctor didn't perform a thorough cognitive test, you may want to request that at a subsequent visit.

For a CT scan it's also a matter of radiation exposure. A CT scan exposes someone to significantly more radiation that a standard x-ray on the magnitude of about 100 times depending on the type of CT scan done. There's no radiation exposure for a MRI but a CT scan is the study of choice for head trauma.

yes, you probably are fit enough to hold the nuclear codes

The President Can Draw a Clock

The cognitive test that Trump passed was neither thorough nor difficult.

www.theatlantic.com

The clock draw test is one of the simplest and most sensitive tests to screen for dementia. It's typically not used in trauma situations. I'm wondering in this day and age of digital clocks and mobile devices how well kids these days are learning to tell time on an analog clock.

 

[raytseng]

yea, that was my feeling as well that the test was more to just to work the brain and see if I fall into gibberish or confusion or couldn't follow along at all versus the actual scoring of answers.

 

[dbostedo]

I'm wondering in this day and age of digital clocks and mobile devices how well kids these days are learning to tell time on an analog clock.

That's been a topic of discussion on watch forums... and the answer is "not well".

 

[Prosper]

That's been a topic of discussion on watch forums... and the answer is "not well".

Everyone in this next generation is going to screen positive for dementia when they get into their senior years.

 

[Pequenita]

It wouldn't be surprising if a lot of cashiers these days got 10 nickels plus 5 dimes wrong or took forever without the computer.

I pay in cash every now and then to see how cashiers count back the change. Remember when they used to do it common core math style: "45 cents makes 4, and 1 is 5, and 5 is 10" if you gave $10 for something that cost $3.55? Few people do that anymore.

 

[James]

^ No idea what that is! New math is hard... Good thing Newton didn't have to learn it.

We just did 5 to 50, then another 50.

My first job I learned to make change because I worked the register once in a while. Somewhat terrifying because you had to know taxed vs untaxed items, checks, and how to make change.

Nowadays there's often a meltdown if you go over to reduce pennies. Say it's $5.21. I give a $10 bill, a quarter, and a penny. Change should be $5.05. If they enter $10 and open draw before the .26 comes, there's confusion.

 

[KingGrump]

Pull on your waders and get out of your ivory tower once in a while.
You guys have no clue how muddy the shallow end of the gene pool can get.

 

[James]

I'm wondering in this day and age of digital clocks and mobile devices how well kids these days are learning to tell time on an analog clock.

I often check for clock knowledge with young kids, <10. It's not good.

Sometimes kids have an analog watch on and on idea how to read it.

Next up... Roman Numerals
MCMLXXXVI "Hot Tub Time Machine"

 

[oldschoolskier]

It wouldn't be surprising if a lot of cashiers these days got 10 nickels plus 5 dimes wrong or took forever without the computer.

Well, I had none of those more detailed but essentially passed most just by normal interaction over 2 days.

Apparently that's pretty normal. I was surprised.

Sorry its not. My kid has seizures since birth (21years now) so compared to most we know way more unfortunately. Seizures are not normal even more so when they are cause be head injury. They are generally a very good indication that’s something's very wrong.

 

[VickieH]

Everyone in this next generation is going to screen positive for dementia when they get into their senior years.

And by senior, you mean senior in high school, I assume.

 

[James]

Sorry its not. My kid has seizures since birth (21years now) so compared to most we know way more unfortunately. Seizures are not normal even more so when they are cause be head injury. They are generally a very good indication that’s something's very wrong.

Very sorry to hear about your child. That’s a difficult situation.

This is the most complete info on mTBI, or concussion I’ve found. I think, I haven’t gotten far. It’s 250 pgs.
Here’s a guide for CT scan:
Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms
Ontario Neurotrauma Foundation, 2018

[GCS = Glasgow Coma Scale]

Note 6: “Brief generalized seizures immediately following head injury are not significant risk factors. Prolonged, focal or delayed seizures are risk factors for intracranial injury.”
————————

https://braininjuryguidelines.org/concussion/fileadmin/pdf/18-06-07-adult-guidelines.pdf

I don’t know how you differentiate focal seizures from generalized. Severity?

 

[oldschoolskier]

Very sorry to hear about your child. That’s a difficult situation.

This is the most complete info on mTBI, or concussion I’ve found. I think, I haven’t gotten far. It’s 250 pgs.
Here’s a guide for CT scan:
Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms
Ontario Neurotrauma Foundation, 2018

[GCS = Glasgow Coma Scale]
View attachment 88870
View attachment 88871
Note 6: “Brief generalized seizures immediately following head injury are not significant risk factors. Prolonged, focal or delayed seizures are risk factors for intracranial injury.”
————————

https://braininjuryguidelines.org/concussion/fileadmin/pdf/18-06-07-adult-guidelines.pdf

I don’t know how you differentiate focal seizures from generalized. Severity?

Couple of things, initial study published in 2012 in New South Wales, this is just the document saying to adopt in Ontario 2018, Canada. FYI, expect something new coming out as a result of Rowens Law in Canada (missed concussion followed by a second little bump caused a death resulting in this law after a lawsuit). Slight bump and no other symtoms are considered serious and have legal repercussions that action MUST be taken.

Second search up seizure in the document and you fall under HIGH RISK MILD HEAD INJURY, follow chart on right side.

Finally, prolonged is something that is longer than minute (our understand after dealing with seizures), 5 minutes is serious concern and 10 minutes doctors really start to worry.

LAYMANS TERMS

Momentary is a reset of the brain, can be good as it prevents damage to brain, you’re brain glitching and brain resets to protect itself.

Longer, damage starts because other functions (blood flow, O2 intake....etc) are interrupted and this causes cell death all over, including the brain. Think of this as the dreaded Blue Screen Of Death. Depending on length and which areas suffer the most determines outcome. (Side note we can see O2 drop in body in less than a minute of seizure to below OMG 92% that starts getting doctors excited).

So even by your own research take this SERIOUSLY! Few hundred dollars / few thousand dollars (no new equipment or skiing for a year or two), big deal, beats not skiing ever again because of missed, hidden, surprise complications . This is a no brainer.

Stop trying to justify you are OK and tough, take care and make sure you are (in this case don’t be old school).