What year is it? What’ya’ mean “what year is it?”

If you happen to strike your head so hard that you feel you need medical attention, as Conan O’Brien did recently, the doctor will ask you a series of seemingly silly questions—that is, if you’re cognizant enough for them to seem silly. Failure to answer one or more of these questions correctly may raise concerns.

An injury like Conan’s is commonly referred to as a concussion. The questions from the doctor are used to determine the severity of the injury and the level of necessity for concern. Questions might include, “do you know what year it is?”, “do you know who the President is?”, or “can you count backwards by tens from 100?” Failure to answer some of these questions after a significant bump on the noggin is not the end of the world, and is usually temporary, as the brain’s cells are theoretically “stunned.”

The strictest definition of a concussion includes a period, however brief, of lost consciousness. This period, which some may call “blacking out” or being “knocked out,” typically involves an inability to process or respond in a meaningful way to stimuli such as sound or touch. Such a loss of consciousness is almost always associated with loss of memory for the events that occurred just before, during, and for some period after the impact. Many of these memories will return, though most people never remember what happened immediately prior to, or after their blow to the head. Conan probably does not remember much of what happened to him, but he has at least seen the video or the event, an opportunity most of us don’t get.

The period of memory lost as a result of a concussion is roughly proportional to the amount of time one is “knocked out,” which is roughly proportional to how hard one strikes his head, which is roughly proportional to how much damage was done to some of the brain cells. The great majority of concussions do not cause detectable permanent damage to the brain, although seemingly minor cranial injuries sometimes result in long-term symptoms.

It is also possible to experience a significant blow to the head which does not result in a period of lost consciousness. Some may say they were “stunned” or believe they were “just out of it for a few seconds.” This sort of event may still be referred to as a “concussion.” Blows to the head that render one completely or partially unconscious until an ambulance arrives are much more serious injuries and are a topic for another time.

It is exceedingly rare for one to go his entire life without experiencing at least a “minor concussion” or without being “stunned” by being struck on the head. Those who have seen the video of Conan’s accident may find his experience a familiar one. Particularly active people or those thinking back to their childhood may recall slipping and falling backward just as Conan did on his stage, briskly striking the back of the head. This may bring back memories of “seeing stars.” Conan probably did, too.

This experience of “seeing stars” happens because our brains basically “float” in fluid called “spinal fluid,” which is found predominantly in our spinal column, but which is produced in the brain. When our head strikes or is struck by an object, our brain actually bangs up against the inside of our skull. Think of shaking a jar full of water with a golf ball in it—except imagine that the golf ball is soft. The impact of the brain striking the skull can result in the temporary dysfunction or even permanent damage of some of the cells on the surface of the brain where the impact with the skull has occurred.
The brain, which shares the consistency of Jell-O, may be briefly distorted by such impact. Though the brain itself immediately returns to its normal shape, cells throughout the brain might be temporarily or permanently affected, causing a loss of consciousness. The cells responsible for our consciousness lie deep in the brain, far from where the organ might strike the inside of the skull. We may “see stars,” particularly with a hard blow to the back of the head like the one Conan sustained, because the back part of the brain is where our vision is processed. A blow to the back of the head causes the brain to suddenly float backwards, striking the “vision area” against the inside of the back of the skull. While we can tolerate the loss of a small number of cells in certain areas of the brain without any noticeable effects, loss of a few cells in just the right area of the brain can have considerable permanent effects.

Additionally, even minor injuries can cause breakage of small blood vessels on the surface of or deep inside the brain. If a CAT scan is performed after a concussion, areas of bleeding similar to a bruise may be visible inside the brain. Despite how serious this phenomenon may sound, it is seldom of consequence in a person who has fully regained his faculties shortly after a concussion.

Most of us don’t seek or require medical attention for a concussion. If even a small percentage of all concussions were serious, they would represent a major health problem in society, which is not the case. Then again, a relatively minor blow to the head can sometimes fracture the skull, which may result in a torn artery inside of the head. This can cause rapid development of a large blood clot that presses on the brain, often causing coma and even death unless it is removed quickly by a brain surgeon. A period of time during which the person seems perfectly fine may occur between this sort of blow to the head and the development of coma. The blood clot resulting from this scenario is called an “epidural hematoma,” and the time between the blow and the coma is called a “lucid interval.” This is what happened in the sad case of Natasha Richardson, who was reportedly chatting it up with ambulance personnel just before she died.

Alternatively, older persons may sustain a minor bump to the head that they hardly even notice, yet these bumps may be sufficient to tear a vein over the surface of the brain. Such sort of brain damage may go unnoticed for weeks, during which time an initial blood clot may slowly develop.

The reason why this sort of damage may go unnoticed for a longer period of time in older people than in younger is because... continued in ABILITY Magazine

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Articles in the Scott Caan issue; Humor — I Do?; Ashley’s Column — Breaking News; ABILITY House — Laura’s Story; Sen. Tom Harkin — SSA Backlog; Bonner Paddock — King of the Mountain; Adam Lee — Inspiration Through Inflation; Conan's Concussion Junction — Head Injury for Dummies; Bad Boys — EEOC Tackles Job Discrimination; Straight From the Heart — Vascular Disease and You; Pluck O’ The Irish — Exploring the Emerald Isle; Taking the Sky — Paraplegic Adventurer Flies Again; USBLN — Business Leadership Celebrates Disability; Scott Caan — Entertainer Makes Waves for Autism; Blue Cross — Insurance Expert on Health Care; The Skinny On Obesity— Breaking Down the BMI; Tap Into Your Potential — An Excerpt from Wise Mind; ABILITY's Crossword Puzzle; Events and Conferences... subscribe

Oct/Nov 2009