Dr. Elizabeth Pieroth (NorthShore)
Most concussions occur with one significant blow to the head so you do not need to have multiple contacts. We do see volleyball players who suffer a concussion after being struck with significant force. If it was not a very hard hit and the symptoms are just headache, it may be a neck injury and not a concussion.

Dr. Elizabeth Pieroth (NorthShore)
No, chills would not be a symptoms of concussion. Yes, people can have a return of symptoms if they are not fully recovered and engage in activities that aggravate your symptoms. However, concussions don't return. If someone is truly recovered and their symptoms return at a later date than it would be due to another cause. Emotional swings can be seen immediately after a concussion. If they return at a later date they are more likey due to something unrelated to the neurologic changes of concussion. However, athletes can feel quite stressed by their symptoms and be more emotional. Lack of sleep, hormonal changes and many other factors can causes emotional lability (shifting emotional states) in young people.

Dr. Elizabeth Pieroth (NorthShore)
A concussion is a brain injury but does not result in bleeding of the brain or tissue damage. If someone does suffer bleeding of the brain or other structural injury to the brain, we do not call that a concussion. However, a concussion is a brain injury and should be taken seriously though! It's an injury that occurs at the cellular level so it cannot be seen on CT or MRI. We also do not have a blood test to detect concussion. The diagnosis is based on symptoms reported by the patient.

Dr. Elizabeth Pieroth (NorthShore)
That depends. If someone is hit in the head with significant force, they may suffer a hemorrhage (i.e., bleeding). If the bleeding continues, this can cause increased intracranial pressure and displacment of the brain tissue, which can be fatal if not managed. If someone is awake they would experience a significant increase in their symptoms which would be reported by the patient or observed both others (e.g., increasing confusion). If they are asleep, this could be missed. Fortunately, this is very rare. If someone has been examined by a physician, had a negative CT, or has been monitored for several hours without an increase in symptoms, it is not recommended to wake them frequently. We tell parents to contact their primary care docs or pediatricians for advise about symptoms to watch for or take them to the local emergency room.

Dr. Elizabeth Pieroth (NorthShore)
There are two main strategies. First is education to the players, coaches and parents. Some players do not realize their symptoms are suggestive of a concussion. Others do not know that dangers of continuing to play while concussed. Good education can improve self-reporting of concussions, and help improve teammates, coaches and parents noticing behaviors that suggest concussion. Coaches need to create an environment where players are comfortable reporting their symptoms. Second, is to have a qualified athletic trainer available at all games and practices. They are well-trained and know their athletes so are more likely to pick up signs of a concussion. There is a great deal of sensors on the market designed to assess contact to the helmet or head but unfortunately there are too many problems with the current ones to recommend them.

Dr. Elizabeth Pieroth (NorthShore)
I am sorry to hear about her injury. First, has the true cause of the headaches been determined? We often see headaches that have been called "post-concussion syndrome" are actually due to something else? Has she had a thorough examination of her neck by a cervical specialist? With this mechanism of injury, we can see constant headaches from cervical injuries. Is there a family history of migraines? Migraines don't typically present as constant headaches. Has she seen a neurologist? Any pattern or triggers for increases in the headache pain?

Dr. Elizabeth Pieroth (NorthShore)
No, concussions are not fatal. However, a more severe trauma to the head that results in hemorrhage, increase intracranial pressure, or damage to parts of the brain responsible for functions such as your heart beating or breathing can be fatal. Traumatic brain injury is on a spectrum from mild (mTBI) to severe TBI. The types of injuries that are fatal are considered severe TBI. That does not mean we take concussions lightly. They are still brain injuries and need to be monitored and managed correctly. Sometimes the media reports that a person died from a concussion but further examination indicate there was a hemorrhage or other severe injury.

Dr. Elizabeth Pieroth (NorthShore)
Yes, concussions occur in all ages and in many different activites. We see plenty of concussions in younger kids from falls, bicycle accidents, and other causes. That is why we need to be diligent about having kids where helmets when riding bikes, scooters or skateboards. However, every blow to the head is not a concussion so you want to distinguish between a concussion (a brain injury) and those frequent contacts to the head that do not cause a concussion.

Dr. Elizabeth Pieroth (NorthShore)
There are four things we look for to allow higher level exertion. First, are they asymptomatic (fully without symptoms)? Second, is there balance intact? We do not want a patient engaging in activities that risk them falling if they are still demonstrating impaired balance. Third, is there any evidence of residual cognitive (thinking) changes? There are a number of tests that are administered to asses this. Fourth, does lower level exertion cause a return of the symptoms? If someone meets all four criteria, they are allowed to increase their exertion. This should be monitored by an athletic trainer, if possible. Of note, we used to say that the patient should not participate in any physical exertion until they were fully without symptoms but that is no longer the case. Increasing evidence shows that "active rehabiliation" (getting them back to limited exertion sooner) is better for patients, especially athletes.