By Jack Gruber, USA TODAY

USA Today has reported that because of a new military ruling more soldiers are being diagnosed with concussions than ever before.

The ruling, which came into effect last July, says that soldiers near a blast have to be pulled from combat for 24 hours to check for a concussion.  The idea is to protect soldiers from the risk of receiving one concussion on top of another.

Dr. Guy McKhann, Florence Irving Associate Professor of Neurological Surgery here at Columbia says, “Early diagnosis is imperative,” especially in high risk environments such as those faced by soldiers.  McKhann explains, “Following concussion, the brain is more susceptible to another injury. If the concussion is not recognized and the individual sustains another “second hit” soon thereafter, much more severe brain swelling and damage can result.”

According to the USA today article, the military has set up “rest centers” where troops can recover.  ”In general,” Dr. McKhann says he recommends, “patients rest until all symptoms have completely resolved, including under high physical strain.  Although, for exactly how long and whether certain types of graduated brain activity may be beneficial is unclear.”

According to McKhann, “It is not known whether some individuals are more genetically susceptible such that recovery is incomplete and brain function impaired following a low number of concussions.”

In any case, McKhann says, “Any policy that allows for a more systematic and accurate assessment of soldiers who may have sustained a blast related concussion is commendable.”

Read the article More troops’ concussions diagnosed under new rules in USA Today

NY Yankees Catcher Jorge Pasada

Good news was reported in the New York Daily News; Jorge Posada, catcher for the New York Yankees, has been cleared of a concussion.  He was hit in the head by a foul ball on Tuesday night and sources said he was exhibiting concussion-like symptoms.  He was sent to Columbia Presbyterian where doctors cleared him of a concussion.

“Whenever an athlete suffers a significant blow to the head, and particularly when they develop any persisting symptoms or neurological signs, they should be seen right away,” advises Dr. Guy McKhann from the Department of Neurosurgery.

A concussion is a type of traumatic brain injury and can occur with a hit to the head or even strong sudden jarring of the head.  Signs of a concussion include: loss of consciousness, loss of memory, confusion, headache, loss of balance, or ringing in the ears among others.

Dr. McKhann says, “A concussion can be a relatively minor brain injury and symptoms most commonly subside within a few days to weeks.  However, there is significant risk of more permanent damage with repeat injury soon after a concussion.  Also, in the case of baseball, where the ball can reach such high velocity, it is imperative that the athlete see a doctor to make sure there isn’t a more serious injury.”

When they do occur, however, they can be the worst kind of tragedy.  ”For this reason”, says Dr. Richard Anderson from the Pediatric Neurosurgery Center, “it is important to understand the typical mechanisms of injury in children and their special treatment needs.”

In children under 8 years old, spinal cord injuries are most often located in the cervical spine (the neck region.)

This is because of the unique anatomy and biomechanics of children in this age group.  They usually have a disproportionately large head, underdeveloped neck musculature, and a much more flexible spinal column.  This has to do with the shapes of the bones and an increase in flexibility of the joints. (For more information about this, see our blog: Pediatric Spine- Not Just Smaller- Different.)

The increased flexibility in their spinal column does not proportionately apply to their spinal cord, however.  According to Anderson, “while the column has 2 inches of play, the cord has a mere quarter inch.”  This means that in an accident, the spinal column can be thrust in one or more directions that exceed the flexibility of the cord resulting in grave injury.

Spinal cord injury itself happens in two phases.  The first is the irrevocable force that actually injures the spinal cord. The second is what happens afterward.  While the original injury can’t be undone, doctors do have some control over how a child survives the second phase.

Immediately after injury, the child’s spine must be stabilized to prevent any further mechanical injury from an unstable spine, or the possibility of loose bone fragments.  The injury itself will also trigger a complex cascade of events throughout many systems within the body that can cause further damage.

Among these are  severe inflammation, shock, and changes in the immune system.  Physicians can use a number of medications and other therapies to mitigate these effects and they need to be sensitive to the dosage requirements specific to children.

An X-Ray needs to be taken as soon as possible to begin to determine the extent of the injury.  Dr. Anderson emphasizes, that there can be a spinal cord injury present even when X-Rays appear normal.  He urges that if a physician suspects injury based on their examination, then dynamic imaging studies, a CT scan, or MRI should be performed.

He recommends further, that if any instability is discovered, then surgery should be considered regardless of whether the cord has sustained any injury.  This is because an unstable spinal column is extremely dangerous and poses a continued risk until it is stabilized.

The surgical procedures performed on children need to take not only their smaller size into consideration but also their unique biomechanics too.  Dr. Anderson says, “Thorough preoperative planning is critical.”

The continued growth of young children is a large consideration both in planning surgery and in how long the child should be followed afterward.  Surgeons may often opt for less instrumentation placed inside the body and greater external bracing to allow for continued growth and to maximize the exceptional healing potential that children have.  Dr. Anderson recommends at least yearly follow-up until the the child is fully grown.

To learn more, see our blog; Pediatric Spine- Not Just Smaller- Different, our pages on Spinal Cord Injury, and Pediatric Trauma.