Late Effects of Concussions and Other Head Injuries
©2003 Melissa Kaplan
Through the years, many articles about chronic fatigue syndrome (CFS), fibromyalgia (FM), and chronic mypfascial pain (CMP) have mentioned prior concussions as being common to many patients meeting the various diagnostic criteria for these disorders.
The earliest head injury I can recall did not result in loss of consciousness (LOC) or concussion, but did result in a terrific knock on the forehead while being pushed on the rings on a school playground. The injury resulted in my being led, bleeding, through the empty after-hour halls of the school to the nurse's office, waiting for my parents to come pick my up to go to the doctors. A couple of stitches put things to right, other than the incident leaving a small scar in the middle of my forehead, now nicely blending into the increasingly prominent horizontal wrinkles. Or so I thought.
In subsequent years, I knocked my head, as people do, falling from a horse, loading things into the trunk of my car, and so on. All left painful swellings on my head. The point of impact was most often on the front of my head, with a few on the top of my head, and some on the back and sides. Only one incident for sure resulted in a concussion: my brother, sorely in need of anger management training, hit me in the side of my head, with force enough to bounce the other side of my head into the wall.
The interesting thing about these non-cocussive head injuries, as well as those resulting in concussion, is that it isn't just the part of the brain beneath the impact site that is injured as a result of the impact. The side of the brain opposite the impact site is also injured, often more seriously, as the brain itself slams into the bony skull, then back again to the point of imact. The injury to the side of the brain opposite the site of impact is called a contra coup injury. This type of brain injury can also happen when the body, not the head, is the point of impact or sharp movement, as in a car accident, where the seat belted body is thrown sharply forward, then back against the headrest. While the seat belt and shoulder harness keep the body from slamming into the windshield in a head-on or rear-end impact, nothing is preventing the brain from slamming into the braincase, resulting in contracoup injuries.
Something else not widely known or discussed is that, even though the head injuries are relatively mild, and the patient fully recovered without incident and without any of the typical clinical signs of concussion (loss of consciousness, blurred vision, confusion, temporary short-term memory loss), the brain was still damaged, and is more susceptible to damage from future injuries. Further, while there may be a period of normalcy subsequent to the recovery from the last injury, neurological effects may occur down the line. The type of effects will be generally consistent with those parts of the brain that received the most trauma.
The potential for cumulative late onset of neurological problems as a result of earlier head injuries didn't really sink in to my already problematic brain until I attended a talk on the neurological problems associated with fibromyalgia and CFS, given by a neuropsychologist who also has fibromyalgia which set in after she was seriously injured and nearly crippled in an auto accident. That's when it hit me (no pun intended) that the executive function, decision-making, organization, and other tasks normally performed in the frontal lobe are affected by cumulative injuries to the that area.
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