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One of the current hot topics in sports medicine is athletes sustaining a concussion. While most people associate a concussion (also known as mild traumatic brain injury) with football, they are, unfortunately, also common in baseball. A player or a coach can be hit in the head with a thrown or batted ball. A player can collide with a wall or even another player while trying to make a defensive play. Catchers and umpires are at risk when hit on the masks by foul balls, and batters following through on their swings can deliver a blow to the back of the catcher’s head with the end of a bat.

The brain is protected by the hard, bony shell of the skull and within the skull the brain is suspended in a fluid-filled sac. These two structures - the hard bone and the bag of fluid - are sufficient to protect the delicate brain against mild blows, but harder blows can bruise the brain and disturb its metabolism. In fact, the symptoms of a concussion - such as headache, blurred vision, nausea and vomiting, light sensitivity, ringing in the ears, and feeling as if in a fog - are believed to be manifestations of disturbed brain metabolism that results from the hard blow.

Other signs of a concussion are loss of consciousness, emotional irritability, slowed reaction time, sleep disturbance, and the hallmark finding of post-traumatic amnesia. In other words, the individual who sustains a concussion has no memory of the events immediately following the delivery of the blow.

If a player is allowed to completely recover before returning to play, the outlook is good and the chance for persistent, long-term damage is minimal. However, if a player returns to action before resolution of the concussion, another blow to the head can have an exaggerated effect and lead to longer short-term disability and a higher chance of long-term consequences such as dementia, Parkinsonism and depression.

All players go through what is called “neurocognitive” testing at the start of each year. They are given a standardized test that asks them to perform simple tasks such as putting words or numbers into a certain order. It tests concepts and memory and establishes a baseline for that player for that year. In order to be cleared to return to play after a concussion, a player must be symptom-free - both at rest and with exertion (in a controlled environment and off the diamond) - and his neurocognitive testing must have returned to its pre-injury level.

For most players, the cognitive recovery takes longer than symptomatic recovery. A player will actually feel much better or even recovered for a period of time before his testing shows his brain function to have returned to baseline. Treatment of a concussion is enforced physical and cognitive rest. Physical rest is, of course, avoidance of daytime exertion and adequate nighttime sleep. Cognitive rest means reducing activities that require concentration such as studying, video games and text messaging.

In general, 40 percent of concussions recover in one week, 60 percent in two weeks, and 80 percent in three weeks.

I hope that this gives you some insight into how concussions are assessed and treated.

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