Friday, 20 June 2008

Concussion versus Compression

Something new and exciting today, dear reader. This is the first guest post on A Sceptical I, brought to you by my friend who goes by the name Asclepius. Asclepius authors a medical blog over at Hippocrates Got Lost, described as the account of "a Nursing student staggering through the mundane and the insane". He's here today to help dispel a medical myth which is, in my experience, very widespread. So without further ado, here are the words of Asclepius:

"He's taken a knock to the head. You've got to keep him awake, the concussion might kill him!"

This is a misconception held by almost everyone I have ever met, including a few healthcare professionals. Its not easy to challenge an idea that has been reinforced with every generation.

Concussion is by far the least dangerous of all brain trauma. The word says it all. The brain has been shaken, it doesnt like being shaken. The result may be felt throughout the body. Nausea, Dizziness, Slurring, Difficulty Concentrating. The brain will restabilise from a concussion. Assuming the trauma hasnt caused any other problems there is no reason their condition should deteriorate.

A much greater threat is commonly referred to as Compression. Anything from a major to a very minor blood vessel in the brain may have ruptured. It may be so minor the patient doesnt show any stroke symptoms. However when the blood that has leaked out of its conduits coagulates (usually against the lining of the meninges) it becomes harder and denser this pushes the brain away from the side of the skull and compresses it. This is a medical emergency and can only be treated with surgery.

You can have a concussion without having compression. This is the case for most people. However If you knocked your head hard enough to blow a vessel you will have experienced a concussion (assuming the patient isnt on thrombolytics such as warfarin or has just been treated with streptokinese. The idea of keeping a patient awake for as long as possible after a head trauma is to assess any deterioration in their state. They may descend into diminished awareness, they may demonstrate extreme behavioral changes. This deterioration is a good indicator of one of two things -

1. A compression.
2. Some fat bastard has kept you awake for 18 hours and all you want to do is sleep off your headache.

To conclude -
Concussion = Non-Life Threatening.
Compression = Brown Trousers Time.

I make no apologies for any technical precision lost in making this post ready for the general public. I also realise I may have misspelt a few of the words unique to my profession.

I would like to thank Darkwinter for giving me the opportunity to act as a guest author on his blog.


Anonymous said...

So what you're telling us is that it doesn't matter if people fall asleep with concussion as it won't kill them, but if they have compression they may die, and that you get compression in the same way as you get concussion, and the best way to diagnose compression is to keep them awake? This doesn't seem so much like dispelling a myth as it does seem an argument in semantics.

Darkwinter said...

There is a certain amount of semantics going on here, yes - I'll let Asclepius reply himself for the most part. But the myth being dispelled is probably less substantial or important: if you hear that someone has been reliably medically diagnosed with concussion, the point is that you shouldn't consider this to be potentially fatal. Perhaps this will simply prevent overreaction.

Asclepius said...

My argument is the falling asleep wont kill you. It merely allows an observer to track any decline in mental functionality. And by and large I am protesting to the misuse of the word concussion.