Symptoms Of Brain Trauma (Or Lack of Them If We Are Talking Sub-concussions)

First, if you are on this page and your child has had a concussion, please get them to a hospital or Primary Care Physician immediately. This page is only to provide some common links to sites for parents to understand the damage that could be sustained by a concussion.

Second, I understand that “brain trauma” as a description for a concussion may seem overdone, but to us, that is what it is, a traumatic brain injury caused by a significant, often violent impact. We don’t want to understate the importance of this. We should have dug deeper when Mac got his concussions but thought that it was all handled properly… which it was, by all accounts. But to know that concussions are a lot more serious than they appear and to be more aware of sub-concussive trauma, we would have become more informed. 

One of the reasons for this page is that concussions are estimated to be under-reported by a lot…. Sometimes by almost 50%.[i] There seem to be several reasons for that, first, children do not understand when they have had a concussion and that some “knocks” they take should be one, second, they under-report cause they are very involved in their sports and want to play.  

Regretfully, even though every child taking part in a contact sport will undergo sub-concussions, they are not reported at all, even though most organizations recognize their potential impact on young brains. Since they are recurring and involved in almost every contact sport practice or game, they can be the largest contributor to cognitive and mental health declines because of trauma. As there is no diagnosis for them and they are never reported by an athlete or parent, critical stakeholders in protecting our children like medical staff, trainers and coaches are not trained to analyze the aggregate sub-concussive exposure from sports and recreational activities that kids take part. 

The Gap in Concussion and Sub-concussion Knowledge

There are many areas where one can find symptoms of concussion, and they all state the same thing. In fact, coaches and trainers are excellent at identifying the acute or “sideline” concussions when they take place. We have found that, from all accounts, athletic staff and most parents understand concussions. They should be, over 4 million of them take place every year.

The knowledge gap is the understanding of what can happen after a concussion, as when most kids are cleared to return, it is assumed that the concussion is healed and looking at the combination of a concussion and aggregate sub-concussive activity endured by the athlete. Since it’s virtually impossible to get a granular look at what damage took place inside the skull using the most common methods of detection like Magnetic Resonance Imaging (MRI) when the concussion occurred most treatment plans involve rest for two weeks, no physical participation in sports, limited electronics, and such. Concussions and sub-concussions are not like a broken arm, there is no definite diagnosis and the treatment plans for the athlete are nothing more than guidelines. Guidelines are not prescriptive medicine designed to recover from a specific illness, with concussions they are a guess at what may work to heal the athlete and we are talking about our kids’ brains!! Because of the lack of granularity in a diagnosis for a concussion, it is conceivable that physiological damage can occur that, when left undetected and exposed to more and more sub-concussive or concussive impacts after return, can cause long-term issues.

That is why we, as parents, recommend that any concussed child is followed up by their parents, medical staff, and/or a therapist for months after a concussion, especially if it is a moderate-to-severe concussion or if the child had multiple concussions. These specialists must have experience dealing with concussions but also should understand the impact of sub-concussive trauma to analyze the athletes’ risk based on years of playing sports, the sports being played, the seasons of the sports (back-to-back?), any recurring medical issues like headaches, dizziness, physical pain, etc., and recreational activities. By reading this site, it is quite possible that you will be the smartest person in the room regarding all of this and you should make your position known. Do not be bullied by the experts, whether they are trainers and medical staff, or coaches and fathers who used to play sports. 

Mac was diagnosed with two moderate concussions and one mild one over 18 months. Those never should have contributed to his passing, but combined with external factors such as 10 months a year of continued sports practice and playing, learning to snowboard…. he was a much higher risk than anyone knew. Yet, because of his return from the concussion to his normal routines without complaints and the fact that Mac remained stable and himself to his last day, we never thought to question him about persistent issues like light sensitivity, headaches, or psychological issues or would have him talk to a therapist, things we would do now. 

Sometimes kids won’t talk. We were uninformed and relied on the training and medical staff for the right answers, and when he was concussed, they provided them in line with their knowledge and training, or lack of it, with sub-concussive trauma. But for Mac, it wasn’t enough. 

Symptoms of Sub-concussive Trauma

Here is a bulletin for you, there are none! That is why it is so important for you to read this site and do research on sub-concussive trauma. You must be cognizant of the fact that your child will undergo it but that it can be mitigated by reducing the amount of exposure that they have. You, as a parent, will have the best reason in the world to be informed, protecting your child. You want them to play sports; they want to play sports, and sports are good, but there are risks we are only understood.  

Even though there has been no concussion, sometimes kids will show signs of a concussion from sub-concussive trauma. From the overexposure of the brain to the continuous hits and impacts it takes from the long-term playing of sports and recreational activities. However, unless your kids mention it or you are educated, some of these signs, like headaches, dizziness, or light sensitivity, may just appear to be temporary issues associated with growing up or just being a child, not indicators of a brain injury. Pay attention to your child. If they are manifesting some signs of a concussion as outlined below, but have never had a concussion, it may be an indicator of a brain injury from concussive trauma.

Unfortunately, when there are issues because of sub-concussive trauma, they are severe and often irreparable. 

They manifest themselves as mental illness, cognitive declines in education, and physical impairments like light sensitivity and headaches. If not identified and checked early enough, this condition could progress to mental illness, CTE, and self-harm/suicide.  

So read, be aware, and protect your child. 

Short Term Symptoms of Concussions

There are many sites to go to to find short-term symptoms of concussions. According to the experts, most of these symptoms will resolve themselves in the two weeks of rest that are usually required. However, care should be taken to ensure that, after those two weeks, the child questions repeatedly for persistent signs of these symptoms that could show that they need more rest or time off. If the child has multiple concussions or just a moderate to a severe one, that could be a sign of Post Concussive Syndrome or PCS and require a lot longer period of rest and more in-depth monitoring. Again, this is where we think we could have been more proactive… maybe Mac wouldn’t have told us anything as he was too early in his journey, but maybe he may have. No one thought to ask, and with him never complaining or informing us of any issues, we assumed all was well. 

Post Concussive Syndrome Symptoms

Post Concussive Syndrome or Disorder refers to concussive symptoms that persist longer than the two-week period where most of the symptoms resolve themselves. The Concussion Legacy Foundation categorizes PCS symptoms into four categories[ii]:

The good news about PCS is that almost all patients make a full recovery after diagnosis and that all these issues will go away. But it takes getting informed and being able to continuously interact with your child about these issues to identify them. Our boy never displayed any of these except sleeping too much just before he passed, we had little to go on but now realize that we should have just pestered him after his concussions and maybe we would have known more. However, some of these signs can be indicators of brain trauma associated with subconcussive exposure so parents should be aware of them anyway. 

Tying Conditions to Concussive Events, PCS, or Subconcussive Trauma.

One of the problems with Post Concussive Syndrome and the progression to more serious issues like personality disorders or Chronic Traumatic Encephalopathy is that the symptoms listed above are not usually identified unless the child or adolescent talks about it or responds to questions from a parent or a third party. 

As any psychologist will tell you, “Kids, especially teenagers, don’t talk”. Sometimes these symptoms even replicate those actions one would expect from growing young men getting ready to separate from their families. Symptoms like sleeping too much, or having a dark room are usually identified as what a “teenager” does, and unless conversations are taken to identify these issues some may never be found.

As mentioned earlier, another factor preventing associating these indicators to a concussion or subconcussive trauma is, after concussive protocols are reached and the child/adolescent cleared, these symptoms can occur or be identified months after the injury. At this point, most doctors and parents don’t have the knowledge or awareness to question the indicators were related to a concussive event as now they are treated as a separate illness or issue. The correlation of illness, physical or psychological to a concussive event or subconcussive trauma is a significant issue today. We have interfaced with adolescents who are “hearing voices” or have had multiple suicide attempts that have had very active, long-term, concussive sports careers spanning over 10 years with multiple concussions, and no one had ever tied their pain to concussions. Children who are having physical, cognitive, mood, or sleep issues must be continuously monitored and evaluated in the context of having a connection with concussive events or extensive exposure to subconcussive trauma.

The chances of someone recovering from PCS are very high in fact, most patients make a full recovery. But the risk of not identifying and treating PCS is huge. Left unchecked, symptoms of PCS can progress to more severe conditions to include aggression, dementia, and impulsivity as well as suicide. The fac is why it’s critical to try and diagnose PCS and/or subconcussive trauma, as early as possible, 

Chronic Traumatic Encephalopathy (CTE)

Description: According to the Boston University CTE Center, Chronic Traumatic Encephalopathy (CTE) is a degenerative brain disease found in athletes, military veterans, and others with a history of repetitive brain trauma. Most of what we have learned about CTE has come from the research of Dr. Ann McKee, director of the VA-BU-CLF Brain Bank. In CTE, a protein called tau misfolds and malfunctions, causes other proteins to misfold and sets off a chain reaction where this malfunctioning tau slowly spreads throughout the brain, killing brain cells. CTE has been seen in people as young as 17, but symptoms do not generally begin appearing until years after the onset of head impacts.[iii]

Symptoms of CTE

Mood and behavior symptoms

Among individuals diagnosed with CTE, some report mood and behavior symptoms that can appear as early as the patient’s 20s. Common changes seen include:

Cognitive symptoms tend to appear later in life, often in a patient’s 40s or 50s. Patients may exhibit one or both symptom clusters. In some cases, symptoms worsen with time (even if the patient suffers no additional head impacts). In other cases, symptoms may be stable for years before worsening.

It is suspected that Mac, with his concussions and the frenetic pace of his sports and leisure activities, progressed from PCS to CTE with signs of a severe personality disorder. We had minimal signs of anything other than him sleeping a lot during summer vacation, but our son was struggling emotionally, with significant internal anguish, and was unable to talk about it. His condition had a very high level of impulsivity and without anyone knowing that it allowed him to act as he saw fit to resolve his pain. https://www.bu.edu/cte/about/frequently-asked-questions/

This is again, why we need to be continuously monitoring our kids for signs of concussive symptoms, long after the concussion has taken place. While we will never be able to identify all the symptoms, even one or two can give us some indication that our children are still undergoing issues and need more time to heal and repair. Interaction and continuous monitoring by parents, even when the adolescent is in their late teens and twenties is critical to timely intervention and treatment. 

 [i] https://news.brockusa.com/2014/03/more-than-50-of-high-school-athletes-with-concussions-play-despite-their-symptoms

[ii] https://concussionfoundation.org/PCS-resources/what-is-PCS

[iii] https://www.bu.edu/cte/about/frequently-asked-questions/