Experts: Troy Aikman Will Never Fully Recover

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By Susan A. Steeves
WebMD Medical News

Doctors this week will
reevaluate Dallas Cowboys quarterback Troy Aikman to determine if he
can resume play after suffering his seventh brain concussion in 11
years, three of them in the past 10 months. But experts say the
latest injury, sustained a week and a half ago, contributes to an
already dangerous scenario.

Concussions generally are one of the milder forms of traumatic brain
injury. They occur when there is jarring of the brain that causes
transient loss of consciousness or transient loss of function. A
severe or numerous concussions, however, can lead to psychological
and physical damage and even coma or death, experts say.

"Once an athlete has been knocked out, then he is four times as
likely to be knocked out again," says Harris Methodist Fort Worth
Hospital neurosurgeon Thomas Ellis, MD. "I liken it to a battery that
has gone dead once; it won't ever hold the charge as well after that."

The CDC says that after the second injury, the risk for a third brain
trauma injury is eight times higher.

Because sports-related concussions are not always reported, it's
unknown exactly how many people annually suffer them. But a 1999 CDC
report estimates that every year, the nation's emergency rooms treat
1 million Americans for traumatic brain injuries and release them
without hospitalization. Another 80,000 people have long-term
disabilities from these types of injuries, and 50,000 people die.

University of Pittsburgh Medical Center concussion researcher Mark
Lovell, PhD, who oversees National Football and National Hockey
leagues' neuropsychological testing programs, says about 10% of
contact-sport athletes suffer concussions each season. The American
Medical Association says 21% of the traumatic brain injuries that
children receive are due to sports or recreational activities.

To call a concussion mild because a CAT scan or MRI doesn't show
injury to the brain is a bit misleading, experts say. If bruising,
cuts, or excessive bleeding were detected, it would no longer be
termed a concussion but rather brain contusions, lacerations, or
hematomas respectively. The severity of the concussion is based on
whether the person is just dazed or rendered unconscious, and how
long that state persists. The severity of the injury symptoms, such
as dizziness, nausea, vomiting, and general unsteadiness, and how
long they continue, also are taken into consideration.

"The longer the person is out the more serious it is, but if he is
just dazed then we call it a mild concussion," Ellis tells WebMD. "If
you have a 16-year-old playing football who is dazed or just knocked
out briefly and the CAT scan is normal, then you remove him from the
game. If he stays asymptomatic for a week, then you let him go back
to the sport.

"If the person has a mild concussion a second time, you make him stay
out several weeks; a third time he's out for the season. If it's more
severe and the patient has any amnesia, you make him stay out a
month. If an athlete has had two severe concussions, then you pull
him for a year."

Those precautions are necessary after such a brain injury because
secondary damage can occur if the brain stops regulating its blood
flow. Secondary complications include hematoma, brain swelling or
edema, increased pressure inside the skull, spasms of the brain's
blood vessels, infection, and seizures.

Ellis says autopsies done on young boxers who died after multiple
concussions show cell death and other changes in the brain, including
plaque tangles similar to those found in Alzheimer's disease patients.

"It's difficult to judge how much damage has been done to a young
athlete when they are still alive, but it's important that when they
have a concussion they undergo intense neuropsychological testing to
see if they are declining a lot faster than they should," Ellis says.

Researcher Lovell and his colleagues at the University of Pittsburgh
and the Henry Ford Health System in Detroit have begun using a
computerized testing system to evaluate concussion severity in
athletes. They spent the past five years devising the Immediate
Post-concussion Assessment and Cognitive Testing (ImPACT) program.
Through funding from the NCAA and the National Academy of
Neuropsychology, the Pittsburgh Steelers and several college and high
school teams are using it for the first time this season.

The athletes take a 20-minute computerized test that measures brain
processing, speed, memory, and visual motor skills. This gives the
doctors baseline data that subsequently can be compared to a repeated
test administered after a concussion.

But how should you deal with a concussion if you or your child
suffers one? Ellis says rest and take only Tylenol. Aspirin or
ibuprofen are not good because they could cause or increase bleeding.
Narcotics should not be taken because they can mask the symptoms of a
brain injury, Ellis says.

As for continuing to play a sport in which you could suffer a
concussion, Ellis says, "For most of us, three severe concussions and
you're out. If you have one mild or one moderate and two severe,
you're definitely approaching the limit."

As for Aikman, Ellis prefaces his opinion by saying he has not
examined the 11-year, three-time Super Bowl winning quarterback, so
he can't give a medical opinion. "However, if it was my brother and
he was telling me about this over the phone, I'd tell him to give it
up," Ellis says. "It will get easier for it to happen every time, and
it will probably get worse every time, and the recovery time will get
longer."