Nobody Really Knows What A Concussion Is


Hi, this is Julián from MinuteEarth. Millions of people are diagnosed with concussions
each year. In addition to immediate concerns like headaches,
dizziness, and fatigue, concussions have been linked with long term health issues like depression,
chronic traumatic encephalopathy, and even Alzheimer’s and Parkinson’s disease. But progress in treatment has been hampered
by a small problem: no one can seem to agree on what exactly a concussion is. Many neuroscience researchers define a concussion
as a specific minor brain injury. But the fancy equipment necessary to detect
minor brain injuries is mostly confined to specialty research labs, so instead, when
doctors evaluate patients who’ve recently knocked their noggins, they diagnose based
on symptoms like: their short-term memory, their vision and their coordination. If you have too many of those symptoms, they’ll
diagnose you with a concussion and send you home with the advice to rest, avoid bright
lights, and essentially wait to recover. But many concussion-related symptoms aren’t
necessarily the result of a brain injury. A headache could actually be the result of
a neck injury, dizziness a consequence of an inner ear problem, and unexpected fatigue
could be due to emotional trauma, or even a symptom of pre-existing depression rather
than recent injury. All of these issues have their own separate
treatments that are overshadowed when the diagnosis is “concussion.” It’s kind of like if a doctor were to diagnose
you with “chest pain” and prescribe a generic treatment without determining if the
pain is coming from your heart, your lungs, or your ribs. And even when the symptoms are caused by a
brain injury, there’s a small chance the injury could be more severe than a concussion
diagnosis implies. Some dangerous injuries – like subdural hematomas
– can present the same symptoms as concussions and may thus be missed by routine tests, especially
when they don’t include brain scans. So … if the diagnosis of “concussion”
isn’t really working – and may even be putting people at risk, why do we still use
it? It’s partly because a concussion is simpler:
doctors can ask a few questions, diagnose the patient with a concussion, send them home,
and move on and in lots of cases, the patient will be fine. It’s partly because a simple diagnosis benefits
influential sports organizations, who like that athletes with concussions can be cleared
to return to play much sooner than if they were diagnosed with a more severe injury. And … it’s partly because the confusion
around the term “concussion” mucks up the available data, so we don’t exactly
know how big of a problem it is. If doctors had to make more specific diagnoses
– and potentially even ditched the term ‘concussion’ altogether – then researchers would have better
data to work with and patients could potentially get better treatment – all of which would
help us deal with one of our literal biggest headaches. Hey! We just made a new show! It’s about the human body, and it’s called
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of a different body part. There’s one about muscles, one about kidneys
and one about poop. Ok, poop’s not a body part, but – you know
us – we made a video about it anyway. The show is primarily for kids, but adults
seem to like it too. We’re launching it on Nebula, a new streaming
platform built by and for independent educational creators so we can try out new ideas that
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Comments

  1. So I'm in week 4 of a stage 3 concussion. I was assaulted and robbed. I was unconcious for at least a few minutes. I somehow drove myself to the hospital but thought someone else drove me. I was in the hospital for 4 hours and then was told I was fine to go even though no one was capable of driving me

  2. Well, no one bothers to check what virus is responsible for your cold either… it is so rare that some more serious infection would be overlooked that no one bothers to run expensive tests if it appears to be just a cold.

  3. When you have concussion, it feels like you can't control your brain but instead you feel like your brain is moving back and forth and there are worms crawling inside it.

  4. Most hospitals don’t have a 3T MRI scanner so it’s hard to diagnose. In most cases the diagnosis is made from the patients history.

    A negative CT or MRI scan can exclude other significant abnormalities.

    So for most hospitals the diagnosis of concussion is meds based on negative scan plus working symptoms.

  5. 1) I saw those unknown on nurse Joy's chart. Well played.
    2)As a chronic migraine sufferer with MDD, I can confirm that my doctors don't actually know how a brain works, and that they are just as troubled by this as you are.

  6. I wish somebody would do it to me until I'm dumb enough to barely bathe and browse the internet. Once I stop praying to god, and start talking about a guy named "Grug" then you're good.

  7. How did you guys not mention that TBIs are a thing, and that brain damage is cumulative? Lots of minor hits add up over a lifetime.

  8. i suffered a concussion. or maybe you should call it a tbi. it changed my personality, it has lead to life long problems with balance. i have aphasia, which is endlessly frustrating. it just took me about 30 seconds to think of the word frustrating. i have memory loss. i basically cant remember anything from before 2004, and my memory feels like a haze. there are some things i remember vividly and about 99% of everything else i cannot remember at all. this concussion robbed me of pretty much everything i wanted to do in my life. i lost my career, i lost friends, i lost my history and my personality.

  9. Thought it was going to be more biological but its just about what it is and isnt. Was interested because ive had a few good hits on the noggin.

  10. Could you please change the link in the description https://www.minuteearth.com/ to https://minuteearth.com/ ? The www one seems to lead to a site it's definitely not intended to.

  11. Hmm, a new sponsor this time. Wonder when NordVPN, Skillshare, Wixcom and Squarespace start sponsoring these guys.

  12. Julian, it's nice you included the references but I don't think you presented them well. What I heard in your video is that doctors don't know a headache from a car crash from a headache from an ear infection. As a qualified doctor I find that quite insulting. You might be surprised but we don't actually just randomly guess what's wrong with people.
    And also implying everyone who comes to hospital cannot be properly diagnosed without a head scan is absurd. CT literally irradiates your brain and MRI is super expensive and not readily available to everyone with a head injury.
    Stop trying to make patients out of every person.

  13. >Denmark (social democracy) lets check everything to make sure you're !00% healthy as you you already paid for this through your taxes

    >'USA(capitalism) pls dont check anything as it will economically ruin me and my family
    >americans die (or get severe preventable issues) of easily preventable things
    >americans: "surprised pikachu face.png"

  14. 0:12 *These concerns have even lead to calls to stop kids from playing potentially head-damaging sports like American football.

  15. <inserts random reference about random popular medical drama series in (that i havent watched) and that normies totally find funny>
    am i right 😂

  16. You said yourself in the start of the video that MRI's are very expensive and are reserved for specific by-need cases, but then go on to say that doctors should spend the time and be forced to make more accurate diagnostics. It's not that simple with the cost and accessibility constraints.
    "Hey Doc, I hit my head"
    "Okay, step in here."
    "WHY WAS MY BILL $6000"

  17. You said that headaches are a short term symptom of a concussion but that's not really true. Some times the headache after a concussion will be fleeting and never come back, but in many many situations end up being a life long problem. Little things like running, turning your head to fast, falling on your bed, getting up to fast, just any quick motion can flare up another migraine like headache.

  18. Well if you just recently hit your head in an accident or with a fist, then the usual Concussion meant by neurologist is just the right diagnosis. You comparing here long-term sicknesses with a diagnosis which is used mainly in the emergency room. If you go to stay in the hospital, the term concussion gets specified quite fast (usually.) So I recently dislike your videos more and more, because you either fake, do complete bs, or just throw out each personal opinion, without reasonable fact checks.

  19. I have a definition:
    A concussion is the term for the smallest scale of brain injury due to trauma such as the brain hitting the inside of the skull.
    A concussion is the base for all brain injuries, is what I am saying.

  20. Some sports "professionals" just say they got a concussion and can't play only to take a break, while they sit at home and keep making money. Really, gotta have that money to bribe the doc.

  21. I got a bad concussion from a heavy wood door getting slammed into the side of my head while in high school and actually got knocked out and collapsed, I was out cold for a good minute before coming too again. It wasn't until I started losing my balance, coordination, and speech that my family took me seriously and let me stay home from school.

  22. Well when I got one, I lost hearing for a period of time, heavily slurred my speech, and my hand eye cordination was so bad that it was apparently funny. So that was definitely a concussion

  23. I feel like you've misunderstood what doctors do. We don't do a checklist of symptoms and 'match' someone to a diagnosis. We constantly think whilst asking questions to narrow down a large list of differential diagnoses to 'most likely' and 'most serious'. This comes from, as some say, 90% history, 8% examination, 2% investigations. Yes, serious head injuries (like SDH in your video) can present in a similar way to a 'concussion' which is why most countries have very specific rules regarding which patients might be at risk of this and would therefore warrant a scan of their head. Your other 'differentials' (like BPPV or depression) make little sense in the context of the history of head injury. It feels like you only spoke to a non-clinical researcher, and didn't actually speak to a clinician for this episode, which is silly. You wouldn't make a video on marine biology with out speaking to a marine biologist. Don't make a video on medicine with out speaking to a doctor!

  24. I don't know if this is an American thing but where I live you don't get diagnosed with concussion but with a name that categorises the amount of possible brain damage. Concussion is an old term that isn't used in modern medical diagnosis. Also if they think it is necessary they scan your head to check for signs of hemotoma. Also an you don't need an mri for detecting bleeding in the brain. In the emergency room they just use an ordinary ct-scan. It is true that we don't know enough but this video makes it sound like we invented a name for something to get people to go back to playing sports.

  25. The easiest way to solve this problem:
    Don't do anything that involves you having a somewhat worrying chance of hitting your head H A R D.

  26. 0:13
    *These concerns have even led to calls to stop kids from playing potentially head-damaging sports like American football.

  27. I once fainted from dehydration
    When I woke up I didn't even realize I was on the floor, I just remembered that I was talking with my friend and Bam! I'm on the floor.
    When I fell I hit the edge of a stair and it gave me a wound on my eyebrows.
    Apparently I got a seizure and memory lost from that hit
    Worst 12 birthday ever

  28. The sports industry is keeping “concussion” as a diagnosis to prevent diagnoses of more serious consequences? Really? I missed this in your references, though there was one that described the desire of sports organizations to have a clearer diagnosis, something shared by medical groups. And the diagnostic term that has been replacing concussion has been “traumatic brain injury” usually linked with scales of severity and guidelines for additional evaluation and clinical response. It might have been helpful to include that these are already preferred diagnoses to the less specific “concussion”. I would appreciate some reference of the sports industry trying to prevent these diagnostic systems in favour of “concussion” as you claim. If it is true, it is pretty important and deserves more attention. If it is not true, then is a pretty sloppy claim from a channel that is supposed to be about science.

  29. Poorly researched subject. There is already research on specific blood biomarkers that will distinguish TBI from peripheral causes.

    https://www.frontiersin.org/articles/10.3389/fneur.2019.00446/full

  30. My seniors will scold me and say i only got my medical degree from utube if i included BPPV or depression in a patient with history of head injury

  31. The flashed text @ 0:13 says ‘*these concerns have even led to calls to stop kids from playing potentially heading-damaging sports like American football’

  32. This in short- because the medical industry and it's doctors don't give more than a single fuck about you unless you have money.

  33. I think also for a long time we weren't really paying much attention to concussions and often if someone had an accident we'd just treat any superficial wounds and look for broken bones and not really think about the possibility of a concussion. That's changing now but that's also leading us to this problem.

  34. I’ve had a concussion and then my wife had an infection which created concussion like symptoms. Initial and standard treatments caused a lot of challenges and harm. Misdiagnosis and thus ineffective treatments can be worse than doing nothing.

  35. As a real doctor, I find this video painful. It’s extremely reductive and presents neurological assessment/management in the acute setting as a simple process that silly doctors can’t get right. Turns out reality resists simplicity, who’da thunk?

  36. I don't understand why BPPV was mentioned in context of thinking about concussions and other possible diagnoses on the differential. Context matters, I wouldn't expect a mechanism of head injury when thinking about BPPV, not to mention these are patients usually around 50 and the vertigo is relatively brief and caused by positional changes. Something like SDH is usually older adults (although they typically have history of falls). Doctors will also most likely do a CT scan after a bad head injury especially with loss of consciousness to make sure there is no epidural bleed

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