March is Brain Injury Awareness month. Brain injuries are complex, ranging from mild to moderate to severe. According to the CDC, 75% of all brain injuries are mild, often called concussions. Traumatic Brain Injuries, or TBI’s, are caused by a bump, blow, jolt, or penetrating wound to the head that disrupts the normal functioning of the brain.
“One hundred sixty-six people die every day from Traumatic Brain Injuries. Obviously, we don’t want anyone to die from these injuries. The impact on people who are significantly affected by these injuries really dramatically changes their lives and the lives of the people who love them,” says Dr. Andrew Getzin, Sports Medicine Physician at Cayuga Health, a Member of Centralus Health.
When you think about brain-related injuries, you probably think of athletes in sports like football, where collisions are an expected part of the game, but you don’t need to be on the field to sustain a head-related injury. For the general population, the most common causes of TBI’s are falls, car crashes, and being struck by or against a moving or stationary object.
“I don’t think we can live in a bubble because there’s risk with everything we do, but we can lower those risks.”
Over the years, society has implemented precautions and laws to protect the body’s most critical organ, the brain. Modern safety measures aim to reduce the often permanent, long-term consequences associated with a traumatic brain injury.
“As a society we’ve cut down on drinking and driving. We’ve passed seatbelt laws, and those have strong data to show a decrease in the risk of traumatic brain injuries. Wearing helmets is also very important for athletes and motorcyclists.”
According to Dr. Getzin, a concussion, unlike a broken bone, doesn’t cause a structural anatomic problem. This type of injury causes functional problems where there are changes on the cellular level.
“Major TBI’s go right to the emergency room. They get high level care; these are major traumas. What I see day-to-day are mild traumatic brain injuries; concussions are the same thing.”
Dr. Getzin says concussions are challenging because they are invisible injuries, often showing no abnormalities on standard CT or MRI scans.
“It’s a very challenging diagnosis. There are people, even though they don’t have a severe traumatic brain injury, who need more care—but that’s the exception, not the rule. Most people progress very well.”
Instead of structural damage like bleeding or a skull fracture, doctors look for forces, or mechanisms, that may have caused the brain to shift rapidly within the skull, leading to temporary functional disruption.
“The most important thing I start with is asking if there is a plausible mechanism. Was there significant trauma? It doesn’t necessarily mean being hit in the head—it could be that the head was snapped back and caused symptoms.”
The Post-Concussion Symptom Scale is a questionnaire assessing concussion severity, where patients rate symptoms from 0 (none) to 6 (severe). Total scores range from 0 to 132, with scores above 7 often indicating a concussion, while higher scores suggest more severe injury.
“We try to obtain quantifiable symptoms scores, asking common questions about symptoms people have when they’re concussed, such as dizziness, headaches, difficulty concentrating, sound bothering them, and light bothering their eyes.”
Dr. Getzin says he also looks for physical signs of a concussion.
“We do balance testing. We also check ocular motor patterns; those are altered with concussions.”
Baseline testing—establishing what’s normal for a patient—is best done before an injury to establish brain function. If already injured, a baseline can be estimated by comparing current symptoms against a patient’s known, pre-injury medical history.
“Without a quality baseline exam, we may not know if that’s the individual’s baseline or if it’s been altered because they’re concussed. It’s important to have a good diagnosis because quite often, non-concussions can present with identical symptoms.”
Seek immediate emergency medical care if a head injury causes loss of consciousness, repeated vomiting, severe or worsening headaches, seizures, pupils of unequal size, confusion, or slurred speech. Any blow to the head causing pain or a change in behavior should be evaluated.
Arnot Health and Cayuga Health, members of Centralus Health, provide comprehensive, individualized concussion treatment, focusing on safe, accelerated return-to-activity for athletes and patients. Arnot Health’s Sports Medicine offices are located at 455 Maple Street, Big Flats; 600 Ivy Street, Elmira; and 3318 S Main Street, Horseheads. Cayuga Health’s Sports Medicine office is located at 310 Taughannock Boulevard, Ithaca.
