I guess that Wolverine is going to die because he’s getting his medical advice from a PhD instead of a medical doctor??? Mr. Fantastic, genius leader of the Fantastic Four and holder of multiple doctorates in science fields though, to my knowledge, no actual medical degree to his name (M.D., D.O., M.B.B.S, or otherwise) is contemplating cutting into someone’s skull for a concussion. Okay, to be fair, a “serious concussion”. (Maybe for non-serious concussions he would just tap out a couple of holes?)
So what is a concussion, Reed? Simply, a concussion is a head injury that results in a temporary change, impairment, or loss of mental functioning. The more technical explanation is that a concussion is a type of mild traumatic brain injury, or MTBI. In general, traumatic brain injuries are just like they sound —
All that soft brain shifting around in the hard skull, banging up against the sides of its non-adamantium covered “house” (in most of us), is…well…no good. TBIs can be classified in multiple ways — time of unconsciousness, amnesia, and/or the most common Glasgow Coma Scale (GCS) — and are usually graded as mild, moderate, or severe. TBI can also be categorized by the location of injury, how widespread the injury is, etc.
Again, by classification, concussions fall within the mild category of TBI. The formal definition of concussion from the American Academy of Neurological Surgeons is:
“a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status and level of consciousness, resulting from mechanical force or trauma”.
From the American Medical Society for Sports Medicine consensus statement, a concussion is:
“a tramatically induced transient disturbance of brain function and involves a complex pathophysiological process … a subset of mild traumatic brain injury (MTBI) which is generally self-limited and at the less-severe end of the brain injury spectrum”.
And, one more, this time from the American Academy of Neurologists, a concussion is:
“recognized as a clinical syndrome of biomechanically induced alteration of brain function, typically affecting memory and orientation, which may involve loss of consciousness”.
So, all in all, we’re talking about transient symptoms with changes in mental status. Symptoms can include headache, confusion, amnesia, dizziness, nausea and/or vomiting, blurry/double vision, light and/or noise sensitivity, and tiredness/drowsiness. People who get a concussion may also lose consciousness, but this is NOT “required” and, all told, most people who suffer a concussion do NOT pass out.
To go back to Mr. Fantastic’s assessment of Wolverine, he’s talking about the “usual procedure” for a “serious concussion”. What would a serious concussion be exactly? Keep in mind that, by definition, a serious concussion would still be a mild TBI, meaning that we’re still talking that this is minimal in the “Brain Injury Spectrum” (or BIS, a term I just made up now). The main grading scales for concussion all include loss of consciousness in the highest grade (Grade III), but again remember, that for a concussion, this is a transient thing (seconds to minutes for the most part).
As for the “usual procedure” for concussion? Physical rest, cognitive rest, and observation are the standby norms. Pain can be treated with common analgesics such as Tylenol. You know what’s missing from this list???
What Reed is talking about is called a decompressive craniectomy, a surgical procedure in which a bone flap is removed in order to allow the brain to freely expand. In severe (for the most part) TBIs, pressure could build up inside the hard, non-expandable skull due to brain swelling. As the soft brain expands, it’s looking for somewhere to go less it be crushed within its “house”. The only real option, though, is downward through the hole in the bottom of the skull where the spinal cord leads. The main problem with this, though, is that the very important, life-maintaining functions of the brain are contained in the part that gets wedged down there first. Yeah, bad either way you go. BUT, if you remove part of the skull and allow the brain to expand outward (instead of down or not at all), this may save the person’s life.
I would say, though, that while people who present to a hospital with a concussion could go on to have more severe brain injuries than first expected, such as bleeding (hemorrhage), this takes the diagnosis into a new place, away from a concussion (even a “severe” one).
So, NO, Reed. The usual procedure for a concussion is not to do cranial surgery. But it may be for you to stay far away.
(Note: Charles Soule, the writer of this dialogue, is no dummy. The guy is an Ivy League undergraduate and a lawyer with a degree from one of the most prestigious law schools in the country. This is a smart dude. No question. HE SHOULD NOT BE MAKING THESE MISTAKES. Drop me a note, Charlie. Let’s talk.)