Local doctor highlights dangers of concussions

Posted: October 23, 2015
By Sally Voth
The Winchester Star

WINCHESTER — City neurologist Dr. Mariecken Fowler has a deep knowledge of concussions, both as the director of a concussion clinic and the mother of a hard-charging child.

Fowler — director of the Concussion Clinic, Memory Care Clinic, and Movement Disorders Clinic at Winchester Neurological Consultants — gave a presentation on concussions Thursday to the Rotary Club of Winchester at the Travelodge, 160 Front Royal Pike.

Fowler said her parents met in the U.S. while both were Rotary exchange students from Holland.

She said she has been in Winchester for nine years.

“I realized there was a huge variety in how kids were being cared for with concussions,” Fowler said.

Her 10-year-old son, “who has lots of energy,” has had at least four concussions, she said.

Fowler defines a concussion as an alteration to a person’s mental status due to forces affecting the brain. The brain sloshes against the skull in different places when forces strike the head.

Immediate signs of a concussion can include a dazed look, lack of focus, slurred speech, difficulty walking or balance and disorientation. “They may just be super-moody, just sort of fly off the handle for nothing,” Fowler said.
Later signs of a concussion include persistent headache, memory dysfunction, poor attention, irritability, an intolerance of bright lights and noises and difficulty sleeping.

Concussions are common among athletes and soldiers, Fowler said.

“We kind of pick on football,” she said. “Probably, 20 percent of all football players each season sustain a concussion that we know of,” she said.

And, Fowler said, there are likely many subclinical injuries — those that do not reach the bar of a concussion, but still cause damage to the brain.

She showed photos of donated brains that display damage caused by head injuries.

“You can see changes that don’t look good, discoloration,” Fowler said. “Shrinkage [of the brain] is a bad sign that means there’s been deterioration and cell death.”

In the recent past, it was not uncommon for football players who were on the receiving end of a big hit to be told to “shake it off,” she said.

Sometimes, her patients’ fathers would tell her: “I don’t know why you’re making such a big deal about this.”

“The good news is that most of the people who get these concussions are young,” Fowler said. “They bounce back from things very quickly.”

Several steps should be followed before a concussed patient returns to the field. It starts with rest, followed by light aerobic exercise and sport-specific training. Then comes non-contact drills, followed by contact drills and finally a return to the game, she said.

About 85 percent of patients are better within seven days, she said.

“Those are the kids that don’t need to see me in the clinic,” Fowler said. “Less than 3 percent have ongoing problems after a month.

“There’s something called a second impact syndrome, very rare, but it can cause death. It’s been known to occur up to 14 days after an injury. It doesn’t seem to occur very often in anyone over 21.”

Also, there is a condition referred to as CTE (chronic traumatic encephalopathy).

“It means that there is a brain condition that has been caused by repeated trauma,” Fowler said.

There is a buildup of abnormal protein that causes “tangles and threads” in the brain, similar to those caused by Alzheimer’s disease, she said.

CTE is diagnosed through an autopsy, and its symptoms can include depression, emotional instability, erratic behavior and problems with impulse control.

Fowler started a concussion program encompassing all area high schools in 2009. Athletes are given a baseline test involving memory, visual motor speed, reaction time, impulse control and other areas.

Following a possible concussion, they are given a test called the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Fowler said.

“We used to have to rely on [the reporting of] symptoms before,” she said. “We’ve done over 12,000 baseline exams [on athletes at 11 high schools in the region]. Post-injury, we have over 1,300 tests.”

Some of those were repeat tests, but Fowler estimates that at least 1,000 student-athletes have been helped.

State law requires that high school students exhibiting signs of a concussion remain sidelined until they are cleared by a licensed health professional. It also requires area school boards to have a protocol for dealing with concussions.

Treatment following a concussion can include medicine to alleviate pain and induce sleep, and muscle relaxants.