The sight of a batter getting beaned by a pitch is always a frightening one. When Red Sox shortstop Stephen Drew took a pitch off the helmet in a Spring Training game a gasp went up from the crowd. When he eventually got up and made his way to first base, you could almost hear a collective sigh of relief. What nobody knew at that time, not even Drew himself, was that he had suffered a concussion. Symptoms didn't appear until hours later, and it would be weeks before the shortstop would find relief.
"That is not all that unusual when we are talking about a concussion," said Dr. Michael Alexander of the Beth Israel Deaconess Medical Center Cognitive Neurology Department and professor of neurology at Harvard Medical School. "The onset of symptoms can be immediate or delayed, and the recovery can take days, weeks and even months."
While it's clear that there has been a lot more attention paid to traumatic brain injury lately -- and a concussion is a traumatic brain injury -- what is less clear is the criterion that is used for diagnosis.
"The list can be quite extensive," said Alexander. "There can be more than 15 symptoms that patients report. Headaches, dizziness, nausea and amnesia are among the most common. But it's not as though we can say, 'This person is dizzy and has a headache, therefore they have a concussion.' It isn't that clear-cut."
For example, let's say you've been working at organizing the tangle of wires under your desk. You raise your head too quickly and WHAM! Now you're seeing stars, you have a headache and a nice big lump to go along with it. Two hours later, your head may still be throbbing, but is that evidence of a concussion or just clumsiness?
"When we are talking about an injury to the head and ... by extension, it may involve the brain, it is better to err on the side of caution," said Alexander. "Be sensible. Not that long ago, an athlete might be encouraged to 'shake it off,' but the culture has changed."
Major League Baseball has instituted a policy regarding concussions that includes the creation of a seven-day disabled list specifically for players with concussions. Protocols for evaluating players and umpires for possible concussions, a procedure for clearing a player or umpire for return to activity and mandatory baseline neurological testing are all part of the league's approach to dealing with traumatic brain injury. In addition, each team is required to designate a specialist who deals with brain injuries to evaluate players and umpires when needed, and their reports are then forwarded to the MLB's medical director, who must then decide if a player is cleared to return.
"Given the balance and coordination it takes to play baseball, both as a fielder and a batter, even a slight mental fogginess or concentration lapse could put a player at risk," said Alexander. "With some symptoms, like an increase in irritability or anxiety or perhaps a change in sleep patterns, the impact on baseball-related activity might seem less significant. But as long as they persist, it's evidence that the injury is not fully healed. Everything has to be considered before giving the green light."
Chances are that you won't be in a position to take a 90-mph fastball off the noggin any time soon or collide with a co-worker as you both race to the copy machine. But you could fall off your bike after hitting a patch of sand, trip on a flight of stairs or get rear-ended at a traffic light. If you find yourself a little dazed and confused, take a moment and use your head. Use it to make sure you take care of your brain. It's the only one you've got.
Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox.