When playing sport is your life, the injuries that can come with the game tend to get swept under the rug.
Functional Neurological Disorder, or FND is a condition where structurally, the brain is normal, but the way it functions is not.
Physical trauma to the brain - a concussion - can be a large influencing factor, which is why FND is often seen in sportsmen.
Neurosurgeon and Associate Professor Antonio Di Ieva (Macquarie University Hospital) has worked with concussion and traumatic brain injury (TBI) patients for years. In Canada he worked with hockey players. In Italy it was soccer players.
“In the Emirates, I dealt with people falling off camels. In Australia, I see concussions mostly in rugby players, boxers too,” he said.
Affecting how the brain and body send and receive signals, FND displays itself in numerous ways.
“Pain is the most typical symptom, but not the only one,” Di Ieva said. This might be acute (sudden), or chronic (ongoing), and can present in the neck, or as a headache.
Craniofacial pain in the area of the head, skull, face, neck and jaw is another giveaway.
Neurological problems, such as dizziness due to vertigo (a sensation of loss of balance) might be evident, along with tinnitus (ringing in the ears), and blurry or double vision.
“A patient will suddenly realise that they can’t taste, smell, or hear,” Di Ieva exclaimed. “I’ve seen patients who after a trauma, look fine. But then they realise they’re dripping fluid from their nose a few weeks later, a sign of cerebral spinal fluid leakage.”
“First, neurological function and pain are clinically assessed,” Di Ieva explained. An X-ray then examines spine trauma, and rules out other influential factors, “but there can be false negatives,” he added. “If I suspect a traumatic brain injury or a concussion, I might jump directly to a CT scan or MRI.”
More severe head trauma requires demanding treatment at a broad concussion clinic. A rehabilitation physiotherapist can help the patient gain equilibrium. Sometimes ENT surgeons are involved, and neuro-ophthalmologists to treat double vision.
Neurologists and neuropsychologists treat neurological problems and cognitive status, but Di Ieva acknowledged “it can take a long time to recover” from a neurocognitive problem, where symptoms can range from trouble concentrating, to mood swings, depression and anxiety.
For a severe traumatic brain injury, surgery can be “lifesaving,” and will improve quality of life. “Treatment can be successful when done the right way, and promptly,” said Di Ieva - so ignoring the symptoms won’t help.
“A second or third concussion gives rise to a cumulative effect, which can cause more problems down the track. Getting a concussion and playing a game a day later is a problem.
Sportsmen tend to think that they should be tough and just get on with things.”
Helmets are important
Di Ieva believes that sportsmen and their coaches need more education on the condition. Recognising the warning signs, and taking them seriously means appropriate treatment can start sooner rather than later.
And although helmets don’t provide 100% protection, Di Ieva stressed that they still need to be worn more. “Ultimately what we want is for the concussion and TBI to be avoided in the first place.”