Head Injuries in Anime Part 3- Concussions
As promised, here is the third in my series on head injuries in anime, specifically concussions. Now we can finally talk about what happens to Ash when Misty cracks him on the head for doing something stupid again, or when Erza has to reign in Natsu.
Concussions will differ from the previous head injuries that I have covered in that there are no broken bones or bleeding directly involved with the injury. That being said, concussions can occur with skull fractures and the various intracranial bleeds that I previously covered. What this means is that you can have just a concussion, or a skull fracture and a concussion. The same is true for epidural and subdural hematomas, and subarachnoid hemorrhages. So what exactly is a concussion, then?
A concussion is a traumatic head injury that involves a powerful blow to the head that damages the brain. While going over the brain’s protection in my first post on head injuries in anime, I briefly mentioned that the cerebrospinal fluid protects the brain like an airbag.
When a person is hit on the head, the force of the blow is normally absorbed by the skull, meninges and more importantly, the cerebrospinal fluid, much like an airbag. However, if the force of the blow is not completely absorbed by the protections, the brain will bounce around the skull, since it is not directly connected to the inside of the skull.
The amount of force needed to cause a concussion varies from person to person, and where the impact happens. The brain is more resistant to blows to the front of the head than it is to blows on the side of the head. This has to do with the temporal bone being thinner than other bones of the skull and the areas of the brain that are affected by a blow to that area. The question then becomes is Mikoto really smart or lucky that she hit Mugino in the side of the head with one of Frenda’s dolls, knocking her unconscious during their fight in Railgun S episode 10?
Before I answer that question, let’s take a look at what is happening to the brain as it bounces around the inside of the skull. There are two basic categories of cells inside the human brain, neuroglial cells and neurons. Neurons are the cells that allow us to think and function in the way that we do, while the neuroglial cells support the neurons. The neurons of the brain are connected to each other, forming a network that forms the cornerstone of how the brain works.
When a person has a concussion, the force of the impact and the resulting bouncing around of the brain cause the connections (axons) between neurons (shown above) to be stretched, twisted, or even snapped.
This prevents the neurons from working properly, if at all, placing a lot of stress on the brain. You can think of it like shaking your phone or other electronic device so hard one or two of the wires come loose, preventing it from working. Only in this case it’s your brain and not your cell phone. Additionally, certain types of impacts can also cause the cell membrane of the neuron to actually change in ways that have yet to be fully explored.
Types of Concussions
As with the other head injuries that I’ve covered thus far, and many other medical conditions, there are different types of concussions. While more severe concussions are obviously caused by more forceful impacts, it is very hard to measure the force of the impact after the fact. Instead, concussions are graded based on their symptoms. There are upwards of 16 different concussion grading systems and there is still debate over how to grade concussions. There is also concern over whether or not the current grading systems are specific enough to detect minor concussions. Either way, I’m going to give you a summary of what the different groups can seem to agree on.
General concussion symptoms- confusion or feeling dazed, clumsiness, slurred speech, nausea or vomiting, headache, balance problems or dizziness, blurred vision, sensitivity to light, sensitivity to noise, sluggishness, ringing in ears, behavior or personality changes, concentration difficulties, memory loss.
Type 1 Concussion- Disorientation for less than 15 minutes
Type 2 Concussion- Disorientation for more than 15minutes and some degree of amnesia
Type 3a Concussion- Loss of consciousness for less than 15 seconds
Type 3b Concussion- Loss of consciousness for more than 15 seconds
Type 1 concussions are often the most overlooked because they can present as just a lapse in concentration, a moment of dizziness, or a sometimes just a stumble before the individual regains their composure. I’m sure we have all seen at least one anime where a character has a headache, dizziness, a loss of concentration, or a stumble after taking a hit to the head. The example I am going to use is from Heart Catch Pretty Cure shown below.
If you are wondering why I chose this scene, it’s because Cure Marine just headbutted a monster, and headbutting something is a good way to get a concussion. Also, you’ll notice that it looks like she has a slight wobble while talking after the impact. While it might not look like much, that might be all you see from a very mild concussion, and it is possible for several small concussions to go unnoticed, which will become more important later.
I do not have a specific anime example for a type 2 concussion, but I think the following picture sums it up.
Anime, usually shounen and comedy anime, seem to have a penchant for having characters act like idiots after being hit in the head. Disorientation lasting more than 15minutes and some degree of amnesia are the classic signs of a type 2 concussion. So it is no wonder that harem comedy protagonists are acting like morons half the time, since all of the girls that seem to like them are constantly giving them concussions.
Remember Mugino? Well, she probably had a type 3a concussion since Misaka did manage to knock her out for an unspecified amount of time. The hallmark sign of a type 3 concussion is being knocked unconscious, with a type 3a concussion being a period of unconsciousness of less than 15 seconds. Coincidentally, all of the mistakes Mugino makes after she wakes up and continues her pursuit of Mikoto could be a result of her concussion. A lack of concentration and a lapse in memory would explain how she didn’t notice or remember all of the traps that were laid by Frenda, traps that eventually caused her to lose the fight. Also, her aggressive nature during the fight could have been caused by or exacerbated by the concussion as well. FYI- I do realize that Mugino could have had a type 3b concussion, but I already have a good example lined up for that, so I went with a 3a instead.
A type 3b is the most serious of all the concussions and is defined as being knocked unconscious for more than 15 minutes, and surprisingly there is an anime that actually does this. Revy, the infamous two handed gunslinger in Black Lagoon is knocked unconscious after surviving a close encounter with a grenade. (We’ll leave her surviving being blown up for later.)
One of her coworkers, Benny, even states that she is fine, besides having a concussion. (Again, let’s leave the bit about being fine after being blown up for later.) She remains unconscious during the entirety of a rather long car chase, awakening after the car she is in crashes. Since the chase was more than 15 minutes, Revy has a type 3b concussion. Unlike Mugino, who might have been slightly affected by her concussion, Revy is back to her usual self after waking up, and even remembers who tried to blow her up in the first place.
Let’s begin by saying that there is no anime that accurately depicts the treatment for a concussion, because it would effectively put the plot on hold and dictate a time skip. Realistically, there isn’t a treatment for concussions like take a pill or have a certain procedure done, like there are for other medical conditions. What occurs instead is a recovery plan that gives the body time to recover on its own.
Step 1– Have a medical professional check for additional injuries, like skull fractures and hematomas.
Step 2- Rest, and by rest I don’t mean sitting on the couch watching TV or playing video games. The rest includes limiting brain stimulation so this means no school or other activities that stimulate the brain. By limiting the amount of brain stimulation, you are giving the brain time to focus on healing and not other tasks. As the symptoms of the concussion resolve, additional activities can be added. This can take days to weeks to months to occur.
Step 3– Introduction to physical activity. After the brain has recovered, the patient can slowly be reintroduced to physical activity, again this is done slowly as to not stress the brain.
Step 4- Return to normalcy and prevention. By this point the individual will have returned to his or her previous activity, but a focus is placed on preventing further concussions. This is important because having a concussion raises the risk of having further concussions. These repeat concussions can also be more severe than the initial concussion as well. In fact, in some sports, athletes can be discouraged or banned from playing if they have too many concussions.
So there you have it, concussions in anime. Black Lagoon is one of the few anime I have ever seen to actually say that a character has a concussion. While it does a poor job in depicting said concussion beyond Revy being unconscious, it still does show a character with a concussion. This means that while I have some problems with how Revy got the concussion (she should have been turned into chunky salsa), Benny is right in calling it a concussion, so the Black Lagoon concussion is confirmed.
However, I am not done with head trauma just yet, as there is one last topic to cover, chronic traumatic encephalopathy or CTE. It is this condition that has everyone so worried about concussions these days, especially multiple concussions. (Can you say the NFL.)