Steven Woolfe: the danger of a single blow to the head

    7 October 2016

    There is still much to be made public about the so-called ‘altercation’ between Ukip MEPs Steven Woolfe and Mike Hookem, with accounts ranging from Woolfe being punched, to banging his head against a wall, and to it simply being a case of two men shaking their fists at each other and being very silly.

    Whatever the truth, it resulted in Woolfe being taken to hospital two hours later as the result of a reported collapse, with doctors being called and a subsequent brain scan showing no brain damage. He subsequently said: ‘At the moment I am feeling brighter, happier, and smiling as ever. As a precaution, I am being kept in overnight awaiting secondary tests to make sure everything is fine.’

    So, what to make of this handbags at dawn? If — and that remains a big if — a punch was thrown and connected, then he may have experienced the most common and least serious type of traumatic brain injury, known as concussion. The word comes from the Latin concutere which means ‘to shake violently’ and is most often caused by a sudden direct blow or bump to the head.

    The brain is made of soft tissue, cushioned by spinal fluid and encased in the protective shell of the skull. When you sustain a concussion, the impact can jolt your brain, making it literally slosh around in your head. Traumatic brain injuries can cause bruising, damage to the blood vessels, and injury to the nerves. (The most extreme example of this is found in professional boxers who suffer repeated head injury and are diagnosed with the condition ‘dementia pugilistica’. Here, repetitive punches to the face over the years cause a decline in mental abilities, with memory problems and diminished co-ordination occurring as a result.)

    Whatever the cause of the head trauma, the result is that your brain doesn’t function normally. If you’ve suffered a concussion, your vision may be disturbed, you may lose your equilibrium, or you may fall unconscious. In short, your brain is confused.

    Concussions can also be notoriously tricky to diagnose. Even if there is a visible cut or bruise to the head, you can’t actually see a concussion. Signs may not appear for days or weeks after the injury, and in this case hours, with some symptoms lasting for just seconds; others longer, and if Woolfe did indeed suffer a concussion then this would explain the delay in his symptoms developing.

    Each case of concussion triggers a different set of individual symptoms but the typical ones include feeling confused or dazed, clumsiness, slurred speech, nausea or vomiting, headache, dizziness, blurred vision, sensitivity to light and noise, fatigue and difficulties with concentration and memory.

    Concussions are graded as mild (grade 1), moderate (grade 2), or severe (grade 3), depending on such factors as loss of consciousness, amnesia, and loss of equilibrium.

    In a grade 1 concussion, symptoms last for less than 15 minutes. There is no loss of consciousness. With a grade 2 concussion, there is no loss of consciousness but symptoms last longer than 15 minutes. In a grade 3 concussion, the person loses consciousness, sometimes just for a few seconds.

    How serious a concussion is dictates what kind of treatment you should seek. Most people with concussions fully recover with appropriate treatment. But since a concussion can be serious, it is important to take care. A healthcare professional can decide how serious the concussion is and whether you require treatment. If you have suffered a grade 1 or grade 2 concussion, wait until symptoms are gone before returning to normal activities. That could take several minutes, hours, days, or even a week.

    If you have sustained a grade 3 concussion, see a doctor immediately for observation and treatment. A doctor will ask how the head injury happened and what symptoms are present, and will also ask you simple questions to evaluate memory and concentration skills such as ‘Where do you live?’, ‘What is your name?’ or ‘Who is the prime minister?’ (This may have caused extra frustration for Woolfe.) As with his case, a CT scan can also be performed to rule out bleeding or any other serious brain injury.

    I expect he will make a full recovery, but the injury to Ukip — already punch drunk — will take much longer to heal.