By Mary Carpenter
This season’s bumper crop of acorns creates a small risk of traumatic brain injury (TBI) —it’s why we’re taking the opportunity to republish most of Mary Carpenter’s 2019 post on the topic.
“IT IS just a very heavy mast year,” writes Washington Post columnist John Kelly— referring to the “hailstorm..rifle-crack” sounds of abundant acorns falling from oak, hickory and pawpaw trees in the Eastern U.S. this autumn. (“Mast” is the collective term for acorns, and other fruits and nuts, and is also the label given years of abundant production, resulting from growing seasons one to two years earlier.)
“Trauma to the head…could be from an acorn falling from a tree…or a bullet or shrapnel penetrating the skull,” according to Practicalneurology. In rare cases, an acorn hitting the head can cause TBI similar to injuries during tackle sports, vehicular accidents and war. Although acorns have little mass, falling from a high tree can provide acceleration and thus the force — based on the formula F=ma—to split them open.
ACoRN (After Concussion, Return to Normality), by coincidence, is the acronym for the Scottish Brain Injury Trust’s advisory leaflet on handling concussion sustained during sports events: “If in doubt sit [sporting events] out.” Acorns littering the ground have also led to trips and falls—notably for anyone running on tennis courts and other hard surfaces.
MILD CONCUSSIONS don’t get the respect they deserve—for how debilitating they can be, and for how many weeks, months or years the brain can take to recover completely. Four months after hitting her head on a pole while rushing to get off a Metro train, DC artist and teacher A.M. still struggled, at first mostly with headaches and facial pain focused in her jaw.
But A.M.’s eyes caused her the most trouble—in the presence of any light, indoors and outside. Reading was difficult, especially black print on white pages and even more, anything on an electronic screen. In addition to its bright lights, a screen also continually flickers, making the eyes work harder.
“Sensitivity to light is the worst,” she said, “because everything involves light.” Most of the time, even indoors, she wore two or three pairs of dark glasses. A.M. also had trouble with noise, both the uncontrolled ringing of tinnitus and the amplification of voices, including her own, which sounded like a recording blasted through a loud speaker inside her head. At the four-month mark, she received an official diagnosis of post-concussion syndrome with ocular-motor difficulties, a prescription for vision therapy and the prognosis that these could take months or even years to heal.
With a concussion, severity and recovery time are often unrelated to the original impact or its immediate effects, such as blacking out. It’s almost impossible to detect how far the initial damage has spread, and every concussion is unique.
“Imagine you have a mason jar that is full of thick liquid and just big enough to accommodate a peach,” writes Lori Fox about her girlfriend’s head injury. “If you shake the jar violently, the peach sustains multiple impact points. When you take the peach out, the bruised places are visible. If you cut into the bruise, you will see the damage spreads beyond the area around the impact sites.”
“I just saw someone the other day who had a dog toy thrown at their head by their toddler,” said clinical neuropsychologist Alicia Sufrinko at the University of Pittsburgh Sports Medicine Concussion Program. “The injury comes from the brain shifting inside the skull and affecting your nervous system.”
“Usually it’s only in retrospect that you can say how severe a concussion is,” according to Vanderbilt neurosurgeon Andrew Gregory. Bruising caused when the brain moves back and forth inside the skull often affects the frontal lobes. These are responsible for cognitive functions, also called “executive functions,” such as attention and completing tasks; planning and organization; inhibition and emotions. Head injury can also cause fatigue, irritability, anxiety and insomnia.
Most people, including physicians, are unaware that sufferers should avoid triggers such as bright lights, loud noises and physical or mental exertion until the symptoms are gone, Gregory pointed out. Said Sufrinko, “We give people a structured rehab program, and we follow up with them and make sure they get to 100 percent before we discharge them.”
Few physicians are also aware that, for symptoms that persist after three to four weeks, more aggressive interventions should begin, including vision therapy for eye problems, vestibular therapy for balance problems and cognitive therapy for difficulties with concentration and multi-tasking. As with a stroke, undamaged areas of the brain can take over tasks from the damaged areas but need therapy and practice to master those tasks.
What can help predict recovery time is the total number of specific early symptoms, such as sensitivity to noise or light, difficulty concentrating, insomnia and balance issues. Others that appear less relevant include amnesia, tinnitus, loss of consciousness and hyper-excitability. The strongest predictor of a lengthy recovery from a mild traumatic brain injury is painful headaches in the days immediately following the impact. And the one effect of head injury with an unquestionable prognosis is loss of smell, because impact can completely sever the brain connections involved, and their functions cannot be replaced.
As for mast years, a secondary fate for East Coast residents is “a substantial elevation of populations of seed-feeding animals,” writes Kelly. “But more animals that feed on seeds means more animals that feed on animals that feed on seeds…an increase in ticks, fleas and mites can lead to an increase in diseases transmitted by the blood sucking insects, such as Lyme disease.”
An acorn is what hits Chicken Little in the children’s story and makes her believe “the sky is falling.” The hen then convinces many animals to join her on a trip to tell the king, including the fox, who kills them all except the hen who escapes. But acorns also bring hope: one resident of a New York City high-rise, seeing an acorn lodged between paving stones outside the front door, believes that someday a giant oak might grow.
—Mary Carpenter regularly reports on topical subjects in health and medicine.