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Brain Brownout: Concussion Recovery May Be Slower for Women

Ellie Weikamp, 24, of San Clemente, California had four concussions playing volleyball in college, the last in 2012.

Ellie Wiekamp, 24, of San Clemente, California had four concussions playing volleyball in college, the last in 2012. Ellie Wiekamp

Women may have a harder time recovering from concussion, a new study suggests.

Taiwanese researchers found women were more likely than men to continue to have memory deficits nearly three months after a mild traumatic brain injury, or mTBI, according to the study published in the journal Radiology.

The findings provide “evidence that women may have greater risk for developing working memory impairment after mTBI and may have longer recovery time,” said study coauthor Dr. Chi-Jen Chen, a professor at Taipei Medical University Shuang-Ho Hospital.

Ellie Wiekamp
Ellie Wiekamp, 24, of San Clemente, California, had four concussions playing volleyball in college, the last in 2012. Ellie Wiekamp

“According to our preliminary results, more aggressive management should be initiated once mTBI is diagnosed in women, including close monitoring of symptoms, more aggressive pharmacological treatments, rehabilitation, as well as longer follow-up.”

Chen had noticed that almost twice as many women as men were showing up in her clinic after concussions. She wondered if there might be some kind of physical difference making concussions more severe in women.

To determine whether there was a real effect, she and her colleagues rounded up 30 concussed patients and 30 non-brain-injured volunteers. Each group had equal numbers of men and women. The concussed patients were scanned shortly after doing a memory test with functional MRI twice: one month after their injury and again six weeks later. The volunteers were scanned once.

All the study participants took neuropsychological tests designed to measure attention span, impulsivity, and deficits in working memory.

The first set of fMRI scans showed differences between the concussed patients and the healthy volunteers in the area thought to contain working memory circuits. Intriguingly, there was an increase in the activation of working memory circuits in men and a decrease in the women.

By the second scan, the concussed men’s brains were much closer to those of the healthy male volunteers. But the concussed women’s working memory circuits were still less active, suggesting that their brains had not healed. Their neuropsychological test scores backed this up.

All of this comes as no surprise to Sharon Chayra. It’s been 10 years since the Las Vegas woman’s horse rolled on top of her and she’s still feeling the effects of the concussion she experienced. The doctor who saw that day her sent her home with a prescription pain killer and told her she’d be fine. But she still has problems with her memory and her verbal abilities remain diminished.

“It used to be that extemporaneous speaking was easy, now I struggle to find simple words,” Chayra, 51, says. “The concussion really knocked my verbal skills for a loop, though strangers probably wouldn’t notice. It hasn’t crippled me. But it’s frustrating.”

You can look at concussions as a sort of brain brownout, says Dr. Douglas Smith, a professor of neurosurgery and director of the Center for Brain Injury and Repair at the University of Pennsylvania.

When the brain gets concussed, axons, the nerve cell’s communication cables, “become dysfunctional and lose their ability to conduct electricity,” Smith said. “We think the vast majority can recover function. But there’s good evidence that some axons do not recover. Instead they degrade and then they are gone forever.”

People who have trouble recovering from a concussion may end up with more axons going the degradation route, Smith said. And it’s possible that this is more common among women, he said.

Concussion expert David Hovda commended the researchers for taking on the tough task of trying to disentangle the effects of gender on mTBI.

“We know so much more about males between the ages of 16 and 25 with mTBI than we do about children and women,” said Hovda. “

One thing we do know, said Hovda, a professor of neurosurgery and director of the Brain Injury Research Center at UCLA, is that women are more likely than men to end up in the “miserable minority,” the 10-20 percent of people whose symptoms linger for years.

That’s what happened to Ellie Wiekamp, 24, of San Clemente, California.

Wiekamp had four concussions playing volleyball in college, the last in 2012. She still has headaches, trouble focusing, slowed mental processing and memory problems. “My own mother says I was always witty and quick to respond,” Wiekamp says. “All these concussions seem to have diminished that. It’s hard to come up with things on the spot. It drives me insane.”