Our patients' stories: Tackling concussion head-on

On September 12, at 6 p.m. Mark Proctor, MD, director of Children’s Brain Injury Center, will lead a dynamic discussion on concussions in pediatric patients during a live, interactive Webcast. A multidisciplinary team from Children’s Hospital Boston departments of Neurology, Neurosurgery, Neuropsychology, Neuroradiology and Sports Medicine, will join Proctor. Sign up for an email reminder about the webcast and read on to learn more about the patient featured in the presentation.

Even at just 7-years-old, Nicklas Johnson seemed more comfortable on skates than he did walking. A natural born athlete, Nick split his time between the hockey rink, soccer and lacrosse fields, but it was clear that the ice was his true passion. But in 2006 Nick sustained a hockey injury that would force him to reevaluate not only his love for the sport, but his future as well.

During a routine hockey practice, Nick’s skate was tripped and the fall bounced the back of his head hard against the ice. It was a scary moment for Nick and his teammates, but he was back on his feet so quickly that his coach thought nothing of it, especially after Nick passed the on-ice concussion test being used at the time. (Massachusetts has new on field concussion guidelines. Click here for more info.)

Practice resumed and Nick spent the rest of the evening as he usually did. It wasn’t until late that night that Nick’s parents knew something more serious was wrong.

Nick on the soccer field

In the middle of the night Nick’s father, Jim, heard noises coming from the bathroom. He went in to find Nick acting disoriented and breathing laboriously. Assuming it was an asthma attack—Nick has had asthma his whole life— Jim gave his son an inhaler and hoped the episode would pass. After a few minutes, Nick’s mother Kristin walked in and saw that Nick’s pupils were dilated and his hands and feet were jerking up and down while he sat in his dad’s arms.  Nick’s parents knew immediately that he was having a seizure. Having dealt with seizures in the past, Kristin and Jim put Nick to bed and carefully monitored his sleeping for the rest of the night.

The next day Nick woke up with a screaming headache and no recollection of his midnight episode. Within minutes the family was on their way to a local hospital, where a CT scan would eventually show that Nick’s fall had resulted in multiple brain bleeds.

Nick spent the next two months on the sidelines being monitored by doctors, coaches and his parents; a grueling amount of downtime for a young athlete whose whole existence seemed to revolve around sports. It took several weeks, but eventually it was deemed safe for Nick to rejoin his friends, both on the ice and fields. Being back among his teammates was heaven for Nick, but two years later another head injury threatened to take him out of the game for good.

...and on the ice

In a January of 2009, an errant practice check sent Nick crashing to the ice, with the back of his head again taking the brunt of the fall. Like last time Nick was up on his feet within seconds, but this time the hit took much more out of him. Kristin watched from the sidelines (she’d been attending every practice since Nick’s first injury) and saw her son fall to his knees only to be dragged to the bench minutes later. As his helmet and pads were removed Nick complained about the brightness of the rink’s lighting system. Recognizing light sensitivity as a concussion symptom, Kristin, quickly got Nick in the car and headed to Children’s Hospital Boston where his doctors Michael Rivkin, MD and Michael O’Brien, MD were waiting.

“Both Dr. Rivkin and Dr. O’Brien have been amazing through this whole journey,” says Kristin. “They treated Nick as the patient, but always included us as part of the decision making team. It’s good to feel like you play a role in your child’s care, especially when it affects many aspects of their life.”

Based on his previous injury, Kristin, Jim and Nick’s doctors weren’t taking any chances. For the next six months Nick was periodically kept out of school and had little access to TV, books or any activity that might agitate his condition.

Having practically grown up in a locker room, living in semi-isolation was very difficult for Nick. But in just shy of a year’s time he passed various tests and was cleared to play sports again. Unfortunately, the return to active play was physically stressful and it exasperated Nick’s concussion symptoms. Within a few months he was back at Children’s, this time being examined by Celiane Rey-Casserly, PhD of Children’s Brain Injury Center.

She told us point blank that if Nick suffered another concussion, she couldn’t promise he’d be OK afterwards.

“We met with Dr. Rey-Casserly who after extensive testing, told us things weren’t lining up cognitively for Nick, at least not in the way they were supposed to,” Kristin says. “She told us that if he was at risk for a third knee injury, they had the surgery to fix that, but brain injuries were a different story. She told us point blank that if Nick suffered another concussion, she couldn’t promise he’d be OK afterwards. It was very painful to hear, but she really made us understand the severity of his situation.”

From that point on Rivkin, O’Brien, Rey-Casserly and other Children’s specialists have examined Nick regularly, and he’s making good progress. In that time he’s been able to return to sports, first trying his hand at squash and golf, and more recently as a long distance runner. Being forced away from the contact sports and teams he’s grown to love over the years is extremely hard on Nick, but through it all he’s tried to maintain a positive attitude.

“The concussions have prevented me from playing hockey, but on the positive side, I discovered golf and squash,” he says. “I try really hard to look at this as an opportunity to learn other sports and just be the best at whatever I can do.”

To learn more about sports related concussions and their treatment, be sure to sign up for our concussion webcast featuring members of Nick’s medical team.