SEARCH FOR AN ANSWER : LITTLE IS KNOWN ABOUT EFFECTS OF CONCUSSIONS.

Byline: Jim Puzzanghera San Jose Mercury News 

When something slips his mind, former Stanford quarterback Don Bunce often jokes that it probably was the result of the dozen or so concussions he sustained in his playing days.

He's only half-kidding.

Now a sports physician in Palo Alto, Bunce just doesn't know for sure. That's what makes concussions such a scary thing. That's why no one can say with certainty what's going on inside the head of 49ers quarterback Steve Young after he suffered his second concussion in three weeks in a Nov. 10 loss to the Dallas Cowboys.

In professional football, where larger and stronger players are running around the field at faster and faster speeds, concussions are becoming an increasing problem. Concussions have robbed Cowboys quarterback Troy Aikman of any memory of his team's NFC championship victory over the 49ers in 1994, robbed St. Louis Rams quarterback Chris Miller of this entire season and robbed players like Roger Staubach of the final years of their careers.

The problem, however, goes beyond the pro game.

``There's the athletes of notoriety who get a lot of attention, but then there's the almost-epidemic problem of the large number of high school athletes who get concussions,'' said Dr. Julian Bailes, a Pennsylvania neurosurgeon who works with the Pittsburgh Steelers. He said about 10 people die each year from head injuries in football, and the less-severe cases are difficult to diagnose.

``The symptoms are subjective,'' he said. ``If you have a swollen ankle or a swollen knee, it's a physical part of the body, but if the brain is not processing information correctly maybe only you know that if you're the athlete. It's a difficult area to treat because we can't see inside the person's brain.''

Despite the technological advances in medicine in recent decades, when it comes to detecting the potentially dangerous effects of a concussion, doctors might as well be in the Dark Ages. All they know for sure is that you're much more likely to get a second concussion after suffering the first one, and that the cumulative effect of a number of those injuries can lead to problems like severe headaches, dizziness, and memory loss that will last a lifetime.

Because of some of the high-profile injuries, the National Football League formed a special subcommittee last year on mild traumatic brain injury - a clinical term for concussion. In addition, the National Athletic Trainers Association and the NFL Players Association are sponsoring a February conference in Florida on concussions.

``There's so much research that needs to be done,'' said Ron Cunningham of the trainers' group, which is conducting its study with two top neurological groups. ``Nobody really knows what the effects are of a number of small concussions - what's called mild brain injuries - over the long term.''

The concussion that knocked Young out of the Cowboys game was not as severe as the one in Houston three weeks ago that left him unsure what city he was in, but 49ers head coach George Seifert said that it was ``very doubtful'' Young would play today.

Concussions come in three categories of severity but all result from the same thing - some sort of impact to the head or body that causes the brain to bash against the inside of the skull.

``The problem is the brain is soft, it's kind of like custard almost,'' said Stanford University neurosurgeon Dr. Reid Thompson. ``It's sitting in a bony case. If you hit your head hard enough, you're going to rattle your brain around, and sometimes you can actually hit it hard enough you can bruise it.''

The most severe concussion involves a brief loss of consciousness when the sensitive electrical activity in the brain is disturbed. In less severe concussions, the person does not lose consciousness, but the memory of anything immediately before the injury.

``Right after you get hit there's sort of a stunned experience, then you often come back to the huddle and you have difficulty remembering plays,'' said Bunce, the most valuable player in the 1972 Rose Bowl whose professional career was ended largely because of a concussion he suffered while playing in Canada a year later. ``As time goes, the more serious side effects of the concussion occur. That's when the brain further swells, you start getting a headache, which can be very intense. You often get blurred vision. You start getting nauseated.''

Bunce's experiences bears out research that says a football player is four times more likely to suffer a second concussion than he is a first one. While the brain is recovering from an initial hit, it could be more susceptible to subsequent contact.

``With every succeeding concussion, it seemed to be easier and easier to get a subsequent one,'' said Bunce, an orthopedic surgeon and former Stanford team physician who served for six years on the NCAA's medical safeguards committee, he said. Bunce's last concussion was triggered not by a blow to the head, but by a hit to his upper chest that snapped his head back.

Changes in equipment could protect the head more from concussions, but possibly at the expense of more spinal injuries, Bailes said.

``You don't want to make the head and neck some kind of guided missile that maybe protects the head and neck and makes someone more liable to cervical spine injuries,'' Bailes said. New equipment is being designed that links the helmet to the shoulder pads, spreading the impact of head blows through the shoulders, Bunce said.

He said he worries about what impact his concussions will have on him as he gets older. And he has just a few words of wisdom for Young.

``My only advice would be, make sure you're fully recovered from the series of two (concussions) now that you've had before you consider getting back into it,'' he said.

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