Post-traumatic amnesia: why Kramer can’t remember his play in the World Cup Final
It was 17 minutes into his second World Cup appearance when German midfielder Christoph Kramer slammed brutally into his Argentine opponent. Kramer's head swerved a sickening 90 degrees and the 23-year old collapsed on the ground, looking dazed and confused. Yet he played on, and on, and on. It wasn’t until a quarter of an hour later that he was finally escorted off the field.
Official sources have not yet confirmed whether Kramer had a concussion; however, both Die Spiegel and the Guardian reported that he could not remember the first half of the game nor how he got back into the dressing room.
Kramer may have suffered from post-traumatic amnesia (PTA), a state of clouded consciousness that occurs immediately after traumatic brain injury. During PTA, the patient suffers from a host of neurological symptoms: confusion, disorientation, agitation and cognitive dysfunction. Memory is also impaired: the patient can’t recall events preceding the injury (retrograde amnesia) nor encode new memories while suffering from PTA (anterograde amnesia). While there is still no universal agreement, many health professionals believe that the duration of PTA correlates with the severity of brain damage.
As illustrated by Kramer, PTA can occur while a person is conscious and seemingly functional. Unlike a bleeding wound on the face or an angry bite mark on the shoulder, PTA doesn’t look particularly harmful to bystanders. Yet inside the head neuronal dysfunction spreads far and wide. A 2001 study with patients undergoing a PTA episode found decreased blood flow in the frontal and occipital areas, as well as the caudate nucleus – a brain area important for goal-directed actions and learning and memory. During PTA, patients often show abnormal EEG responses particularly in brain areas supporting cognition and memory. Mild traumatic brain injury also appears to damage the structural integrity of neurons and alter neurotransmitter function – if perhaps only transiently – and disrupt the brain’s normal processing of working memory. A handful of studies even found gross structural abnormalities such as damaged axonal fibres or decreased brain volume, although thankfully such severe changes are rare.
The good news for Kramer (and Die Mannschaft) fans is that his injury appears to be minor. According to the Cantu Grading System for Concussion, those suffering from a brief period of PTA lasting less than 30minutes without loss of consciousness are expected to fully recover. Yet brain trauma stacks up: once a player has incurred one concussion, his or her chances of getting another are 3 to 6 times more than someone who’s never been through the ordeal. Functional and structural brain damage is also cumulative, and repeated insults can lead to persistent cognitive, emotional and behavioural impairments.
Without a doubt, Kramer should not have been allowed to keep playing after the incident; that he did clearly illustrates how antiquated and useless FIFA’s current concussion protocols are. Players are often unaware of the extent of their own injuries and will beg to return to the pitch if they can; at the very least, FIFA’s protocols need to be able to protect the players from themselves in this beautiful game. This shouldn't ever happen again.
The World Cup may be over, but this conversation needs to continue.
Arciniegas DB, Anderson CA, Topkoff J, & McAllister TW (2005). Mild traumatic brain injury: a neuropsychiatric approach to diagnosis, evaluation, and treatment. Neuropsychiatric disease and treatment, 1 (4), 311-27 PMID: 18568112
PS. Deutschland ist Weltmeister!! Endlich wieder Weltmeister!!