Page 19 - Layout 1

NEUROLOGY &
SLEEP DISORDERS

lay observers as an overt, visual indi-
cator of moderate injury forces ap-
plied to the brainstem and midbrain.
This aids in real-time concussion
identification and classification for
individuals of all ages and in all situ-
ations. Observing the Fencing Re-
sponse should initiate immediate
medical attention and accepted con-
cussion protocols. If injury forces
were sufficient to elicit the Fencing
Response, then the likelihood exists
for injury to nearby brainstem areas
that could impact breathing, cardio-
vascular function, alertness, and
other brainstem functions.
Investigation into other brainstem
functions that may be affected by
concussive forces have yielded addi-
tional overt, visual indicators of
brain injury. It is hypothesized that
these pathophysiological responses
originate from forces applied to nu-
clei in close proximity to the LVN in the brainstem. Evoked seizures, snoring, crying, and vomiting may also be indicative of
pathophysiological responses include responses such as seizing, concussive forces applied to the brainstem. Knowledge of these
snoring, crying, and vomiting following injury. These responses tools can speed access to care for concussed individuals and
may occur in addition to or independent of the Fencing Response ought to be considered in a clinical differential. The clinical and
and therefore represent additional signs of concussion. By ob- translational research that accompanies the pentad of concussion
serving the pathophysiological manifestations of concussion, cli- responses identified here helps to improve access to treatment
nicians and lay public can ensure that patients receive appropriate that may mitigate the acute and chronic effects of concussion for
care following head injury. patients of all ages.
By acting on clear and objective indicators of brain injury, such You can learn more from the Wikipedia page
as the Fencing Response, patients can receive immediate medical (https://en.wikipedia.org/wiki/Fencing_response) and YouTube
care and thereby be positioned for optimal outcomes. The con- videos (https://youtu.be/ZlXjwAlOflA) prepared by BNI@PCH
cussed individual may not be aware of the events of their own in- faculty.
jury, its severity, or potential neurological consequences. The
Fencing Response removes subjectivity from the evaluation. While Jonathan Lifshitz, Ph. D. is Director, Translational Neurotrauma Re-
a positive Fencing Response, even observed by the lay public, rep- search Program, BARROW Neurological Institute at Phoenix Children’s
resents a concussion requiring medical attention, an impact to the Hospital and Associate Professor, Department of Child Health, University
head without eliciting a Fencing Response may be severe enough to of Arizona College of Medicine-Phoenix.
require medical attention. All head impacts require an evaluation
from individuals with specialized training on the subject. Joshua A. Beitchman, MBS is a medical student at University of Texas
In sum, the Fencing Response is a diagnostic biomarker iden- Health San Antonio, Long School of Medicine and a Graduate Research
tified as forearm posturing that indicates a concussion of mod- Assistant, Translational Neurotrauma Research Program, BARROW
erate severity. Furthermore, pathophysiological response such as Neurological Institute at Phoenix Children’s Hospital.

visit us at www.bcms.org 19