Inside Earnhardt's concussion discovery

Dale Earnhardt Jr. says that he knew something wasn't quite right, so he wanted to be checked out before he returned to the race car. In meeting with neurosurgeon Dr. Jerry Petty this week, it was determined that the driver had a concussion and that it would keep him from racing right away. Thursday morning at Charlotte Motor Speedway, Earnhardt Jr. outlined what led him to step out of his car for the NASCAR Sprint Cup races at Charlotte Motor Speedway and Kansas Speedway. He said that the issue didn't start with the multicar wreck at Talladega Superspeedway, but with a crash during a tire test at Kansas Speedway on Aug. 29. And then he and Dr. Petty, who has worked with NASCAR drivers since 1968 when he joined a neurosurgery practice in Charlotte and who has also worked with the Carolina Panthers, explained why these incidents will keep the sport's most popular driver on the sidelines. "We had a test at Kansas about five weeks ago, and we blew a right front tire going into Turn 1, and I remember everything about that accident and everything after that accident, but I knew that I didn't feel, you know your body, and you know how your mind works, and I knew something was just not quite right," he said. "But I decided to just try to push through and work through it. I'd had concussions before and knew exactly kind of what I was dealing with." He said he was 80-90 percent by the time the Chase for the Sprint Cup started. Then he was caught up in the massive 25-car pileup Sunday at Talladega Superspeedway. The crash left him feeling disoriented and seeking help. "I went a couple days wondering how my body would react and sort of waiting for it to process what was happening," he said. "About (Tuesday), I was still having some headaches, that was really the only symptoms that I was having was the headaches. So I took it upon myself to I contacted my sister, and we talked about seeing a neurosurgeon, and we ended up getting steered toward Dr. Petty. "Met with him, ran through a couple tests, everything was checking out, and did an MRI, everything looked good there. But I was really honest with him about how I felt and honest with him about the whole process from Kansas all the way on." The key to all of this, it seems, is Earnhardt Jr.'s own detailed history of his crashes and the way he has felt after them. Petty pointed out that after the first concussion, one is more susceptible to future ones. And that letting the doctor know what a driver is experiencing is critical. "Ninety percent of a concussion probably depends on individual information," he said. "The headache people around you might notice that you're different. By and large it's a patient's history that the patient gives is the thing that tells you that they've had a concussion. A concussion can be seeing stars. A concussion can be just being addled for a minute. Any time the brain is not doing what it's supposed to be doing after an acceleration or deceleration, that's a concussion." Petty told team owner Rick Hendrick Wednesday that regardless of what the MRI showed, he would not clear Earnhardt Jr. to race this weekend. On Tuesday he did an impact test and an exam. "He had very few signs at that time," Petty said. "In other words, his neurological exam was normal." He ordered an MRI to check for previous injuries, which also turned out normal, something Petty says "was very encouraging." Earnhardt Jr., he said, gave a good history of the incidents. "He had no amnesia on either side of either of the incidents, which is very important, and I think that there's every reason to expect what we'll do now is we want him to have four or five days after he has no headache, and then we'll give him some sort of test like to get his pulse rate up, see if we can provoke a headache, and then if we can't, we'll let him go out and drive a lap or two and see how that goes, and if that goes well, we'll probably clear him to race." Earnhardt Jr. himself said that in past cases, the symptoms have gone away after 24 to 48 hours. This was different. So how did Petty know when to pull Earnhardt Jr.? And when will he know the driver is cleared to race? "If an MRI scan or a CT scan is abnormal, then it's no longer a concussion, it's a hemorrhage or a contusion. By definition it's not a concussion," he said. "So some of the testing that's done, like the impact tests that Dale had, those are tests that we can follow, and if he should have an injury again in the future, we can use that as a baseline. What we'd want to make sure is that baseline doesn't start to fall off and even fall off without being tested. "The period of what he has is really called a diffuse axonal injury, and it's something that does not show on scans, and we don't have a test that will show that other than symptoms and signs. Sometimes there will be some residual signs left over, but Dale had none of those. He had no his eyes did what they were supposed to do; his balance tests and so forth are perfect. "The biggest one test, the one symptom that is more important than all the tests is headache, and as long as there's any headache, the brain is not healed, and until that's healed and had some time to rest and then you provoke it again and can't make it happen again, then that's then you feel like you're on the road to recovery."