What are the common symptoms of a concussion. How is a concussion diagnosed. What are the safety guidelines for concussion prevention and management. When should you seek immediate medical attention after a head injury. What are the statistics on concussion prevalence in sports.

Understanding Concussions: More Than Just a Bump on the Head

A concussion is a complex brain injury that demands serious attention. Often misunderstood as a minor incident, concussions can have significant short-term and potentially long-term effects on brain function. But what exactly happens during a concussion?

A concussion occurs when the brain experiences a sudden jolt or impact, causing it to move rapidly within the skull. This movement can lead to chemical changes in the brain and sometimes damage brain cells. The result is a temporary disruption of normal brain function, affecting various cognitive and physical abilities.

Contrary to popular belief, concussions don’t always involve a loss of consciousness. In fact, many individuals with concussions remain conscious throughout the incident. This misconception often leads to underreporting and inadequate treatment of concussions, especially in sports and recreational activities.

Causes of Concussions

Concussions can result from various situations, including:

• Direct trauma to the head (e.g., falls, collisions, accidents)
• Rapid acceleration-deceleration of the head (e.g., whiplash injuries)
• Blast injuries (common in military settings)

It’s important to note that external signs of head trauma, such as bleeding or bruising, are not always present in concussion cases. This lack of visible injury can sometimes lead to a false sense of security, emphasizing the need for careful assessment following any potential head injury.

Recognizing the Signs and Symptoms of a Concussion

Identifying a concussion promptly is crucial for proper management and recovery. The symptoms of a concussion can be subtle and may not appear immediately after the injury. How can you recognize a concussion?

Common signs and symptoms of a concussion include:

• Confusion or feeling dazed
• Headache
• Dizziness or balance problems
• Nausea or vomiting
• Memory loss, especially about the event
• Difficulty concentrating
• Sensitivity to light or noise
• Vision disturbances (e.g., blurred or double vision)
• Ringing in the ears
• Changes in sleep patterns
• Mood changes or irritability

Is it possible to have a concussion without experiencing all these symptoms? Absolutely. Concussion symptoms can vary widely between individuals, and some people may only experience one or two symptoms. This variability underscores the importance of seeking professional medical evaluation after any suspected concussion, regardless of symptom severity.

Diagnosing Concussions: A Multi-Faceted Approach

Diagnosing a concussion requires a comprehensive evaluation by a healthcare professional. Unlike other types of injuries, concussions cannot be definitively diagnosed through a single test or imaging study. So, how do medical professionals diagnose concussions?

The diagnostic process typically involves:

1. A detailed medical history
2. Physical examination
3. Neurological assessment
4. Cognitive testing
5. Balance testing
6. Observation of symptoms

Contrary to common belief, brain imaging studies like MRI and CT scans are not routinely used to diagnose concussions. These tests are primarily useful for identifying structural brain injuries, while concussions typically involve functional rather than structural changes. When are brain scans recommended? Healthcare providers may order these tests if they suspect more severe brain injury or if symptoms worsen over time.

The Importance of Proper Concussion Management

Proper management of a concussion is crucial for optimal recovery and prevention of further injury. What does appropriate concussion management entail?

The cornerstone of concussion treatment is rest, both physical and cognitive. This means avoiding activities that could lead to another concussion and limiting activities that require intense concentration or mental effort. As symptoms improve, a gradual return to normal activities under medical supervision is recommended.

Why is proper management so critical? Research has shown that individuals who sustain a second concussion before fully recovering from the first are at risk for more severe symptoms and potentially long-term complications. This phenomenon, known as Second Impact Syndrome, can have devastating consequences, particularly in young athletes.

Return-to-Play Protocols

For athletes, a structured return-to-play protocol is essential. This typically involves a step-wise progression of activities, with each step lasting at least 24 hours. The stages often include:

1. Complete rest
2. Light aerobic exercise
3. Sport-specific training
4. Non-contact drills
5. Full-contact practice
6. Return to competition

Progression through these stages should only occur if the individual remains symptom-free. Any recurrence of symptoms necessitates a return to the previous stage.

Concussion Prevention: Strategies for Reducing Risk

While it’s impossible to prevent all concussions, there are strategies to reduce the risk of sustaining one. How can we minimize the occurrence of concussions?

Prevention strategies include:

• Wearing appropriate protective gear during sports and recreational activities
• Ensuring proper technique and form in contact sports
• Implementing and enforcing safety rules in sports
• Creating safe play environments for children
• Using seatbelts and child safety seats in vehicles
• Preventing falls, especially in older adults

Education plays a crucial role in prevention. Athletes, coaches, parents, and healthcare providers should be well-informed about concussion risks, signs, and proper management. This knowledge can lead to quicker recognition of concussions and more appropriate responses, potentially reducing the risk of severe outcomes.

The Long-Term Impact of Concussions: What We Know

While most people recover fully from a single concussion, there’s growing concern about the potential long-term effects of multiple concussions or inadequately managed concussions. What do we currently understand about the long-term impact of concussions?

Research has linked repeated concussions to various long-term health issues, including:

• Chronic Traumatic Encephalopathy (CTE)
• Increased risk of neurodegenerative diseases
• Persistent post-concussive symptoms
• Cognitive impairments
• Mental health disorders

It’s important to note that not everyone who experiences multiple concussions will develop these issues. The relationship between concussions and long-term health outcomes is complex and influenced by various factors, including genetics, overall health, and concussion management.

Ongoing Research

Scientists continue to study the long-term effects of concussions, particularly in athletes and military personnel. Advanced neuroimaging techniques and biomarker studies are providing new insights into the subtle changes that occur in the brain following concussions. This ongoing research aims to improve our understanding of concussions and develop more effective prevention and treatment strategies.

Concussion in Sports: A Growing Concern

Sports-related concussions have garnered significant attention in recent years, particularly in contact sports like football, hockey, and soccer. How prevalent are concussions in sports?

According to the University of Pittsburgh’s Brain Trauma Research Center, over 300,000 sports-related concussions occur annually in the United States. The likelihood of sustaining a concussion while playing a contact sport is estimated to be as high as 19% per year of play. This means that nearly all athletes participating in contact sports may experience a concussion within five years of play.

In high school contact sports alone, more than 62,000 concussions are sustained each year. Among college football players, 34% have had one concussion, and 20% have endured multiple concussions. These statistics highlight the significance of the issue in competitive sports.

Concussion Rates in Different Sports

While football often receives the most attention regarding concussions, other sports also carry significant risks. A study conducted by McGill University found that 60% of college soccer players reported symptoms of a concussion at least once during the season. Surprisingly, the study revealed that concussion rates in soccer players were comparable to those in football.

The risk of concussion varies across different sports:

• Football: Highest risk, especially during games
• Hockey: High risk, particularly in checking leagues
• Soccer: Moderate to high risk, especially from heading the ball
• Basketball: Moderate risk
• Wrestling: Moderate risk
• Volleyball: Lower risk, but still present

Understanding these risks is crucial for athletes, coaches, and parents to make informed decisions about participation in sports and to ensure appropriate safety measures are in place.

When to Seek Immediate Medical Attention

While most concussions are not life-threatening, certain symptoms warrant immediate medical attention. When should you seek emergency care after a head injury?

Seek immediate medical attention if the following symptoms occur:

• Worsening headache that doesn’t go away
• Slurred speech, weakness, numbness, or decreased coordination
• Significant nausea or repeated vomiting
• Seizures
• Loss of consciousness
• Inability to wake up
• One pupil larger than the other
• Unusual behavior or increased confusion
• Clear fluid or blood draining from ears or nose

These symptoms may indicate a more severe brain injury that requires urgent medical intervention. It’s always better to err on the side of caution when it comes to head injuries.

Monitoring Recovery

Even if immediate medical attention isn’t necessary, it’s important to monitor symptoms closely in the days and weeks following a concussion. If symptoms persist beyond 10-14 days or worsen at any time, consult a healthcare provider. Additionally, individuals with a history of multiple concussions should be particularly vigilant and seek medical advice promptly after any suspected concussion.

Remember, every concussion is unique, and recovery times can vary significantly between individuals. Some people may recover within days, while others may experience symptoms for weeks or even months. Patience and proper management are key to optimal recovery.

The Role of Technology in Concussion Management

As our understanding of concussions evolves, so too does the technology used to diagnose, monitor, and manage these injuries. How is technology shaping the future of concussion care?

Several technological advancements are making waves in concussion management:

• Wearable sensors: These devices can detect and measure impacts during sports, providing real-time data on potential concussive events.
• Virtual reality: VR systems are being used to assess balance and cognitive function in concussion patients more accurately.
• Mobile apps: Smartphone applications help track symptoms, cognitive function, and recovery progress.
• Advanced neuroimaging: New MRI techniques can detect subtle changes in brain structure and function following a concussion.
• Biomarker testing: Research is ongoing to identify blood-based biomarkers that could indicate the presence and severity of a concussion.

While these technologies show promise, it’s important to note that they are not replacements for clinical judgment. Rather, they serve as additional tools to aid healthcare providers in making more informed decisions about concussion diagnosis and management.

The Future of Concussion Research

Ongoing research continues to shed light on the complexities of concussions. Scientists are exploring various aspects of concussion, including:

1. The genetic factors that may influence concussion susceptibility and recovery
2. The cumulative effects of subconcussive impacts
3. Novel treatment approaches, including targeted therapies for specific concussion symptoms
4. The long-term consequences of concussions across different populations
5. Improved methods for assessing concussion severity and predicting recovery timelines

As this research progresses, we can expect to see more personalized approaches to concussion management, tailored to the unique needs and circumstances of each individual.

Concussion – Symptoms, Diagnosis and Safety Guidelines

A concussion is an injury to the brain that results in temporary loss of normal brain function. Medically, it is defined as a clinical syndrome characterized by immediate and transient alteration in brain function, including alteration of mental status or level of consciousness, that results from mechanical force or trauma.

Concussions can be caused by direct trauma to the head, such as from falling, getting hit or being in an accident. They can also occur as a result of rapid acceleration-deceleration of the head, such as in whiplash injuries or blast injuries, like in a war zone. Many people assume that concussions involve passing out or a loss of consciousness, but this is not true. In many cases, people with a concussion never lose consciousness. In several cases, external signs of head trauma, such as bleeding, may also be absent.

A concussion can affect memory, judgment, reflexes, speech, balance and muscle coordination. People with concussions often report a brief period of amnesia or forgetfulness, where they cannot remember what happened immediately before or after the injury. They may act confused, dazed or describe “seeing stars.” Paramedics and athletic trainers who suspect a person has suffered a concussion may ask the injured person if they know their name, what month/year it is and where they are.

Even mild concussions should not be taken lightly. Neurosurgeons and other brain injury experts emphasize that although some concussions are less serious than others, there is no such thing as a minor concussion. In most cases, a single concussion should not cause permanent damage. A second concussion soon after the first one does not have to be very strong for its effects to be permanently disabling.

Common Symptoms of Concussion

• Confusion
• Headache
• Vision disturbances (double or blurry vision)
• Dizziness or imbalance
• Nausea or vomiting
• Memory loss
• Ringing ears
• Difficulty concentrating
• Sensitivity to light
• Loss of smell or taste
• Trouble falling asleep

If any of these occur after a blow to the head, a health-care professional should be consulted as soon as possible.

Most people will recover quickly and completely following a concussion. Some people can have symptoms that last for several weeks before gradually getting better. Seek immediate medical attention if:

• Headache is worse or does not go away
• Slurred speech, weakness, numbness or decreased coordination
• Significant nausea or repeated vomiting
• Seizures
• Loss of consciousness
• Inability to wake up
• Symptoms have worsened at any time
• Symptoms have not gone away after 10-14 days
• History of multiple concussions

Brain imaging studies with MRI and CT scans should not be performed routinely in the diagnosis of concussions. They typically do not show any significant changes and, with CT scans, expose individuals to unnecessary radiation. While such tests are more useful for identifying structural defects, an injury from concussion is metabolic and microscopic in nature that often presents normally on neuroimaging.

The doctor asks a variety of questions about how the injury occurred, where on the head and what symptoms are shown. The patient should report any unusual experiences to the health care provider.

According to the Centers for Disease Control and Prevention (CDC) surveillance report of traumatic brain injuries, about 2.87 million TBI-related ED visits, hospitalizations and deaths occurred in the United States in 2014. Each year, more than 800,000 children are treated for TBI at emergency departments in the U.S. The highest incidence of TBI occurred in people over the age of 75, children aged 0-4 years and individuals aged 15-24 years.

University of Pittsburgh’s Brain Trauma Research Center reports more than 300,000 sports-related concussions occur annually in the U.S. Additionally, the likelihood of suffering a concussion while playing a contact sport is estimated to be as high as 19% per year of play; in other words, almost all athletes of contact sports suffer from a concussion within five years of participation. It has been reported that more than 62,000 concussions are sustained each year in high school contact sports. Among college football players, 34% have had one concussion and 20% have endured multiple concussions. Estimates show that 4-20% of college and high school football players sustain a brain injury over the course of one season. The risk of concussion in football is three to six times higher in players who have had a previous concussion.

A study conducted by McGill University in Montreal found that 60% of college soccer players reported symptoms of a concussion at least once during the season. The study also reveals that concussion rates in soccer players were comparable to those in football. According to this study, athletes who suffered a concussion were four to six times more likely to suffer a second concussion. Research such as this has led to greater interest in developing protective headgear for soccer participants, but it is not clear that such headgear actually reduces the risk of concussion.

Concussion symptoms can affect people in a variety of ways, including vision, balance and even mood. Historically, the standard treatment for concussion was to get plenty of rest. However, newer approaches involve therapy to target specific symptoms. Clinics exist that help determine the most affected system and appropriate therapy for a given symptomology. In addition, a thorough medical examination may be needed before returning to sports or activities with the potential for contact or further head injury.

Following a concussion, some people may suffer persisting symptoms, such as memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia and excessive drowsiness for several weeks to months. This is known as post-concussive syndrome. Patients with post-concussive syndrome should avoid activities that put them at risk for a repeated concussion. Athletes should not return to play while experiencing these symptoms. Athletes who suffer repeated concussions should consider ending participation in the sport.

Second impact syndrome results from acute and often fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. The impact is thought to cause vascular congestion and increased intracranial pressure, which can occur very rapidly and may be difficult or impossible to control. The risk of second-impact syndrome is higher in sports like boxing, football, ice or roller hockey, soccer, baseball, basketball and skiing. The CDC reports an average of 1.5 deaths per year from sports concussions. In most cases, a concussion, usually undiagnosed, had occurred prior to the final one.

Buy and use helmets or protective headgear approved by the American Society for Testing and Materials (ASTM) for specific sports 100% of the time. The ASTM has vigorous standards for testing helmets for many sports; helmets approved by the ASTM bear a sticker stating this. Helmets and headgear come in many sizes and styles, and must properly fit to provide maximum protection against head injuries. In addition to other safety apparel or gear, helmets or headgear should be worn at all times for:

• Baseball and softball (when batting)
• Cycling
• Football
• Hockey
• Horseback riding
• Powered recreational vehicles
• Skateboards/scooters
• Skiing
• Wrestling

Headgear is recommended by many sports safety experts for:

• Martial arts
• Pole vaulting
• Soccer

Sports Tips

• Supervise younger children at all times, and do not let them use sporting equipment or play sports unsuitable for their age.
• Do not dive in water less than nine feet deep or in above-ground pools.
• Follow all rules at water parks and swimming pools.
• Wear appropriate clothing for the sport.
• Do not wear any clothing that can interfere with vision.
• Do not participate in sports when ill or very tired.
• Obey all traffic signals, and be aware of drivers when cycling or skateboarding.
• Avoid uneven or unpaved surfaces when cycling or skateboarding.
• Perform regular safety checks of sports fields, playgrounds and equipment.
• Discard and replace sporting equipment or protective gear that is damaged.

General Tips

• Wear a seat belt every time, whether driving or riding in a motor vehicle.
• Never drive while under the influence of drugs or alcohol, or ride as a passenger with anybody who is under the influence.
• Keep unloaded firearms in a locked cabinet or safe, and store ammunition in a separate, secure location.
• Remove hazards in the home that may contribute to falls. Secure rugs and loose electrical cords, put away toys, use safety gates and install window guards. Install grab bars and handrails for the frail or elderly.

The skull protects the brain against penetrating trauma, but does not absorb all the impact of a violent force. The brain is cushioned inside the skull by the surrounding cerebrospinal fluid. Despite this, an abrupt blow to the head, or even a rapid deceleration, can cause the brain to contact the inner side of the skull. There is a potential for tearing of blood vessels, pulling of nerve fibers and bruising of the brain.

Sometimes the blow can result in microscopic damage to the brain cells without obvious structural damage visible on a CT scan. In severe cases, the brain tissue can begin to swell. Since the brain cannot escape the rigid confines of the skull, severe swelling can compress the brain and its blood vessels, limiting the flow of blood. Without adequate blood flow, the brain does not receive the necessary flow of oxygen and glucose. A stroke can occur. Brain swelling after a concussion has the potential to amplify the severity of the injury.

A blow to the head can cause a more serious initial injury to the brain. A contusion is a bruise of the brain tissue involving bleeding and swelling in the brain. A skull fracture occurs when the bone of the skull breaks. A skull fracture by itself may not necessarily be a serious injury. Sometimes, however, the broken skull bones cause bleeding or other damage by cutting into the brain or its coverings.

A hematoma is a blood clot that collects in or around the brain. If active bleeding persists, hematomas can rapidly enlarge. Like brain swelling, the increasing pressure within the rigid confines of the skull (due to an enlarging blood clot) can cause serious neurological problems, and can even be life-threatening. Some hematomas are surgical emergencies. Hematomas that are small can sometimes go undetected initially, but may cause symptoms and require treatment several days or weeks later.

Warning Signs of a Serious Brain Injury

• Pain: Constant or recurring headache
• Motor dysfunction: Inability to control or coordinate motor functions or disturbance to balance
• Sensory: Changes in ability to hear, taste or see; dizziness; hypersensitivity to light or sound
• Cognitive: Shortened attention span; easily distracted; overstimulated by environment; difficulty staying focused on a task, following directions or understanding information; feeling of disorientation, confusion and other neuropsychological deficiencies
• Speech: Difficulty finding the “right” word; difficulty expressing words or thoughts; dysarthric speech

Seek immediate medical attention if any of these warning signs occur

Because each player and each concussion is unique, there is no set timeframe for recovery and return to participation under the NFL’s current guidelines. The decision to return a player who has a concussion back to practice and games resides with the team physician managing the concussion protocols and is confirmed by an independent neurological consultant (INC), who is consulted specifically for the player’s neurological health.

After a player is diagnosed with a concussion, the protocol calls for a minimum of daily monitoring. The player’s past concussion exposure, medical history and family history are considered, creating a more complete picture of his health. The protocol progresses through a series of steps, moving to the next step only when all activities in the current step are tolerated without recurrence of symptoms. Communication between the player and the medical staff during the protocol is essential.

The first step is rest. During this time, in addition to avoiding physical exertion, the player is to avoid electronics, social media and even team meetings until he returns to his baseline level of signs and symptoms. The next step introduces light aerobic exercise, which takes place under the direct oversight of the team’s medical staff. If aerobics are tolerated, the team physician will reintroduce strength training. The fourth step includes some non-contact football-specific activities, and the fifth step, which is clearance to resume full football activity, comes only after neurocognitive testing remains at baseline and there is no recurrence of signs or symptoms of a concussion.

When the team physician gives the player final clearance, the player has a final examination by the INC assigned to his team. As part of this examination, the INC will review all reports and tests documented through the player’s recovery. Once the INC confirms the conclusion of the team physician, the player is considered cleared and is eligible for full participation in the next game or practice.

This protocol allows for players to heal at their own individual rates, includes the expertise of both the team physicians and a neurological consultant and specifically includes an assessment of not only the most recent concussion, but also takes into account the medical history of the player.

The National Collegiate Athletic Association (NCAA) 2011-2012 Sports Medicine Handbook includes a section called “Concussion or Mild Traumatic Brain Injury (mTBI) in the Athlete,” which notes:

“In the years 2004 to 2009, the rate of concussion during games per 1,000 athlete exposures for football was 3.1; for men’s lacrosse, 2.6; for men’s ice hockey, 2.4; for women’s ice hockey, 2.2; for women’s soccer, 2.2; for wrestling, 1.4; for men’s soccer, 1.4; for women’s lacrosse, 1.2; for field hockey, 1.2; for women’s basketball, 1.2; and for men’s basketball, 0.6, accounting for between four and 16.2% of the injuries for these sports, as reported by the NCAA Injury Surveillance Program by the Datalys Center.”

The NCAA defines concussion or mild traumatic brain injury as “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces.”

The handbook also states, “NCAA member institutions must have a concussion management plan for their student-athletes on file with specific components as described in Bylaw 3. 2.4.16 (see Guideline 2i).”

The NCAA Plan

• Requires that student-athletes receive information about the signs and symptoms of concussions. They also are required to sign a waiver that says they are responsible for reporting injuries to the medical staff.
• Mandates institutions to provide a process for removing a student-athlete that exhibits signs of a concussion. Student-athletes exhibiting signs of concussions must be evaluated by a medical staff member with experience in the evaluation and management of concussions before they can return to play.
• Prohibits a student-athlete with concussion symptoms from returning to play on the day of the activity.
• Requires student-athletes diagnosed with a concussion be cleared by a physician or a physician’s designee before they are permitted to return.

The signs of a concussion, according to the NCAA, are as follows:

• Amnesia
• Confusion
• Headache
• Loss of consciousness
• Balance problems
• Double or fuzzy vision
• Sensitivity to light or noise
• Nausea
• Feeling sluggish
• Concentration or memory problems
• Slowed reaction time
• Feeling unusually irritable

The NCAA handbook includes much more information on concussions starting on page 55. The NCAA also recommends viewing the National Athletic Trainers’ Association’s Heads Up video, which takes a closer look at the types of head injuries incurred and how they happen.

Sports-related neurosurgical injuries were the focus of the November 2011 issue of the Journal of Neurosurgery. It included the results of a study of 451 patients about the mechanisms and consequences of head injuries referencing an anonymous survey that found that more than 46% of university soccer players experienced a concussion in just one fall season, and almost two-thirds of the same group experienced a concussion over the 12-month period while playing soccer. Another article described a new smartphone app designed for on-the-field concussion testing.

The Neurosurgery Research and Education Foundation (NREF) is the philanthropic arm of the AANS. The NREF funds research into new and existing neurosurgical treatments, helping neurosurgeons save and improve lives every day.

If you would like to share a story of how your neurosurgeon helped you, please contact the NREF at info@nref. org. To make a donation that supports neurosurgery research and education, visit www.nref.org.

This page has been edited by Nitin Agarwal, MD, Rut Thakkar and Khoi Than, MD, FAANS

The AANS does not endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your area through the AANS’ Find a Board-certified Neurosurgeon”online tool.

Concussion – Injuries & first aid

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1. 1.

   About concussion

2. 2.

   Symptoms of concussion

3. 3.

   Causes of concussion

4. 4.

   Diagnosing concussion

5. 5.

   Treating concussion

6. 6.

   Complications of concussion

7. 7.

   Preventing concussion

About concussion

Concussion is the sudden but short-lived loss of mental function that occurs after a blow or other injury to the head. It is the most common but least serious type of brain injury.

The medical term for concussion is minor traumatic brain injury.

Symptoms of concussion include brief:

• loss of consciousness after the head injury
• periods of memory loss
• disturbances in vision, such as “seeing stars” or blurry vision
• a period of confusion, a blank expression, or a delay in answering questions immediately after the head injury

If a brain scan is carried out, concussion is only diagnosed if the scan is normal – for example, there is no bleeding or swelling of the brain.

When to seek medical help

Concussion should only be diagnosed by a health professional trained in assessing patients with head injury. They will be able to rule out serious brain injury that needs a brain scan or surgery.

You should visit your nearest accident and emergency (A&E) department if you or someone in your care has a head injury and develops the following signs and symptoms:

• loss of consciousness, however brief
• memory loss, such as not being able to remember what happened before or after the injury
• persistent headaches since the injury
• changes in behaviour, such as irritability, being easily distracted or having no interest in the outside world – this is a particularly common sign in children under five
• confusion
• drowsiness that occurs when you would normally be awake
• loss of balance or problems walking
• difficulties with understanding what people say
• difficulty speaking, such as slurred speech
• problems with reading or writing
• vomiting since the injury
• problems with vision, such as double vision
• loss of power in part of the body, such as weakness in an arm or leg
• clear fluid leaving the nose or ears (this could be cerebrospinal fluid, which surrounds the brain)
• sudden deafness in one or both ears
• any wound to the head or face

Anyone drunk or high on recreational drugs should go to A&E if they have a head injury as it’s easy for others around them to miss the signs of a more severe injury.

Phone 999 for an ambulance immediately if the person:

• remains unconscious after the initial injury
• is having a seizure or fit
• is bleeding from one or both ears
• has been vomiting since the injury
• is having difficulty staying awake, speaking, or understanding what people are saying

Certain things make you more vulnerable to the effects of a head injury. These include:

• being aged 65 or older
• having previously had brain surgery
• having a condition that makes you bleed more easily, such as haemophilia
• having a condition that makes your blood more prone to clotting, such as thrombophilia
• taking anticoagulant medication, such as warfarin or aspirin, to prevent blood clots

There are things you can do at home to help relieve concussion symptoms, including:

• apply a cold compress to the injury to reduce swelling – a bag of frozen peas wrapped in a towel will do
• take paracetamol to control any pain – do not use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin, as these can cause bleeding
• avoid drinking alcohol or taking recreational drugs

Read more about how concussion is treated, including information on self care tips and when you can return to playing sport.

Recovery

After experiencing concussion, careful monitoring is needed. This is usually for 48 hours.

This is because the symptoms of concussion could also be symptoms of a more serious condition, such as:

• subdural haematoma – bleeding between the skull and the brain
• subarachnoid haemorrhage – bleeding on the surface of the brain

Outlook

While the medical term “minor traumatic brain injury” can sound serious, the actual extent of damage to the brain is usually minimal and does not cause long-term problems or complications.

There is evidence that repeated episodes of concussion could cause long-term problems with mental abilities and trigger dementia. This type of dementia is known as chronic traumatic encephalopathy (CTE).

However, this seems to only be a significant risk for professional athletes who experience repeated episodes of severe concussion, such as boxers – CTE is sometime nicknamed “boxer’s brain”.

Post-concussion syndrome (PCS) is a poorly understood condition where symptoms of concussion can last for weeks or months afterwards.

Read more information about PCS as a complication of concussion.

Who’s at risk?

Most cases of concussion occur in children and teenagers aged 5 to 14, with the two most common causes being sporting and cycling accidents.

Falls and motor vehicle accidents are a more common cause of concussion in older adults.

People who regularly play competitive team sports such as football and rugby have a higher risk of concussion.

Read more information about the causes of concussion and tips on preventing concussion.

Symptoms of concussion

Symptoms of concussion can be mild to severe, and in some cases emergency treatment may be needed.

The most common symptoms of concussion are:

• confusion, such as being unaware of your surroundings, a delay in answering questions, or having a blank expression 
• headache
• dizziness
• nausea
• loss of balance
• feeling stunned or dazed
• disturbances with vision, such as double vision, blurred vision or “seeing stars” or flashing lights
• difficulties with memory

Difficulties with memory can mean:

• you are unable to remember events that occurred before the concussion happened (this usually only affects the minutes immediately leading up to the concussion) – retrograde amnesia  
• you are unable to remember any new information or events after the concussion happened – anterograde amnesia

Both types of memory loss usually improve within a few hours.

Less common symptoms

Less common symptoms include:

• loss of consciousness
• slurred speech
• changes in behaviour, such as feeling unusually irritable
• inappropriate emotional responses, such as suddenly bursting into laughter or tears

When to seek medical advice

As a precaution, it is recommended that you visit your nearest accident and emergency (A&E) department if you or someone in your care has a head injury resulting in concussion and then develops any of the following signs and symptoms:

• loss of consciousness from which the person then recovers
• amnesia (memory loss), such as not being able to remember what happened before or after the injury
• persistent headaches since the injury
• changes in behaviour, such as irritability, being easily distracted or having no interest in the outside world – this is a particularly common sign in children under the age of five
• confusion
• drowsiness that goes on for longer than an hour when you would normally be awake
• a large bruise or wound to the head or face
• prolonged vision problems, such as double vision
• reading or writing problems
• balance problems or difficulty walking
• loss of power in part of the body, such as weakness in an arm or leg
• clear fluid leaking from the nose or ears (this could be cerebrospinal fluid, which normally surrounds the brain)
• a black eye with no other damage around the eye
• sudden deafness in one or both ears

Anyone taking warfarin should seek medical assistance after a head injury, even if they feel well.  

Anyone who is drunk or high on recreational drugs should also go to A&E if they have a head injury. It’s often easy for others around them to miss signs of a more severe head injury.

Certain things make you more vulnerable to the effects of a head injury, such as:

• being aged 65 or older
• a previous history of brain surgery
• having a condition that makes you bleed more easily, such as haemophilia, or having a condition that makes your blood more prone to clotting, such as thrombophilia
• taking anticoagulant medication (such as warfarin) to prevent blood clots, or taking low-dose aspirin

When to seek emergency medical treatment

You should phone 999 for an ambulance immediately if the person:

• remains unconscious after the initial injury
• is having difficulty staying awake, speaking or understanding what people are saying
• is having a seizure or fit
• has been vomiting since the injury
• is bleeding from one or both ears

Causes of concussion

Concussion occurs when a blow or impact to the head causes a sudden disruption to part of the brain known as the reticular activating system (RAS).

The RAS is located in the middle of your brain, and helps regulate your sense of awareness and consciousness. It also acts as a filter that allows you to ignore unimportant information by focusing on details you need.

For example, your RAS helps you to:

• fall asleep and wake up as required
• suddenly hear when your flight is being called in a noisy airport
• notice news items that interest you when you are quickly scanning a newspaper or news website

During a head injury severe enough to cause concussion, your brain is moved out of its normal position for a short time. This rotation disrupts the electrical activities of brain cells that make up the RAS, which in turn triggers symptoms associated with concussion, such as:

• loss of memory 
• a brief period of unconsciousness
• mental confusion

Increased risk

The three main causes of concussion are:

• being involved in a road accident
• an accidental trip or fall
• taking part in sporting or other recreational activities

Activities known to have a higher-than-average risk of concussion include:

• rugby
• football
• cycling
• boxing
• martial arts, such as karate or judo

Most doctors would argue that the physical benefits of regularly taking part in these sports outweigh any potential risks associated with concussion.

But this is only if you (or your child) wear appropriate equipment, such as a helmet, and are supervised by a suitably trained referee, umpire or trainer with experience of diagnosing and treating concussion.

The exception to this is boxing, as most doctors – especially those who treat head injuries – have stated that the risks of serious brain injury associated with boxing are unacceptably high and the sport should be made illegal.

Diagnosing concussion

Because of the nature of concussion, most diagnoses are either made at an accident and emergency (A&E) department, by a paramedic at the scene of an accident, or by a trained official at a sporting event.

The person making the diagnosis will perform a careful physical examination to check if there are any noticeable signs and symptoms of a more serious brain injury, such as bleeding from the ears, while making sure breathing is unaffected.

If you are conscious, you will be questioned so your state of mind (particularly your memory) can be assessed.

Possible questions include:

• Where are we?
• What were you doing before the concussion?
• Can you repeat the months of the year in reverse order?

You may be asked to try what is known as the “finger-nose-finger” test. The person running the test will hold one of their fingers in front of you. You are asked to touch their finger and then touch the tip of your nose as quickly as possible.

This test is a good way of assessing what effect the concussion has had on your balance and co-ordination.

If you are unconscious, as a precaution it is assumed that you have a serious neck or spinal injury until proved otherwise. You should therefore not be moved until a specialist brace can be fitted around your neck and spine to protect it.

Similarly, if you see a person who is unconscious, make no attempt to move them unless they are in immediate physical danger. Instead, dial 999 for an ambulance and wait with them until paramedics arrive.

Further testing

In some circumstances, further testing may be recommended if there are any signs or symptoms that suggest a more serious injury to your brain. The most widely used test for suspected brain injury is a computerised tomography (CT) scan. 

However, if it is thought you may have damaged the bones in your neck, an X-ray may be used to assess the damage quickly. CT scans are avoided on children under 10 where possible, but may be necessary in some cases.

A CT scan takes a series of X-rays of the inside of your skull and puts them together using a computer. The image that is created forms a cross-section of the inside of your skull and brain.

Adults

A CT scan is usually recommended in adults who:

• have persistent problems in speaking, carrying out instructions or opening their eyes
• have signs and symptoms that suggest the base of the skull is fractured, such as clear fluid running from the nose or ears, or very dark blotches above and below the eyes (“panda eyes”)
• have a seizure or fit after the injury
• have vomited more than once since the injury
• are unable to remember events more than 30 minutes before the injury
• have any signs of neurological problems, such as loss of feeling in certain parts of the body, problems with balance and walking, and persistent changes in eyesight

A CT scan is also recommended for adults who have experienced some loss of consciousness or memory since the injury and who:

• are aged 65 or over
• have a problem that makes them prone to uncontrollable bleeding, such as a blood clotting disorder (for example, haemophilia) or are taking the anticoagulant medication warfarin
• were injured in a particularly serious accident, such as a road accident or falling from a height of more than one metre

Children

A CT scan may be recommended in children who:

• lost consciousness for more than five minutes
• are unable to remember what happened before or after the injury and this has lasted more than five minutes
• are unusually drowsy
• have been sick three times or more since the injury
• had a seizure or fit after the injury
• have signs and symptoms that suggest the base of the skull is fractured, such as “panda eyes”
• have memory loss
• have a large bruise or wound to the face or head

A CT scan is also usually recommended for babies less than a year old who have a bruise, swelling or cut on the head bigger than 5cm (2 inches).

Treating concussion

There are some self care techniques you can use to relieve mild concussion symptoms. If more serious symptoms start to develop, you should seek immediate medical treatment.

Some self care techniques for mild symptoms of concussion are:

• if concussion has resulted from playing sport, you should stop playing immediately
• apply a cold compress to the injury to reduce swelling – a bag of frozen vegetables wrapped in a towel could be used, but never place ice directly on the skin as it’s too cold; apply the compress every 2 to 4 hours and leave it in place for 20 to 30 minutes
• take paracetamol to control pain – do not use non-steroidal anti-inflammatory drug (NSAID) painkillers like ibuprofen or aspirin as these can sometimes cause bleeding at the site of the injury
• get plenty of rest and avoid stressful situations where possible
• avoid drinking any alcohol or taking recreational drugs
• undertake a step by step return to work, college, school and sport – you can read more about this in the return to sports section
• only drive a car or ride a bike when you feel you have completely recovered
• do not play any contact sports for at least 3 weeks – this includes sports like football and rugby
• make sure you have someone to stay with you for the first 24 hours after the injury in case you experience more serious follow-up symptoms

When to seek follow-up advice

Sometimes the symptoms of a more serious brain injury do not occur for several hours, or possibly days, after the initial injury has taken place. This means it’s important that you remain alert for signs and symptoms that could suggest a more serious injury has occurred.

Immediate action required:

Go to your nearest A&E if you or someone in your care experiences symptoms like:

• unconsciousness or lack of consciousness, like problems keeping their eyes open
• mental confusion, like forgetting who or where they are
• any drowsiness that goes on for longer than one hour when they would normally be wide awake
• any problems understanding or speaking
• any loss of balance or problems walking
• any weakness in one or both arms or legs
• any problems with eyesight
• a very painful headache that will not go away
• any vomiting
• any fits or seizures
• clear fluid coming out of the ear or nose
• bleeding from one or both ears
• sudden deafness in one or both ears

Urgent advice:

Contact your GP if:

• your concussion symptoms last longer than 28 days

Returning to sports

You should rest for at least 24 to 48 hours after a concussion.

Following this, you can gradually return to normal life and then sport using a step by step approach. In the first 24 to 48 hours you can continue to do things like reading and walking.

You should carefully and slowly return to normal life to lower the risk of:

• making your symptoms worse or
• causing new symptoms.

You should only move to the next step if the activity isn’t making symptoms worse or causing new symptoms. If the activity makes your symptoms worse, then you should rest and try again the next day if you feel ready.

After the initial rest period, doing some light physical activity can be good for your recovery. You should aim to return to normal daily activities like work and education, before you return to sport.

Current UK concussion guidelines for non-elite (Grassroots) sports recommend these steps:

1. Relative rest for 24 to 48 hours – minimise screen time and do some gentle exercise.
2. Gradually introduce daily activities like reading and some light physical activity like walking.
3. Increase study or work-related activities with rest periods, increase the intensity of exercise.
4. Part time return to study or work and sports training – you should not take part in any activities that risks impact to your head.
5. If you’re not experiencing symptoms after resting for 14 days, you can consider returning to full sports training.
6. After 21 days, you can consider competitive sports again, as long as you’re symptom free after 14 days of rest and during training in stage 5.

You should stop experiencing symptoms after about 2 to 4 weeks. Sometimes it can take longer. Everyone’s recovery is different. It’s important to gradually return to your normal activities to reduce the risk of a further brain injury or longer-term problems.

Children and teenagers might take longer to recover than adults.

If you’ve like to read more about the step by step return to sport, you can read the full guidance on the Sport Scotland website.  

Complications of concussion

Post-concussion syndrome (PCS) is the term used to describe a collection of symptoms that can last for several weeks or months after the concussion.

The exact cause of PCS is not known. One theory is that PCS is the result of a chemical imbalance in the brain triggered by the initial injury that caused the concussion. Another theory suggests PCS may be caused by damage to nerve cells in the brain.

Symptoms of PCS

The symptoms of PCS fall into three main categories:

• physical
• psychological
• cognitive (affecting a person’s thinking ability)

Physical symptoms of PCS can include:

• headaches – often described as similar to migraines in that they cause a throbbing pain on one side or the front of the head
• dizziness
• feeling sick (nausea)
• sensitivity to bright lights
• sensitivity to loud noises
• ringing in the ears – the medical term for this is tinnitus
• double or blurred vision
• fatigue
• lost, changed or reduced sense of smell and taste

Psychological symptoms of PCS can include:

• depression
• anxiety 
• irritability
• lack of energy and interest in the world around you
• having problems sleeping
• changes in appetite
• sudden and inappropriate outbursts of emotion, such as having fits of laughter or crying for no apparent reason

Cognitive symptoms of PCS include:

• decreased concentration
• forgetfulness
• difficulty remembering things or learning new information
• difficulties with reasoning (working out problems)

Treating PCS

There is no specific treatment for the symptoms of PCS, though many medications used to treat migraines have also proved effective in treating the headaches caused by PCS.

Antidepressants and talking treatments such as psychotherapy may help control the psychological symptoms, such as depression and anxiety.

Most cases of PCS will resolve within three to six months, and only 1 in 10 people will still have symptoms after a year.

Preventing concussion

There are a number of commonsense precautions you can take to reduce your risk of concussion.

These precautions include:

• always wearing the recommended equipment when taking part in a contact sport such as rugby or boxing
• making sure any contact sport you or your child are taking part in is supervised by a properly qualified and trained person
• always wearing a seat belt when driving
• wearing a motorcycle helmet – this is a legal requirement if you are riding a motorcycle in Scotland
• wearing a cycle helmet – this is not a legal requirement, but cycle helmets have been recommended by several leading organisations, such as the Royal Society for the Prevention of Accidents

It is also easy to underestimate how many cases of concussion occur as the result of a fall or slip at home or in the garden, especially in older people. Following some or all of the suggestions below will help keep your home and garden as safe as possible.

• keep stairways clear so you do not trip over anything
• use appropriate safety equipment if you’re doing any kind of DIY
• use appropriate equipment to change a light bulb, such as a stepladder
• clean up spillages to prevent someone slipping

For more information, visit the Royal Society for the Prevention of Accidents website.

Concussion – causes, symptoms, diagnosis and treatment

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Concussion: causes, symptoms, diagnosis and treatment.

Definition

A concussion is a functionally reversible form of a closed craniocerebral injury without organic damage to the brain, caused by a bruise, blow and, in rare cases, as a result of a sudden movement of the head.

Causes of concussion

Concussion can be the result of a traffic accident, a fall, domestic, sports and industrial injuries, as well as injuries resulting from street fights and collisions during mass events, exposure to a blast wave. Even a seemingly minor head injury can lead to a concussion. Thus, the fact of the presence of an injury may already indicate a possible concussion.

The mechanism of concussion is not exactly known. Most likely, as a result of an injury, certain problems arise with the work of nerve cells in the brain (neurons). It is assumed that there is a functional disconnection between the brain stem and hemispheres. It is believed that due to concussion there is a temporary disruption of interneuronal connections. A slight displacement of the layers of the brain tissue may appear, their nutrition may worsen, and the connection between some brain centers will go wrong, which contributes to the development of functional disorders. At the same time, macroscopic and histological changes in the brain tissue are not detected.

Among all brain injuries, concussion ranks first in frequency. Most patients recover within 1-2 weeks.

If over time the patient’s condition continues to deteriorate, and more severe forms of traumatic brain injury are excluded, then it is necessary to look for other causes of the existing symptoms – psychological problems, mental illness, side effects of drugs or other concomitant diseases.

Disease classification

According to the International Classification of Diseases (ICD-10), concussion has the code S06.0. This nosology is one of the clinical forms of traumatic brain injury.

Depending on the severity of the patient’s condition and clinical symptoms, there are three degrees of concussion.

Mild concussion . The victim has no impairment of consciousness, but disorientation, headache, dizziness, nausea may occur during the first 20 minutes after the injury. Then the general state of health returns to normal. Perhaps a short-term increase in body temperature (37.1-38 ° C).

Moderate concussion . Although the victim does not lose consciousness, pathological symptoms such as headache, nausea, dizziness, and disorientation may be observed. All of them last more than twenty minutes. There may be short-term memory loss (amnesia), most often retrograde amnesia with loss of several minutes of memories preceding the injury.

Severe concussion . Necessarily accompanied by loss of consciousness for a short period of time, usually from several minutes to several hours. The victim does not remember what happened – retrograde amnesia develops. Pathological symptoms bother a person for 1-2 weeks after the injury (headache, dizziness, nausea, fatigue, disorientation, impaired appetite and sleep).

Symptoms of the concussion of the brain

Physical (somatic) symptoms :

• Dizziness, which, when changing the body position, turning or tilting of the head, is intensified – this is explained by a violation of blood circulation in the vestibular apparatus;
• throbbing headache;
• nausea;
• single vomiting;
• rapid breathing, tachycardia;
• blurred vision or double vision;
• flashing flies or stars before the eyes;
• imbalance;
• hypersensitivity to light or noise;
• ringing, tinnitus.

Behavioral, emotional symptoms :

• drowsiness;
• increased fatigue or general weakness;
• irritability;
• depression;
• anxiety;
• excessive hours of sleep;
• difficulty falling asleep.

Cognitive symptoms :

• lethargy and incoordination;
• short-term confusion;
• slow incoherent speech;
• difficulty concentrating;
• memory difficulties.

Diagnosis of concussion

Diagnosis of concussion is established on the basis of history, examination and exclusion of more severe traumatic brain injury.

The doctor examines the entire body of the patient for abrasions, bruises, joint deformities, changes in the shape of the chest and abdomen, and bleeding.

In the first hours after a concussion, the victim’s pupils are dilated or constricted – a traumatic brain injury of any severity leads to disruption of the nerve pathways responsible for the functioning of the eyes. Pupillary reaction to light is normal. The victim complains of pain when moving the eyes to the sides, there is a small horizontal nystagmus (involuntary tremulous movements of the eyeballs), if the eyes are taken to the most extreme positions. There may be slight asymmetry of tendon reflexes, unsteadiness in the Romberg position (legs together, straight arms extended forward to a horizontal level, eyes closed). The level of consciousness is assessed on the Glasgow Coma Scale and is 14-15 points.

The list of laboratory tests includes:

• complete blood count;

Clinical blood test: general analysis, leukoformula, ESR (with microscopy of a blood smear in the presence of pathological changes)

Synonyms: Complete blood count, UAC. Full blood count, FBC, Complete blood count (CBC) with differential white blood cell count (CBC with diff), Hemogram.
Brief description of the study CBC: general a…

Up to 1 business day

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General urinalysis (Urine analysis with sediment microscopy)

Method of determination

Determination of physical and chemical parameters is carried out on an automatic analyzer using the “dry chemistry” method.

Hardware microscope. ..

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Specific changes in the blood, urine and cerebrospinal fluid during concussion should be absent.

Instrumental diagnostics includes:

• x-ray of the skull – no skull fractures in concussion;

X-ray of the skull

X-ray examination of the skull to detect structural and integrity disorders of the skull bones of various nature.

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CT scan of the brain and skull

Scanning of the brain, skull and surrounding tissues, which allows diagnosing various pathologies.

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MRI of the brain

Safe and informative scanning of brain structures for the diagnosis of its pathologies.

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Electroencephalography (EEG)

EEG is a safe and painless method for studying the functional state of the brain.

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Transcranial Doppler Ultrasound

Ultrasound scanning to assess the consistency of cerebral blood flow.

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An MRI of the spine may be needed to rule out spinal problems.

MRI of the cervical spine

Examination to assess the condition of the cervical spine.

RUB 5,990

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Differential diagnosis is carried out with a brain contusion, asthenic condition of the patient, psychoemotional lability, alcohol intoxication, vegetovascular dystonia, postconvulsive syndrome.

Which doctors to contact

If you have a concussion, you need to contact a traumatologist. He examines the patient, collects an anamnesis, checks reflexes, prescribes an x-ray of the skull, and if a more complex brain injury is suspected, he sends him for a consultation to
neurologist or neurosurgeon.

Indication for specialist consultation:

• consultation
  otorhinolaryngologist to exclude pathologies of the ear, throat, nose;
• consultation of an ophthalmologist in order to exclude or confirm violations of the visual apparatus;
• consultation
  therapist for the purpose of correcting the treatment of concomitant pathology;
• consultation
  surgeon, maxillofacial surgeon and other narrow specialists according to indications.

Treatment of a concussion

If a concussion is suspected, first aid must be given to the victim, providing him with complete rest. It is necessary to lay a person in a quiet darkened room, it is better to raise his head slightly. It is very useful to apply cold compresses to the head. Patients with a concussion should remain in bed for at least a few days.

If you have a concussion, you can not read, listen to loud music and watch TV. It is not recommended to drink a lot. Alcohol is strictly prohibited!

Within 12 weeks after the injury, the patient should be under the supervision of a doctor in order to assess their condition and fully return to daily activity. To date, there are no effective drugs that accelerate the recovery period.

Non-narcotic analgesics, tranquilizers, hypnotics, sedatives are used as medicines. As a rule, this is enough.

In some cases, drugs are used to relieve cerebral edema, suppress the gag reflex, as well as antihistamines. If any vegetative symptoms are excessively expressed, then, for example, b-blockers may be required (with severe tachycardia and hypertension). Conduct courses of nootropic and metabolic therapy.

Hospitalization is indicated within three days after injury. The indication for emergency hospitalization is the fact of injury or the presence of severe cerebral and autonomic symptoms.

Complications

It must be remembered that a person who has suffered even a mild concussion may develop post-traumatic neurosis or other more serious complications, such as epilepsy. Approximately 3% of patients experience complications in the form of persistent asthenic syndrome, insomnia, migraines, intracranial hypertension and other conditions. Therefore, some time after recovery, you should definitely visit a neurologist and perform electroencephalography.

The consequences of a concussion of the brain can appear in a few years, significantly complicating the usual life.

The hardest thing is for those who, for one reason or another, did not seek medical help in time for the timely diagnosis of the problems that have arisen.

Concussion prevention

Concussion prevention consists of following the following rules: sports games;

Sources:

1. Big Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition, volume 24.
2. Mild traumatic brain injury: clinical guidelines / Potapov A.A., Likhterman L.B., Kravchuk A.D. etc. – M.: Association of Neurosurgeons of Russia, 2016. – 23 p.
3. Golovacheva V.A., Evzikov G.Yu. Management of a patient with a concussion. iDoctor 2014; 10(29): 60-63.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories can use different research methods and units of measurement to perform the same analyzes.

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symptoms, diagnosis and treatment in Moscow

Concussion is a relatively mild and reversible brain disorder without organic damage. A similar condition occurs as a result of a traumatic brain injury: a strong blow, bruise or sudden movement of the head. In this case, the brain is strongly shaken and soft tissues, by inertia, hit the inner vaults of the skull.

A concussion provokes not only the appearance of unpleasant symptoms characteristic of a head injury, but also structural changes in the brain, leading to various complications. Therefore, even if there are mild signs, it is necessary to consult a doctor in order to protect your health from the development of pathologies when a vital organ is injured.

Clinical picture in case of concussion

Clinical manifestations are explained by a violation of neural connections between the brain stem and cerebral hemispheres, displacement of layers of nervous tissue, and deterioration of blood supply.

Macroscopic and histological changes in cells as a result of concussion were not detected.

In the first time after injury, the neurological status of patients may show nystagmus (involuntary eye movements), slight asymmetry of reflexes, mild meningeal symptoms.

Classification

Depending on the severity of the injury, concussion is of three types and is accompanied by the following symptoms:

1. Mild degree.
   The person is conscious, for 30 minutes the victim experiences a headache, dizziness, nausea and loss of orientation in space. After half an hour passes, the person’s condition returns to normal.
2. Medium degree.
   Consciousness is preserved, short-term memory loss is detected. All other signs are similar to a mild form of concussion.
3. Severe degree.
   The victim loses consciousness from several minutes to several hours. In such a situation, the person does not remember what happened before the CNS (central nervous system) injury. In addition, dizziness, nausea, disorientation in space and headache may remain for 2-3 weeks. Sleep is disturbed and appetite is reduced.

Causes of concussion

What circumstances cause this pathological condition in adults and children:

• domestic bruises;
• sudden head movement;
• traffic accidents;
• sports or work injury;
• blows received during street fights and under other criminal circumstances.

Concussion symptoms

There are 3 groups of signs of the disease:

Pathogenesis

As a result of an injury, the characteristic symptoms appear due to a malfunction of the nerve cells of the brain. Their nutrition is deteriorating, the layers of the brain tissue are shifting, there is no connection between the brain centers.

In a severe form of the lesion, blood vessels rupture and some areas are severely damaged. The main danger in such a situation is intracranial bleeding, resulting in additional tissue compression.

Which doctor to contact if you suspect a concussion

Patients with traumatic brain injury should first see a traumatologist. The doctor will assess the severity of the damage, check the reflexes, and prescribe an x-ray of the skull. In the event of a serious injury, an additional consultation with a neurologist or neurosurgeon may be required.

If a patient has a concomitant injury with damage to the bones of the skull, dislocation or fracture of the cervical vertebrae, emergency surgical assistance is required.

Consultation with an otolaryngologist is required if there is bleeding from the ears or nose, damage to the nasal septum, or prolonged (more than a day) sensation of tinnitus.

If a contusion of the eyeball is suspected, the patient is referred to an ophthalmologist. If the patient does not get pain in the eyes, there is a decrease in vision, clouding or fuzziness of the picture, it is likely that TBI is accompanied by corneal edema or detachment of the iris.

How to identify a concussion

As a result of TBI, a person often loses consciousness for a period of several seconds to several minutes. When he regains consciousness, he does not understand where he is, does not remember recent events and hardly distinguishes faces. In severe cases, it can fall into a coma.

Concussion causes severe nausea or vomiting. The victim turns pale, cannot focus his eyes. In the first hours after the injury, the pupils are excessively dilated or, conversely, narrowed. A patient with such symptoms should not be left without medical attention.

Features of concussion in children and the elderly

The clinical picture largely depends on the age of the patient:

babies	With a concussion, they rarely have a violation of consciousness, but regurgitation during feeding and bouts of vomiting become more frequent. The skin suddenly becomes pale, anxiety and difficulty falling asleep against the background of general lethargy and drowsiness are noted. Concussion symptoms at this age go away after 2-3 days.
Preschoolers and younger students	The pathological condition usually proceeds without loss of consciousness. The pulse becomes labile. Often observed horizontal nystagmus and reduced corneal reflexes. The child is on the mend after 2-3 days after the injury, while in adults the regression of symptoms occurs only on the 5-9th day.
Elderly and senile people	Primary loss of consciousness is rare, but severe disorientation in time and space is common. Patients complain of severe throbbing pain in the back of the head, dizziness, memory disorders. Symptoms last from 3 to 7 days.

Diagnosis

If you have a concussion, you should consult a doctor in order to prescribe timely treatment, if necessary, that will help prevent the development of complications. When diagnosing, the doctor takes into account all the circumstances of the incident, so both the patient and the witnesses of the incident need to be told as much information as possible.

An important role is played by the presence of injuries on the head, the psychological state of a person, alcohol intoxication and other related factors. When collecting an anamnesis and examining the victim, the doctor checks for the absence of anisoreflexia (unequal reflexes on the right and left sides of the body) and prescribes additional research methods:

1. Magnetic resonance imaging (MRI) to detect edema, hemorrhage, bone and cerebral damage to the brain and facial part of the skull.
2. X-ray of the cervical spine allows you to determine whether the motor function of the vertebrae has been preserved. This study also shows the presence of fractures, dislocations and subluxations of the vertebrae.

In addition, if necessary, the specialist refers the patient for a consultation with a neurologist. May also require:

• electroencephalography;
• echoencephalography;
• Doppler study of cerebral vessels;
• MRI of the spine.

In severe cases, a lumbar puncture is performed according to the indications of a specialist. This study makes it possible to determine the pressure, transparency, color and composition of the cerebrospinal fluid.

First aid for concussion

The first thing to do is to call an ambulance. Only a health worker can correctly assess the patient’s condition and the likelihood of serious complications. Late referral to a doctor makes diagnosis difficult.

The victim needs to be kept calm. If possible, the patient should be placed in such a way that the head is located above the body. A cold compress or ice pack can be applied to the injury for 5 minutes.

An unconscious patient should be revived. However, if this is not possible, it must be laid on the right side, bending the left arm and leg at an angle of 90 degrees.

In this way, you will prevent tongue retraction or choking due to uncontrolled vomiting.

Do not give painkillers or other medicines until the doctors arrive, as they will distort the clinical picture.

Treatment

Treatment for concussion consists of bed rest and prescribed medications. It is extremely important for the victim to be at rest and get enough sleep. Symptomatic therapy for the elimination of functional abnormalities in the brain includes the following types of medicines:

• sedatives;
• painkillers;
• psychotropic and hormonal preparations;
• means to eliminate insomnia and more.

Also, in some cases, the introduction of an anesthetic at the site of attachment of the posterior neck muscles, as well as manual therapy and physiotherapy, are prescribed.

Prevention

In order not to treat a concussion that has occurred, it is necessary first of all to be careful during situations that can lead to a traumatic brain injury. When engaging in active sports, you need to use a protective helmet, and when driving in a car, buckle up. In winter, choose shoes with soles that reduce slippage during icy conditions or use special overlays.

Consequences and complications

If you do not treat in time and do not follow the recommendations of a qualified doctor, the following complications may develop:

• epilepsy;
• sleep disturbance;
• deterioration of hearing and vision;
• post-traumatic neurosis;
• vasomotor disorders, manifested by severe headaches, aggravated by physical exertion.

Forecast

The patient recovers completely if all doctor’s prescriptions are followed and in the absence of additional aggravating injuries. Some victims of concussion after the end of the acute period may experience a weakening of memory and attention. Headaches, irritability and depression, sleep disturbance and poor tolerance to loud sounds and bright lights may also appear.