How do doctors diagnose and treat a concussion? Discover the step-by-step process of concussion testing, the role of neuroimaging, and effective treatment options for managing post-concussion symptoms.

Diagnosing a Concussion: The Comprehensive Evaluation Process

When a person sustains a head injury, the first step in the diagnostic process is to rule out any serious structural damage to the brain. Patients taken to the emergency room will undergo basic neurological tests, as well as neuroimaging scans such as MRI or CT scans. These imaging tests are primarily used to identify any visible injuries, such as bleeding or structural abnormalities, which would indicate a more severe traumatic brain injury (TBI) rather than a concussion.

If the scans reveal no visible injury, the patient will then be evaluated for a concussion. This evaluation involves several key steps:

Documenting Retrograde and Post-Traumatic Amnesia

The healthcare provider will interview the patient to determine the extent of any memory loss before (retrograde amnesia) or after (post-traumatic amnesia) the injury. Post-traumatic amnesia is considered a strong indicator of the patient’s prognosis after a concussion, so this step is crucial.

Assessing Symptoms and Neurological Functions

The healthcare provider will use standardized scales, such as the SCAT-2 (Sideline Concussion Assessment Tool), to evaluate the patient’s range and severity of post-concussion symptoms, as well as their attention, memory, balance, and coordination. They will also perform a comprehensive neurological examination to check for any signs of neurological impairment.

Referral to a Concussion Specialist

If a concussion is diagnosed, the patient is typically sent home with instructions to be closely monitored for any signs of deterioration. In the days following the injury, the patient should be seen by a concussion expert, which may be a physician specializing in brain disorders (neurosurgeon or neurologist) or a neuropsychologist with expertise in assessing brain function.

Treatment and Management of Concussions

The primary treatment for a concussion is rest, both physical and mental. This includes refraining from exercise, sports, and other physical activities, as well as avoiding mental tasks that require intense concentration, such as reading, watching TV, or using a computer. These activities can worsen the patient’s symptoms, which may include headache, visual disturbances, sensitivity to light and sound, and concentration problems.

Gradual Return to Activities

The patient’s return to work, school, or athletics is often recommended to be gradual, starting with half-days if possible. Schools and workplaces may offer neuropsychological consultations to help identify any residual problems and make recommendations for a safe, gradual return to full-time activities.

Adherence to Return-to-Play Guidelines

For athletes, it is crucial to follow the CDC guidelines for returning to play after a concussion. Coaches and parents should work closely with the concussion expert to ensure the athlete adheres to the prescribed schedule and does not return to play too soon, which could increase the risk of further injury.

Prognosis and Recovery Timeline

The signs and symptoms of an uncomplicated concussion usually resolve within one to two weeks. It is rare for symptoms to last longer than a month. However, it is essential to follow the guidance of a concussion expert to ensure a safe and complete recovery, as rushing back to normal activities can prolong the recovery process or increase the risk of further injury.

The Role of Neuroimaging in Concussion Diagnosis

While concussions do not typically cause structural damage to the brain, neuroimaging tests such as MRI and CT scans are still an important part of the diagnostic process. These scans are primarily used to rule out more serious traumatic brain injuries, such as bleeding or structural abnormalities, which would require immediate medical intervention.

If the neuroimaging tests show no visible injuries, the patient will then be evaluated for a concussion using the comprehensive steps outlined earlier. It is important to note that a normal neuroimaging result does not necessarily rule out a concussion, as the brain function may still be impaired despite the lack of structural damage.

Concussion Management: A Multidisciplinary Approach

Effective management of a concussion often involves a multidisciplinary team of healthcare providers, including physicians, neuropsychologists, athletic trainers, and other specialists. This collaborative approach ensures a comprehensive evaluation and customized treatment plan to address the patient’s specific needs and facilitate a safe, gradual return to their normal activities.

By working closely with a concussion expert, patients can receive the necessary support and guidance to navigate the recovery process and minimize the risk of long-term complications or premature return to activity, which could potentially lead to further injury.

Conclusion

Diagnosing and treating a concussion is a multifaceted process that requires a comprehensive evaluation and a carefully planned recovery strategy. By understanding the steps involved in concussion testing and management, individuals can better advocate for their healthcare needs and work closely with their medical team to ensure a safe and complete recovery.

Diagnosing and Treating Concussion | Brain & Spine Center

Many concussions are diagnosed in the emergency room after a fall or accident, or after an incident on an athletic playing field. Others are diagnosed later, when a person who’s suffered a head injury seeks medical care for the symptoms. (See Symptoms of a Concussion.) Coaches, athletic trainers and parents of athletes should also be trained to look for signs of concussion, so that they can make an immediate sideline assessment. (Download a PDF of a wallet card that can be used at athletic events to help evaluate players for concussion.)

Anyone taken to an emergency room with a head injury will be given basic neurological tests, and may have neuroimaging tests such as an MRI scan or CT scan. A concussion does not cause structural injury to the brain, so these scans are used primarily to rule out a more serious injury, especially bleeding inside the skull.  If the scans show visible injury, the diagnosis is usually “mild traumatic brain injury” (TBI). If the scans show no visible injury, the patient will be evaluated for concussion.

Since there’s no simple test for diagnosing a concussion, the process takes several steps:

• Interview to document the extent of any retrograde amnesia (loss of memory of the events immediately before the injury), loss of consciousness, or post-traumatic amnesia (loss of memory of events after the injury).  Post-traumatic amnesia is the best indicator of a patient’s prognosis after a concussion, so this step is extremely important.
• Determination of the range and severity of post-concussion symptoms on the field. There are several standardized scales, the most common of which is the SCAT-2 (Sideline Concussion Assessment Tool). This scale inquires about symptoms, attention, and memory; asks about recent events in the game; and checks balance and coordination.  (Download the SCAT-2.)
• Examination for any neurologic signs or symptoms:  Tests of strength, sensation, reflexes, coordination, cranial nerve functions, mental status, and other neurologic functions to determine any serious injury to the brain.

If the diagnosis is concussion, the patient is usually sent home with instructions to stay awake for several hours (or have someone wake them up to be sure they can be roused) and watch for signs of bleeding in the brain (primarily lethargy or a decline in mental status).

In the days following a concussion the patient should see a concussion expert.  That concussion expert could be a physician specializing in brain disorders (a neurosurgeon or neurologist) or a neuropsychologist specializing in assessing brain disorders through tests of mental functions such as attention, concentration, and memory.  Often a physician specializing in concussion works with a neuropsychologist as part of a team approach, ensuring a comprehensive evaluation and diagnosis.  (See Doctors Who Treat Concussion and find out more about our Concussion Program.)

Treatment Options
There is no specific treatment for concussion other than rest — both physical and mental. This includes refraining from exercise, sports or other physical activities, and often refraining from reading, watching TV, or using a computer, all of which can worsen symptoms such as headache, visual disturbances, sensitivity to light and sound, and concentration problems. Strenuous mental tasks that require intense concentration (homework, difficult tasks at work) may also worsen symptoms. Patients are advised to avoid any activity that could cause further head injury, including riding a bicycle, roller skating, even riding a roller coaster.

The patient’s return to work, school, or athletics is sometimes recommended to be gradual, starting with half-days if possible. Many schools offer injured students neuropsychological consultations that can help identify possible residual problems and make recommendations for gradual return to school. Similar consultations for adults can help guide a safe return to full-time work.

Athletes should follow the CDC guidelines for returning to play, and coaches and parents should work together to be sure young athletes adhere to the schedule. Some coaches and most athletic trainers are certified in concussion management, but many are not. Patients and parents should rely on sound medical advice from a concussion expert — either a physician or a neuropsychologist with experience assessing concussion — to ensure a safe return to play.

The signs and symptoms of uncomplicated concussion usually run their course in one to two weeks, and it is very rare to have symptoms that last longer than a month.  

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Concussion Signs, Diagnosis, and Treatment

A concussion is a mild traumatic brain injury caused by a direct or indirect hit to your head or body.

Your brain sits inside your skull surrounded by fluid. When your head or body takes a hit, your brain shifts or shakes around inside the skull.

The impact damages your brain cells, causing chemical and cellular changes in the brain.

Concussion causes and risk factors

Concussions can happen from a direct hit to the head in contact sports, in a car crash, or during a hard fall. But they can also happen from an indirect hit that causes your head to jerk, like when you get whiplash.

Sports that increase an athlete’s risk of head trauma include:

• Football
• Hockey
• Soccer

Younger athletes and females tend to take longer to get better from concussions. While sports concussions are common, people sustain concussions in all types of activities in daily life.

Concussion side effects and complications

Side effects of a concussion cause changes in how the brain functions, such as reduced reaction time. Other common symptoms are included in the next tab. This can increase your chance of getting another concussion if you return to play before seeking treatment.

No athlete should return to the game until all symptoms are gone and a doctor has cleared him or her to play.

Why choose UPMC for concussion treatment?

Every concussion is unique. There are six clinical types, based on concussion signs and symptoms.

This is why — when it comes to concussion treatment — there isn’t a one-size-fits-all model.

The experts at the UPMC Sports Medicine Concussion Program have been leading active, individualized concussion treatment in Pittsburgh since 2000.

Our team tailors active concussion recovery programs to meet each person’s:

• Goals
• Lifestyle
• Symptoms

We treat athletes and non-athletes of all ages, via in-person and virtual appointments. 

Make an appointment for concussion care

If you — or your coaches, parents, or athletic trainers — suspect you have a concussion, it’s crucial that you:

• Stop playing your sport right away.
• See a health professional specially trained in concussion care.

To make an appointment or learn more about concussions, contact the UPMC Sports Medicine Concussion Program at 412-432-3681.

Learn more about concussions

Learn how UPMC Sports Medicine is ReThinking Concussions or see the links below (links open a new browser window):

UPMC’s HealthBeat Blog:

• Debunking the Top Concussion Myths
• Questions to Ask Your Doctor About Concussions
• Quiz: How Much Do You Know About Concussions?

From our Health Library:

• Traumatic Brain Injury

Which doctor treats Concussion in Moscow, make an appointment with a doctor online – Doctor Nearby Clinic

Which doctor treats Concussion in Moscow, make an appointment with a doctor online – Doctor Nearby Clinic

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Symptoms

• Headache
• mood swings
• Weakness
• Nausea
• Dizziness
• Vomit
• Drowsiness
• Hand shake
• memory impairment
• Loss of consciousness
• Nosebleeds
• Irritability
• Apathy
• Memory loss
• Nervousness
• Head shake

If you experience more than half of the listed symptoms, we recommend that you immediately consult a doctor for advice.

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Kameneva Anastasia Sergeevna

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Clinics in Moscow where this disease is treated

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Osteopaths.

Making an appointment with an osteopath doctor in Moscow. Where does a good osteopath see?

How does osteopathy help with concussions

A concussion is a mild form of brain injury. It is believed that the manifestation of concussion is based on a violation of the connections between nerve cells, mainly functional.

Concussion in terms of frequency of occurrence takes the first place in the structure of craniocerebral traumatism. The causes of concussion are both traffic accidents and domestic, industrial and sports injuries; criminal circumstances also play a significant role.

Symptoms of a concussion

Immediately after the concussion may be observed

Single vomiting,

Some rapid breathing increase or decrease in heart rate,

but these indicators will soon normalize. Blood pressure quickly returns to normal, but in some cases it can steadily increase – this is due not only to the injury itself, but also to the stress factors that accompany it. Body temperature during concussion remains normal.

After regaining consciousness, complaints of headache, dizziness, weakness, tinnitus, flushing of the face, sweating, discomfort and sleep disturbance are typical. There are pains when moving the eyes, divergence of the eyeballs when trying to read.

With a concussion, the general condition of the victims usually improves rapidly during the first, less often the second week. However, it should be borne in mind that headaches and other subjective symptoms can last much longer for various reasons.

Age-related features of manifestations

The pattern of brain concussion is largely determined by age factors.

In infants and young children, concussion often occurs without loss of consciousness. At the moment of injury – a sharp pallor of the skin (primarily the face), palpitations, then lethargy, drowsiness. There are regurgitation during feeding, vomiting, anxiety, sleep disorders are noted. All manifestations disappear in 2-3 days.

In children of younger (preschool) age, a concussion may occur without loss of consciousness. The general condition improves within 2-3 days.

In the elderly and the elderly, the primary loss of consciousness during a concussion of the brain is observed much less frequently than in young and middle age. At the same time, pronounced disorientation in place and time is often manifested. Headaches are often pulsating in nature, localized in the occipital region; they last from 3 to 7 days, differing in significant intensity in persons suffering from hypertension. Frequent dizziness.

Diagnosis of concussions

In the diagnosis of a concussion, it is especially important to take into account the circumstances of the injury and the information of witnesses to the incident. Traces of trauma on the head and factors such as alcohol intoxication, the psychological state of the victim, etc. can play a dual role.

Various functional studies (electroencephalography, ophthalmoscopy, ultrasonic intracranial dopplerography, etc.) can indirectly contribute to the objectification of concussion of the brain. The most informative is an otoneurological study (preferably using electrogustometry, audiometry, electronystagmography).

There are no skull fractures in concussion. The pressure and composition of the cerebrospinal fluid without deviations. M-echo is not shifted.

Computed tomography in patients with concussion does not reveal traumatic abnormalities in the state of the brain substance (the density of gray and white matter remains within the normal range – 33-45 and 29-36 H, respectively) and CSF-containing intracranial spaces. The data of magnetic resonance imaging in concussion also do not reveal any lesion.

Treatment of concussions

First aid for concussions

th position with a slightly raised head.

If the person who received a concussion continues to be unconscious, the so-called rescue position is preferable – on the right side, the head is thrown back, the face is turned to the ground, the left arm and leg are bent at a right angle in the elbow and knee joints (preliminary it is necessary to exclude fractures of the limbs and spine). This position, ensuring the free passage of air into the lungs and the unimpeded outflow of fluid from the mouth, prevents respiratory failure due to retraction of the tongue, leakage of saliva, blood, and vomit into the respiratory tract. If there are bleeding wounds on the head, apply a bandage.

All victims with concussion, even if it seems to be mild from the very beginning, are to be transported to the emergency hospital, where the primary diagnosis is specified. Victims with a concussion are placed on bed rest for 1-3 days, which is then, taking into account the characteristics of the course of the disease, gradually expanded over 2-5 days, and then, in the absence of complications, discharge from the hospital for outpatient treatment (lasting up to 2 weeks) is possible. ).

Drug therapy

Drug treatment for concussion is mainly aimed at normalizing the functional state of the brain, relieving headache, dizziness, anxiety, insomnia and other complaints.

Usually, the range of drugs prescribed at admission includes painkillers, sedatives and sleeping pills, mainly in the form of tablets, and if necessary, injectables. Among the painkillers (analgin, pentalgin, baralgin, sedalgin, maxigan, etc.), the most effective drug for this patient is selected. Similarly, they act in case of dizziness, choosing one of the available drugs (belloid, bellaspon, platifillin with papaverine, tanakan, microzer, etc.).

Valerian, motherwort, corvalol, valocordin, as well as tranquilizers (elenium, sibazon, phenazepam, nozepam, rudotel, etc.) are used as sedatives. To eliminate insomnia at night, phenobarbital or reladorm is prescribed.

It is advisable to conduct a course of vascular and metabolic therapy for a faster and more complete recovery of brain function disorders. Preferably a combination of vascular (cavinton, stugeron, sermion, teonicol, etc.) and nootropic (nootropil, encephabol, aminolon, picamilon, etc.) drugs. As options for possible combinations, a daily three-time intake of Cavinton, 1 tab. (5 mg) and nootropil 2 caps. (0.8) or stugeron 1 tab. (25 mg) and encephabol 1 tab. (0.1) for 1-2 months.

To overcome frequent asthenic phenomena after a concussion, the following are prescribed: pantogam 0.5 3 times a day, cogitum 20 ml 1 time a day, vasobral 2 ml 2 times a day, multivitamins-polyminerals such as “Unicap-T”, Centrum, Vitrum, etc. 1 tab. 1 per day. Of the tonic preparations, ginseng root, eleutherococcus extract, lemongrass fruits, saparal, pantocrine are used. In elderly and senile patients who have suffered a concussion, anti-sclerotic therapy is increased. Also pay attention to the treatment of various concomitant diseases. To prevent possible deviations in the successful completion of a concussion, a dispensary observation is required for a year with a neurologist at the place of residence.

Prognosis

With adequate observance of the regimen and the absence of circumstances aggravating the injury, concussion ends with the recovery of the victims with full restoration of working capacity.

In a number of patients, after the acute period of concussion, there is a weakening of concentration, memory, depression, irritability, anxiety, dizziness, headaches, insomnia, fatigue, increased sensitivity to sounds and light. 3-12 months after the concussion, these signs disappear or are significantly smoothed out.

However, in 3% of patients after a concussion, moderate disability occurs if the recommended treatment regimen and behavior are not followed. This can lead to a lengthening of the recovery period and the occurrence of various consequences: asthenic syndrome, vegetative-vascular dystonia, insomnia and other disorders. With alcohol abuse, the development of epileptic seizures is possible.

Treatment of concussion in osteopathic medicine

(what ordinary medicine does not do)

The osteopathic doctor, acting on the membranes of the brain, improves and restores its blood circulation, prevents the formation of adhesions, which are an inevitable factor for the occurrence of headaches, increased intracranial pressure, spasms of cerebral vessels brain. Headache especially often torments patients after closed craniocerebral injuries.

Osteopathic techniques are aimed at restoring the circulation of the interstitial fluid, and hence the normalization of biochemical processes in tissues and cells.

What is being done for this:

– the balance of blood circulation in the body is normalized by synchronizing the work of the cranial, cervical, cervicothoracic, thoracic and pelvic diaphragms;

– the cervicothoracic junction opens for the outflow of venous blood from the brain;

– places of attachment of the dura mater in the cervical and sacral sections are released;

– increases the outflow of venous blood from the skull by releasing the sinuses of the dura mater (the main place of outflow of blood from the skull) and the cervical jugular vein;

– circulation of cerebrospinal fluid in the skull and spinal canal is normalized;

– a new balance is established between the spheres of the skull;

– the biodynamic balance of the entire nervous system is restored;

Observations show that in the treatment of concussion by an osteopathic doctor, the time for healing of fractures is significantly reduced, joint mobility is restored faster, pain and muscle spasms are relieved, the range of motion is expanded, and the process of rehabilitation after injuries is accelerated.