Caring for Concussions | NIH News in Health

May 2020

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More Than a Bump on the Head

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Accidents happen. A fender bender. A collision while playing sports. Or a fall at home. Many types of accidents can cause a bang to the brain. Each year, more than 2 million people in the U.S. visit an emergency room for a traumatic brain injury. Many others experience a blow to the head but never see a doctor.

Brain injuries can range from mild to severe. The most common type of mild brain injury is a concussion. Concussions can be caused by an impact to your head or whiplash motion to your body that makes your brain bounce or twist inside your skull. That can stretch your brain cells and cause harmful chemical changes that interfere with brain activity.

Even though they’re called “mild,” concussions should be taken seriously, explains Dr. Geoffrey Manley, an NIH-funded traumatic brain injury researcher at the University of California, San Francisco.

Most people heal from a concussion relatively quickly. But some will experience long-term effects on their thinking, mood, balance, and more. “If you’re still feeling effects a year after your injury, there’s nothing mild about it,” he says.

Concussions are particularly common among children and young adults. Older adults—age 75 and up—also have a higher than average risk of concussion because they’re at higher risk for falls.

Being able to recognize the causes and symptoms of a concussion is important so you can reduce the risk of getting one and seek immediate treatment if you have one.

Seek Treatment

Some people may briefly lose consciousness right after a jolt to the head. Later symptoms can include headache, nausea, confusion, dizziness, or memory problems. Some people may also have sensitivity to light or noise, feel groggy or slow, or have changes to their sleep patterns.

“No two brain injuries are exactly the same,” says Dr. Dorian McGavern, a brain-injury researcher at NIH. Every person’s brain is a little different, and each impact can affect your brain differently, he explains.

Doctors have become much better at diagnosing concussions over the last decade, says Dr. Christina Master, an NIH-funded researcher studying children with traumatic brain injury at the Children’s Hospital of Philadelphia.

To diagnose a concussion, your doctor will ask how the injury happened and about your symptoms. They may also evaluate your balance, vision, and eye movements.

Most people with a suspected concussion don’t need additional tests. But those with more serious concussions may have bleeding or other damage in the brain. They may need an imaging test, like a CT scan, to detect these issues. A recently approved blood test can help doctors identify adults who need an imaging test.

Manley and other researchers are studying whether blood tests can better, and more quickly, diagnose concussions. “If we can identify who has a brain injury, we can treat them better, and make sure they don’t fall through the cracks,” he explains.

People with a concussion also need follow-up care. But Manley and others found in a recent study that fewer than half of people diagnosed with concussion in the ER receive such care. This lack of follow-up can prevent people from getting treatment that could improve their quality of life, Manley explains.

Drugs don’t yet exist to treat concussion itself. “But we have plenty of drugs and interventions for the side effects of traumatic brain injury,” he says. These include medications to help with chronic headache, depression, and sleep problems.

Avoid a Second Blow

The brain is more vulnerable to a second blow after a concussion. That’s because a concussion can damage nerve cells in the brain. It can also cause the blood vessels that feed the brain to become leaky.

The body usually repairs these blood vessels over a period of several weeks. But in some people, they don’t heal that quickly—or at all.

“Some vessels will still have cracks in the seals. This lets material from the blood enter into the brain,” McGavern says. “These leaks can continue for sometimes months or more after the initial injury.”

Material from the blood is not supposed to get into the brain. Its presence can trigger inflammation Heat, swelling, and redness caused by the body’s protective response to injury or infection. and other types of damage. This damage may help explain the long-term symptoms some people experience after a concussion, McGavern says.

It may also explain why another blow to the head soon after the first can be so dangerous. McGavern’s team found that blood vessels in mice that had a second brain injury within a day had difficulty healing. In contrast, blood vessels in mice that experienced a second injury later repaired themselves normally.

Take Time to Heal

After a concussion, the brain needs some rest. Research has shown that both children and adults benefit from reducing their mental and physical activity for a short time and should return to those activities gradually.

“Visual and balance problems can make it hard to do things like read, write, use an electronic device, or navigate a busy hallway,” Master explains. “Early recognition and accommodations for those problems can make a huge difference in the quality of life for people as they slowly return to work or school.”

People who have experienced a head injury shouldn’t feel frustrated if it takes up to a month to feel normal, she adds. “Rest” for someone with a concussion doesn’t mean doing nothing at all, Master says. Doing light physical activity and using your brain in ways that don’t make concussion symptoms worse can help you heal faster.

Physical rehabilitation programs can also help those with longer-lasting symptoms, explains Master. Talk with your doctor about how to return to your normal activity after a concussion. If symptoms persist, ask about physical therapy.

As scientists have come to understand the importance of protecting the brain after a concussion, new safety rules have followed, Master says. “In the last decade, every state in the nation has passed ‘return to play’ legislation,” she explains.

These rules, designed to protect youth athletes playing school sports, mandate a period of recovery for young athletes after a brain injury. It also requires a doctor-supervised period of gradual physical activity before returning to sports.

“These rules make sure that we don’t return athletes back to play before they are recovered, where another injury could cause more significant problems,” Master says.

Everyone can take steps to decrease their risk of concussion. See the Wise Choices box for tips.

What to do if you have a concussion: four helpful tips

We’ll go over what to do if you suspect you or someone you know has a concussion, including when to seek medical attention at your local CityMD location and how to best care for yourself during recovery.

Concussion symptoms

Concussions can cause a range of symptoms that vary from person to person, but some of the most common ones include the following:

• Headaches
• Dizziness
• Nausea
• Vomiting
• Confusion
• Memory problems
• Sensitivity to light and noise
• Changes in mood or behavior

You may also have difficulty concentrating, feel fatigued or drowsy, and have trouble sleeping. Some people who have a concussion may even lose consciousness.

If you have recently experienced a head injury and have any of these symptoms, seek medical attention right away. At CityMD, our team of medical professionals can help diagnose your concussion, ensure you receive the proper care and treatment, and help you on the road to recovery.

What to do if you have a concussion

If you suspect that you or someone you know has a concussion, there are several steps you should take to ensure a safe and effective recovery.

Here are four helpful tips for when you have a concussion.

1. Rest

You need to give your brain time to heal. That’s why it’s crucial to avoid physical and mental activity as much as possible in the days following the injury.

This means avoiding screens, including TVs, computers, and smartphones, and taking a break from physical activities like sports or exercise.

2. Monitor your symptoms

Keep an eye out for any changes in your symptoms. Let your doctor know if you experience any new or worsening symptoms.

Be honest with your doctor about how you’re feeling. This will help them provide you with the best possible care.

3. Seek medical attention

Make an appointment with a physician right away if you think you have a concussion. At CityMD our providers can assess the severity of your injury and recommend the appropriate treatment.

4. Follow your doctor’s instructions

Your doctor will provide specific instructions for your recovery, including when it’s safe to return to school or work, when you can resume physical activity, and any medications you may need to take.

Remember, recovering from a concussion can take time, so try to be patient and take care of yourself during the process. Most people can fully recover from a concussion with the proper care and treatment.

What not to do when you have a concussion

When it comes to concussions, there are certain things you should avoid to ensure a safe and effective recovery.

Here are some things you should NOT do if you suspect you have a concussion.

1. Don’t ignore your symptoms

It’s important to take your symptoms seriously and seek medical attention right away. Ignoring your symptoms or trying to “tough it out” can worsen your injury and delay your recovery.

2. Don’t return to physical activity too soon

Give your brain time to heal.

Avoid physical activity until your doctor says it’s safe to resume. Returning to sports or exercise too soon can increase your risk of another concussion and other serious complications.

3. Don’t drink alcohol or use drugs

Alcohol and drugs can slow your recovery and increase your risk of further injury. Avoid these substances until you recover from a concussion.

4. Don’t take medications without your doctor’s approval

Some medications can make a concussion worse. Check with your doctor before taking any new drugs or resuming any medications you were taking before your injury.

Remember, a concussion is a serious injury that requires proper care and attention. You can ensure a safe and effective recovery by following these tips and listening to all of your doctor’s instructions.

Concussion treatment At CityMD

At CityMD, we understand the importance of prompt and effective treatment for concussions. Our experienced doctors and medical staff are trained to provide comprehensive care for all head injuries, including concussions.

From evaluations to treatment and aftercare, our providers will answer any questions or concerns you may have throughout the recovery process.

If you suspect you or someone you know has a concussion, don’t hesitate to visit any CityMD urgent care location for prompt and effective treatment. Just walk in.

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.

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:

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

Symptoms of concussion

There are 3 groups of symptoms 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 a 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, an emergency surgeon is needed.

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

In case of a concussion, it is necessary to consult a doctor in order to prescribe timely treatment, if necessary, which 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 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 region skulls.
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, the specialist, if necessary, refers the patient to 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

First of all, the victim should 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, an anesthetic injection 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 disorder;
• impairment 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.

All described post-traumatic symptoms can be observed from 3 to 12 months. In the future, unpleasant symptoms either completely disappear or are significantly smoothed out.

Author

Savchenko Sergey Vladimirovich

traumatologist-orthopedist

Doctor of the highest category, candidate of medical sciences

Experience 41 years

+7 (495) 032-15-21

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Concussion: causes, symptoms, diagnosis and treatment.

Definition

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

Causes of a concussion

A 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.

Classification of the disease

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 of 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.

Concussion diagnosis

Diagnosis of concussion is established on the basis of history, examination and exclusion of a 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…

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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 violations of the structure and integrity of the bones of the skull 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.

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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 advice:

• 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 concussion

If a concussion is suspected, first aid must be given to the victim, ensuring 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 the injury. An 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.

Prevention of concussion

Prevention of concussion 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 may use different research methods and units of measurement to perform the same analyzes.

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