Description

The term "concussion" is often used interchangeably with the term “acute mild traumatic brain injury (TBI)" which is the result of a head injury, usually due to contact. The brain bumps against the inside of the skull as a result of acceleration followed by rapid deceleration and there is a temporary disruption of normal brain functions. While loss of consciousness (LOC) is common with concussions, one can suffer a concussion without LOC. While a concussion can have serious ramifications, it is usually not life threatening, unlike other forms of more serious TBI.

Motor vehicle or bicycle accidents, physical assaults, falls and sports injuries are common causes of concussion.  Motor vehicle accidents account for nearly 50% of all TBI requiring hospitalization. It is estimated that 2.5 million people sustain a TBI every year in the United States, of which more than 75% are considered mild.

Symptoms

The hallmark symptoms of concussion are confusion and amnesia, with or without preceding loss of consciousness, and may appear immediately after the injury or several minutes later.  The amnesia often involves loss of memory for the traumatic event and frequently includes loss of memory for events before (retrograde amnesia) or after (anterograde amnesia) the head injury.  Loss of consciousness is the most serious presentation and should prompt immediate medical attention.

Other common signs and symptoms observed in someone with a concussion include:

• Decreased appetite and changes in sleep habits.
• Decreased concentration.
• Feelings of depression.
• Increased irritability, anxiety, fatigue, decreased energy and malaise.
• Dizziness, lightheadedness, ringing in the ears.
• Sensitivity to light, noise and sound.
• Incoordination, stumbling, inability to walk in a straight line
• Headache

Diagnosis

Concussion is a clinical diagnosis based on history, examination and possibly testing.  History includes questioning people with a suspected concussion regarding many aspects of the injury including the presence or absence of LOC.  Neurological examination includes checking memory, strength, sensation, reflexes, coordination, and balance. Testing may include neuroimaging studies (CAT scan or MRI) and/or brain wave studies (EEG).  An acute evaluation with a head CT is recommended for the following:

• Suspected skull fracture
• 2 or more episodes of vomiting
• Focal neurologic deficit (double vision, persistent focal numbness or weakness, loss of coordination or balance, persistent amnesia)
• Head injury in someone who is on a blood thinner
• Age 60 years or older

Treatment

Observation is important after the injury for at least 24 hours after a concussion because of the risk of intracranial complications including brain swelling and bleeding. The development of any of the following symptoms during the initial observation period would warrant immediate medical attention:

• Headaches that worsen and do not resolve
• Weakness, numbness, impaired coordination
• Slurred speech
• Increasing confusion
• Persistent drowsiness
• Convulsions or seizures

Rest is generally the cornerstone of recovery. Many people require a temporary decrease in their hours of work and restrictions on physical activities. Healing from a concussion can take weeks to months. Certainly one must avoid activities which increase the risk of a second head injury before all symptoms of the first head injury have resolved.  People with a concussion should not return to sports until cleared by a physician.

Prevention of Concussions

• Always wear a seatbelt when in a motor vehicle
• Wear a helmet when riding a bike/motorcycle/motorized scooter, playing contact sports, skiing, horseback riding, or snowboarding
• Minimize your fall risk by optimizing vision, paying attention when walking outside, and being mindful of obstacles in your path