Concussion Overview & Treatment

A concussion is a mild traumatic brain injury (MTBI) that results from forceful impact. Concussions may lead to a temporary lapse in cognitive function and can be accompanied by loss of consciousness in 10% of patients who sustain concussions.

The human brain tissue is quite soft and pliable and is protected by a buffering layer of cerebrospinal fluid (CSF). CSF serves to protect the brain from light trauma. However, severe brain injury may occur depending on the extent of impact and rotational forces on the brain and brain stem. These forces may result in bruising and or bleeding with damage to brain tissue. While traumatic brain injuries may bruise a specific area of the brain, effects may be widespread throughout the brain.

Concussions may result from any sort of blow, impact, or trauma to the head. Some of the most common causes of concussion include:

1. Automobile & Motorcycle Accidents
2. Sports-Related Injuries and Collisions
3. Bicycle Accidents
4. Falls

Common potential risk factors for concussions include:

1. Alcohol consumption
2. Athletic activity

Common Symptoms of Concussions

Concussions may present a series of symptoms, depending on severity. Generally, symptoms begin immediately after injury is sustained. Symptoms may be physical, cognitive, or emotional in nature.

Physical Symptoms:

• Headache
• Dizziness
• Vomiting
• Difficulty with Coordination and Balance
• Light Sensitivity
• Blurred Vision
• Tinnitus [Ringing in Ears]

Cognitive Symptoms:

• Disorientation
• Difficulty Concentrating
• Loss of Consciousness
• Retrograde Amnesia [Inability to remember events prior to injury]
• Confusion
• Slurred/Incoherent Speech
• Changes in sleeping patterns
• Difficulty with Reasoning

Emotional:

• Mood Swings/Inability to regulate emotion
• Irritability
• Loss of appetite
• Tearfulness/Sadness
• Restlessness
• Lethargy

Most concussion symptoms [80-90%] improve within days to weeks.

Diagnosing Concussions

Diagnoses are dependent on a careful neurological examination with cognitive testing.  Imaging studies such as CT or MRI scans are usually normal in mild concussions but may be indicated depending on the individual’s symptoms and neurological examination.

Neurological Examinations

A medical professional may perform a neurological examination to determine the severity or prevalence of mild traumatic brain injury(MTBI). Components of a neurological examination may include:

• Vision Test
• Hearing Test
• Balance Test
• Coordination Test
• Reflex Test

Concussion-Specific Tests

In some circumstances, neurologists and athletic departments may administer a concussion-specific test. In this case, post-concussion scores are compared to a baseline score that was produced by the individual prior to the injury. Medical professionals are then able to contrast scores to assess severity. Concussion-specific tests incorporate a combination of recall and memory tasks and may test balance and vision as well.

Imaging Tests

In more serious circumstances, individuals may undergo neurological imaging tests. Imaging tests may provide insight regarding intracranial swelling, brain contusions or hemorrhage within the brain cavity.  Imaging tests include:

• Computerized Tomography(CT) Scan
• Magnetic Resonance Imaging(MRI) Scan

Cognitive Tests

Medical professionals may also conduct a cognitive assessment. Cognitive assessments include:

• Memory
• Recall
• Concentration & Attention

If you suspect that somebody has sustained a concussion, seek help from a medical professional.

Treatment of Concussions

Those diagnosed with a concussion are usually instructed to decrease their normal activity. Individuals should refrain from engaging in physical or cognitively-demanding activities until cleared by a medical professional. Most (80-90%) mild concussion symptoms resolve within 7-10 days. Examples of cognitive and physical rest includes:

Cognitive

• Reducing school or academic work
• Refraining from Video games
• Refraining from Text messaging
• Reduced Television Consumption
• Avoiding artificial light sources

Physical

• Reducing Rigorous Activity or Physical Conditioning
• Avoiding Sport-specific activities

Individuals may take mild medication as recommended by their physicians for headache, depression or  sleep-related issues. Once cleared by a medical professional, individuals may begin to gradually return to normal activities according to specific concussion protocols. It is not recommended to immediately engage in activities where contact is likely. If symptoms resurface while following prescribed protocols for return to normal activity, seek medical attention.

Students who have sustained a concussion, may on advice of their physicians, consider having accommodations put in place by school administration to include reduced homework, altered class schedules, or home schooling.

Prevention of Concussions

The risk of concussion is greatly reduced by:

• Wearing protective headgear in contact sports
• Wearing seatbelts and using airbags in cars
• Keeping areas clean and clutter-free to prevent falls

Read Dr. Goldfarb’s article on the prevention of sports related head injuries.

Observation

In some circumstances [less than 1% of concussions], mild traumatic brain injury (MTBI) may be accompanied by brain hemorrhage. This condition can be potentially life-threatening. Following a concussion, one should seek evaluation by a medical professional for further evaluation and treatment.  If a post concussion patient experiences an increase in symptoms they should seek medical re-evaluation.

Multiple Concussions

Research studies have concluded that repeated concussions have cumulative effects on the brain.  The severity of concussion symptoms may worsen in an individual who has sustained multiple concussions.  Cumulative effects may include:

• Long-term memory loss
• Psychiatric Disorders
• Emotional Instability
• Chronic Traumatic Encephalopathy (CTE)