Concussion

Overview

A concussion is a type of traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and sometimes stretching and damaging brain cells. Despite being classified as a "mild" brain injury because concussions are usually not life-threatening, the effects can be serious and require proper medical attention and management.

Concussions are often referred to as "invisible injuries" because they typically don't show up on standard imaging tests like CT scans or MRIs. The injury occurs at a cellular level, affecting how brain cells function rather than causing visible structural damage. This functional disturbance can affect various aspects of brain activity, including thinking, memory, balance, mood, and sleep patterns. Each concussion is unique, and symptoms can vary widely from person to person and injury to injury.

The understanding of concussions has evolved significantly in recent years, particularly regarding their potential long-term effects and the importance of proper recovery protocols. While most people recover fully from a concussion within days to weeks, some individuals may experience prolonged symptoms known as post-concussion syndrome. Additionally, research has shown that repeated concussions, especially when occurring before full recovery from a previous injury, can have cumulative effects and may lead to long-term neurological problems.

Symptoms

Concussion symptoms can be subtle and may not appear immediately. They can last for days, weeks, or even longer. Symptoms generally fall into four categories: physical, cognitive, emotional, and sleep-related.

Common Physical Symptoms

Cognitive Symptoms

• Memory problems or feeling foggy
• Confusion or feeling "in a fog"
• Difficulty speaking or finding words
• Difficulty concentrating
• Feeling mentally "slow"
• Difficulty thinking clearly

Emotional/Mood Symptoms

• Irritability
• Sadness
• More emotional than usual
• Nervousness or anxiety
• Personality changes

Sleep Disturbances

• Excessive sleepiness
• Sleeping more than usual
• Sleeping less than usual
• Trouble falling asleep

Associated Physical Symptoms

• Neck pain or stiffness
• Back pain from the impact
• Facial pain if face was impacted
• Rib pain from associated trauma
• Balance problems
• Sensitivity to noise
• Ringing in the ears

Red Flag Symptoms

Seek immediate emergency care if experiencing:

• Loss of consciousness
• Seizures or convulsions
• Repeated vomiting
• Severe or worsening headache
• Weakness or numbness in arms/legs
• Extreme confusion or agitation
• Slurred speech
• One pupil larger than the other

Causes

Concussions result from forces that cause the brain to move rapidly within the skull. Understanding these mechanisms helps in prevention and recognition of potential injury situations.

Direct Impact

• Blow to the head from falling objects
• Head striking a hard surface during a fall
• Sports-related collisions (helmet-to-helmet contact)
• Physical assault or violence
• Motor vehicle accidents with head impact

Indirect Forces

• Whiplash-type injuries without direct head contact
• Blast injuries from explosions
• Violent shaking (shaken baby syndrome in infants)
• Rapid acceleration-deceleration forces

Common Scenarios

Sports-Related

• Football (American)
• Soccer (heading the ball or collisions)
• Hockey
• Rugby
• Boxing and martial arts
• Basketball
• Cycling
• Skiing and snowboarding

Non-Sports Causes

• Motor vehicle accidents
• Falls (especially in elderly and young children)
• Workplace accidents
• Recreational activities
• Military combat injuries
• Domestic violence

Biomechanics of Injury

When the head experiences rapid movement:

• Brain tissue shifts and rotates within the skull
• Neurons stretch and may be damaged
• Chemical and metabolic changes occur
• Blood flow patterns may be altered
• Inflammatory response is triggered

Risk Factors

Certain factors increase the likelihood of sustaining a concussion or experiencing more severe symptoms:

High-Risk Activities

• Participation in contact sports
• Military service, especially combat roles
• High-risk occupations (construction, law enforcement)
• Riding motorcycles or bicycles without helmets
• Engaging in high-impact recreational activities

Previous Concussions

• History of prior concussion increases risk
• Multiple concussions have cumulative effects
• Incomplete recovery from previous concussion
• Shorter time between concussions increases severity

Age-Related Factors

• Children: Developing brains more vulnerable
• Adolescents: Risk-taking behaviors
• Elderly: Fall risk and slower recovery
• Age affects symptom presentation and recovery time

Individual Factors

• Female sex (higher reported incidence in sports)
• History of migraines
• Learning disabilities or ADHD
• Mental health conditions
• Previous neurological conditions
• Certain medications affecting cognition

Environmental Factors

• Poor playing surfaces or equipment
• Inadequate protective gear
• Lack of proper supervision or training
• Pressure to return to play too soon

Diagnosis

Diagnosing a concussion requires a comprehensive evaluation as there is no single test that can definitively diagnose the condition. Healthcare providers use a combination of assessments to make the diagnosis.

Initial Assessment

• Detailed history of the injury event
• Assessment of symptoms and their onset
• Physical examination including neurological testing
• Evaluation of mental status and cognitive function
• Balance and coordination testing

Standardized Assessment Tools

Sport Concussion Assessment Tool (SCAT5)

• Comprehensive sideline evaluation tool
• Includes symptom checklist
• Cognitive and physical assessments
• Balance testing (BESS)

Other Assessment Tools

• Glasgow Coma Scale (for severe injuries)
• Standardized Assessment of Concussion (SAC)
• King-Devick test (eye movement assessment)
• ImPACT (computerized neurocognitive testing)

Imaging Studies

Imaging is typically used to rule out more serious injuries:

• CT scan: To rule out bleeding or skull fractures
• MRI: More sensitive but usually normal in concussion
• Advanced imaging (DTI, fMRI) mainly for research

When Imaging is Indicated

• Loss of consciousness > 30 seconds
• Severe or worsening headache
• Repeated vomiting
• Seizure activity
• Focal neurological signs
• Deteriorating mental status

Baseline Testing

In high-risk populations (athletes), baseline testing may include:

• Pre-season neurocognitive testing
• Balance assessments
• Symptom inventories
• Helps with post-injury comparisons

Treatment Options

Concussion treatment focuses on allowing the brain to heal through rest and gradual return to activities. There is no medication that can cure a concussion, but symptoms can be managed.

Immediate Management

• Remove from activity immediately
• No same-day return to play
• Monitor for deteriorating symptoms
• Avoid activities that worsen symptoms
• Seek medical evaluation

Physical and Cognitive Rest

First 24-48 Hours

• Complete rest from physical activities
• Limit cognitive activities (reading, screens)
• Adequate sleep and rest
• Avoid alcohol and recreational drugs
• Stay hydrated

Gradual Activity Resumption

• Start with light activities that don't worsen symptoms
• Gradually increase activity level
• Monitor symptom response to activity
• Step back if symptoms worsen

Symptom Management

Headache Relief

• Acetaminophen (preferred initially)
• Avoid NSAIDs initially (bleeding risk)
• Rest in quiet, dark environment
• Cold compress to head/neck

Other Symptom Management

• Nausea: Anti-nausea medications if severe
• Sleep issues: Sleep hygiene, melatonin if needed
• Anxiety: Relaxation techniques, counseling
• Balance problems: Physical therapy if persistent

Return-to-Activity Protocol

Gradual return following symptom resolution:

1. Complete rest: Until acute symptoms resolve
2. Light aerobic activity: Walking, stationary cycling
3. Sport-specific exercise: Running, skating drills
4. Non-contact training: Complex drills, resistance training
5. Full contact practice: After medical clearance
6. Return to competition: Normal game play

Return-to-Learn Protocol

For students, gradual return to academics:

1. Complete cognitive rest
2. Light cognitive activity at home
3. Part-time school with accommodations
4. Gradual increase in workload
5. Full return to school

Rehabilitation Therapies

• Vestibular therapy: For persistent dizziness/balance issues
• Vision therapy: For visual disturbances
• Cognitive rehabilitation: For persistent cognitive symptoms
• Physical therapy: For neck pain and headaches
• Psychological support: For mood symptoms

Prevention

While not all concussions can be prevented, many strategies can reduce the risk of head injuries and their severity.

Sports Safety

• Wear appropriate, well-fitted protective equipment
• Follow sport-specific safety rules
• Learn and use proper technique
• Ensure proper conditioning and strength training
• Promote fair play and respect for opponents
• Remove tripping hazards from playing areas

Helmet Use

Always wear helmets for:

• Cycling and skateboarding
• Motorcycling and ATVs
• Contact sports
• Horseback riding
• Skiing and snowboarding
• Construction and industrial work

Vehicle Safety

• Always wear seatbelts
• Use age-appropriate car seats for children
• Never drive under the influence
• Avoid distracted driving
• Maintain safe following distances

Fall Prevention

• Remove tripping hazards at home
• Install handrails on stairs
• Use non-slip mats in bathrooms
• Ensure adequate lighting
• Address balance issues in elderly
• Child-proof homes for young children

Education and Awareness

• Educate athletes about concussion risks
• Train coaches in recognition and management
• Promote culture of reporting symptoms
• Implement baseline testing programs
• Develop emergency action plans

When to See a Doctor

All suspected concussions should be evaluated by a healthcare provider, but certain situations require immediate emergency care.

Seek Emergency Care Immediately

• Loss of consciousness
• Seizures or convulsions
• Repeated vomiting (more than 2-3 times)
• Severe or rapidly worsening headache
• Cannot be awakened or excessive drowsiness
• One pupil larger than the other
• Slurred speech or confusion
• Weakness or numbness in limbs
• Decreased coordination or balance
• Unusual behavior or agitation

See a Doctor Within 24 Hours

• Any suspected concussion
• Persistent symptoms after head injury
• Symptoms that worsen over time
• New symptoms developing after injury
• Uncertainty about severity of injury

Follow-up Care Needed

• Symptoms lasting more than 2 weeks
• Before returning to sports or high-risk activities
• Difficulty with work or school activities
• Mood changes or sleep disturbances
• Previous concussion history

Special Populations

Seek immediate evaluation for:

• Children under 2 years old
• Elderly individuals
• People on blood thinners
• Those with bleeding disorders
• Individuals with previous brain surgery

Related Conditions

Frequently Asked Questions