Concussion
A concussion is a brain injury that can’t be seen on routine X-rays, CT scans or
MRIs. It affects the way a person may think and remember things and can cause a variety of symptoms. Any blow to the head, face or neck, or a blow to the body that jars your head, could cause a concussion.
Through the years, several definitions of concussion have been proposed, often leading to confusion. The most recent Consensus Statement on Concussion in Sport uses the following definition:
Sport related concussion [SRC] is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilized in clinically defining the nature of a concussive head injury include:
- SRC may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.
- SRC typically results in the rapid onset of short-lived impairment of neurological function that resolves spontaneously. However, in some cases, signs and symptoms evolve over a number of minutes to hours.
- SRC may result in neuropathological changes, but the acute clinical signs and symptoms largely reflect a functional disturbance rather than a structural injury and, as such, no abnormality is seen on standard structural neuroimaging studies.
- SRC results in a range of clinical signs and symptoms that may or may not involve loss of consciousness. Resolution of the clinical and cognitive features typically follows a sequential course. However, in some cases symptoms may be prolonged.
The clinical signs and symptoms cannot be explained by drug, alcohol, or medication use, other injuries (such as cervical injuries, peripheral vestibular dysfunction, etc) or other comorbidities (eg, psychological factors or coexisting medical conditions).
What are the signs and symptoms?
Post-concussive symptoms can be physical, cognitive, emotional or sleep-related.
- WPhysical symptoms the patient may describe include: headache, dizziness, nausea, feeling unsteady, feeling “dinged” or “stunned” or “dazed”, feeling like their “bell was rung”, seeing stars or other visual disturbances, tinnitus, double vision, simply “not feeling right”.
- Physical signs of concussion include loss of consciousness or impaired consciousness,poor coordination, balance or gait difficulties, easy distractibility and poor concentration, slowness answering questions and following directions, vomiting, looking “glassy eyed”, photophobia, slurred speech, personality or behavior changes (including inappropriate playing behavior such as skating or running in the wrong direction) and significantly decreased performance or playing ability.
- Cognitive symptoms include: confusion, amnesia, disorientation, poor concentration, and memory disturbance.
- Emotional symptoms include: feeling of depression, being nervous or anxious, and moodiness/irritability.
- Sleep disturbance: drowsiness, insomnia
It is important to note that not all concussions will include all of these features. If any one of the aforementioned symptoms (or other similar symptoms) is present, concussion should be suspected. Keep in mind that signs and symptoms may be more pronounced later or within a short time after the injury.
What exactly causes the symptoms?
The pathology behind concussion and its resultant symptoms is still at the infancy stages of being understood. Injury to the neurons will result in ionic shifts resulting in a metabolic crisis. This interferes with cell-to-cell communication in the brain. However, there is no simple “test” which will give all the answers about diagnosis and resolution of the problem.
Do you have to lose consciousness to have a concussion?
Perhaps the most important misunderstanding made when trying to define a concussion is that people mistakenly believe concussion must involve a loss of consciousness (LOC). LOC is not required to make a diagnosis of concussion. In fact, most concussions occur without LOC. LOC is just one symptom of concussion, and, in fact, recent research has suggested that a brief (less than one minute) LOC is not necessarily as significant an indicator of concussion severity as once thought. It is important to realize that many people will report a loss of consciousness because they cannot recall events before, during or after their concussion. Unless this is witnessed as a true loss of consciousness, it may be that the person is experiencing amnesia, which is an important post- concussive symptom.
What to do if you suspect a concussion
In all suspected cases of concussion, the person should stop the activity right away. Continuing increases their risk of more severe, longer-lasting concussion symptoms, as well as increases their risk of other injury.
Red flags
| Neck pain or tenderness | Double vision | Weakness or tingling in arms or legs | Severe or increasing headache | Seizure or convulsion |
| Loss of consciousness (knocked out) | Deteriorating conscious state | Vomiting more than once | Increasingly restless, agitated or combative | Growing confusion |
If any red flag symptoms are present, call an ambulance right away. These may be signs of a more serious injury.
Concussion treatment
General recommendations for concussion recovery include a short period of rest, followed by a gradual return to activity under the supervision of a medical professional. Caring for a concussion can involve a variety of treatments and a team of health professionals, depending on the symptoms and how a person’s condition improves.
Concussion healing time varies
The symptoms of a concussion usually last one to four weeks, but may last longer. In some cases, it can take weeks or months to heal. If a person has had a concussion before, it may take them longer to heal the next time.