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A concussion is a type of traumatic brain injury caused by a bump, violently shaking, or blow to the head that interferes with normal brain function. Headaches and issues with focus, memory, balance, and coordination are common effects.
Concussions involve the stretching and bruising of nerves and blood vessels, leading to chemical alterations in the brain that result in a temporary disruption of typical brain activity. While some concussions can lead to a brief loss of consciousness, they are generally not considered life–threatening. It’s important to note that a single concussion typically does not lead to permanent brain damage. Experiencing multiple concussions throughout one’s life could lead to alterations in the structural composition of the brain.
Falls are the primary cause of concussions. Concussions frequently result from impacts to the head or forceful shaking of the head and upper body. Additionally, contact sports such as football or soccer often lead to concussions. The symptoms can vary in severity and may endure for days, weeks, or even months. The majority of individuals typically achieve complete recovery following a concussion.
Symptoms
Signs and symptoms of a concussion mostly become evident shortly after a head injury. In some cases, it might take several hours for some symptoms to manifest. Symptoms can evolve in the days following the injury, and others may emerge when the brain is under stress.
Frequent indications of a traumatic brain injury from a concussion encompass headaches, amnesia, and confusion. These symptoms have the potential to persist for a span of days, weeks, or even months.
Common symptoms of a concussion may include:
- Headache
- Nausea and vomiting
- Ringing in the ears
- Confusion
- Problems with balance, dizziness, and lightheadedness
- Tiredness
- Blurry vision
- Amnesia related to the tragic event
- Feelings of “just not right” or being in a “fog”
Symptoms that may appear immediately, or days later include:
- Being irritated, nervous, and worried
- Having difficulty concentrating
- Memory problems
- Light and noise sensitivity
- Sleep pattern changes, such as sleeping considerably more or less than normal or being unable to sleep
- Issues with psychological adjustment, sadness, and depression
- Taste and smell disorders
Some signs and symptoms may be observed by other people, such as:
- Brief loss of consciousness
- Forgetfulness, such as asking the same question repeatedly
- Delay in responding to conversations
- Dazed appearance
- Slurred speech
Symptoms in children
Head injuries are common occurrences among infants and toddlers. Diagnosing concussions in these young children can prove challenging due to their limited ability to communicate discomfort. Signs of concussions in children might encompass:
- Bumps on the back of the head
- Vomiting
- Seizures
- Being irritated and grumpy
- More fussy than normal, won’t stop crying even when calmed
- Dazed appearance
- Change in sleep pattern, sleepy at unusual times
- Listlessness and easily get tired
- Unsteady walking and loss of balance
- Change in eating habits
- Disinterest in favorite toys
Generally, a person who suffered a head injury whether a symptom occurred or not, should see a doctor within 1 to 2 days. If any of the signs and symptoms occur after a head injury, consult a healthcare provider immediately.
Urgent medical care is necessary when a head injury comes with signs and symptoms such as:
- A severe headache or a headache that worsens over time
- Frequent vomiting or nausea
- A loss of consciousness that lasts more than 30 seconds
- Convulsions and seizures
- Confusion is increasing, such as difficulties recognizing individuals or places
- Severe dizziness, loss of balance, or walking difficulties
- Weakness
- Nose or ear discharge that is clear and watery
- Bloody discharge from the ears
- Ear ringing that does not go away
- Vision or eye problems, such as larger–than–normal pupils or uneven in size
- Slurred speech
- Being pale for more than an hour
- Behavior that is unusual, odd, or irritable
- Symptoms that intensify over time
- Large head bumps or bruises on locations other than the forehead in youngsters, particularly in infants under the age of 12 months
- Clearly impaired mental function or physical coordination
- Extreme sleepiness, difficulties waking up, or fainting
If a child displays no notable indications of a major head injury, maintains consciousness, exhibits regular movement, and remains responsive, it’s likely that the injury is minor and does not demand further testing. Nonetheless, if there’s a concern that symptoms could manifest later, it’s advisable to seek immediate medical attention.
Athletes
It is highly recommended that individuals participating in sports, encompassing children, adolescents, and adults, abstain from resuming activities on the same day as a concussion occurrence, irrespective of the presence of signs and symptoms.
Athletes suspected of having a concussion should avoid engaging in activities that heighten the risk of subsequent concussions. It is crucial that children and adolescents be evaluated by a healthcare professional proficient in assessing and addressing pediatric concussions.
Following the completion of the hands–on neurological examination, various neuropsychological tests can be utilized to determine a student–athlete’s capacity to return to school and sport.
Causes
Brain tissue is soft and pliable. Cerebrospinal fluid surrounds it, acting as a cushion between it and the hard protective exterior, the skull.
A concussion occurs when the brain bounces or twists inside the skull, or when it experiences rapid, whiplash–like back–and–forth movement, causing it to crash with the interior of the skull. This movement of the brain stretches and destroys brain cells and causes chemical changes in the brain.
These injuries disrupt brain function for a short period of time, resulting in concussion signs and symptoms. The injury can cause bleeding in or around the brain, resulting in symptoms including drowsiness and confusion. These symptoms could appear immediately or later.
In most cases, concussions are frequently attributed to car accidents, falls, and sports–related incidents. Among children, the majority of concussions arise during play on the playground, while cycling, or while engaged in sports like football, basketball, ice hockey, wrestling, or soccer.
Risk factors
Adolescents are more likely than any other age group to sustain a concussion. Researchers believe that this heightened risk is attributable to the ongoing development of their brains. During this phase, the brain is actively constructing its neural connections, and, concurrently, adolescents tend to have relatively weaker necks in comparison to both young adults and older individuals.
Other factors and activities known to make a person more susceptible to concussion include:
- Being involved in a car or traffic accident
- Falls, particularly in young children and the elderly
- Engaging in high–risk sports without adequate safety equipment and supervision
- Playing a high–risk sport such as football, hockey, soccer, rugby, boxing, or another contact sport
- Serving as a combat soldier
- Experiencing physical abuse
- Having previously suffered a concussion
Diagnosis
Symptoms of a concussion might not become evident until hours or even days following the injury. The process of diagnosis entails inquiring about the details of head injury, evaluating the exhibited symptoms, reviewing the individual’s medical history, and conducting a neurological assessment.
To validate the diagnosis, the assessments might encompass:
- Neurological examination: A neurological exam involves checking the neurological function and reflexes, vision, eye movement, hearing, strength, sensation, light sensitivity, balance and coordination, and neck muscles for their motion and for tenderness.
- Cognitive testing: Verbal, written or computerized tests may be used to check one’s thinking ability, problem–solving skills, and memory and concentration. These are often administered during neurological examination.
- Imaging tests: Brain imaging may be performed to evaluate whether the injury is severe and has resulted in bleeding or edema in the skull. This is usually not required in the early stages of a concussion since most of the symptoms of a concussion are not visible on imaging. These tests are often requested of those who have severe headaches, seizures, persistent vomiting, or symptoms that are worsening.
- CT scan: This is a type of X–ray that produces cross–sectional images of the skull and brain. In children, CT scans are only utilized if certain criteria are met, such as the type of damage or evidence of a skull fracture to minimize radiation exposure in young children. In adults, the standard procedure for evaluating the brain immediately after an injury is a cranial CT scan.
- Magnetic resonance imaging (MRI): An MRI creates comprehensive images of the brain by using powerful magnets and radio waves. It may be used to detect brain alterations or to assess issues that may occur after a concussion.
- Observation: If the healthcare provider approves home monitoring after a concussion, it is essential to have someone with them, checking the patient for at least 24 hours to ensure that symptoms are not getting worse. In some cases, one might require an overnight hospital stay for observation.
Treatment
There are actions you can take to aid in the healing of your brain and accelerate the recovery process.
- Physical and mental rest: To recover from a concussion, a healthcare provider would usually advise patients to rest both physically and mentally. For the first two days after a concussion, it is advisable to limit activities that demand thinking and mental attention.
While it is crucial to prioritize extra rest and sleep during the recovery, it is not advisable to aim for complete inactivity. Research suggests that excessive mental rest can potentially extend the recovery timeline and heighten sensitivity to activities when one eventually resumes them. Instead of completely discontinuing activities, learn to identify the triggers that cause concussion symptoms.
Begin gently and in modest increments. When symptoms appear, take a step back and rest. During the initial 48 hours, it is advisable to minimize engagement in mentally demanding activities like video games, TV watching, schoolwork, reading, texting, or computer usage if they exacerbate the symptoms. It is also advised to steer clear of physical activities that worsen any of the symptoms, including general physical exertion, sports, or strenuous movements.
Research has shown that engaging in light exercise and physical activity, if well–tolerated, a few days post–injury can potentially accelerate one’s recovery. It is advisable to gradually ease back into the daily routine, including activities like screen time. However, it is vital to steer clear of activities that pose a high risk of another head impact until fully healed.
The healthcare provider may offer alternative therapy, such as vision rehabilitation, balance rehabilitation, or cognitive rehabilitation for thinking and memory issues. As part of the recovery process, one may be required to temporarily shorten their school hours or workdays, take breaks during the day, or modify or minimize their school responsibilities or job tasks.
- Returning to routine activity: The healthcare provider will determine when it is appropriate to reintroduce light physical activity. Usually, as the symptoms subside, patients can progressively reintroduce more of their usual activities into their daily life. Once all signs and symptoms of a concussion have subsided, returning to sports may be discussed. However, this is critical since returning to sports too soon raises the chance of another brain injury. (1)
Typically, within a few days following the injury even if the symptoms have not entirely subsided, engaging in light physical activities like using a stationary bike or light running may be advised. People with concussion can also gradually incorporate more thinking–intensive tasks, such as accomplishing more schooling or work projects, or increasing their time spent at school or work.
- Pain relief: Aspirin and nonsteroidal anti–inflammatory medicines (NSAIDS) like naproxen and ibuprofen should be avoided immediately after a suspected concussion, as these medications mask symptoms and thins the blood, which may increase the risk of bleeding. If a concussion is detected, acetaminophen is a safer option for pain relief. Headaches are common in the days and weeks following a concussion.
