CONCUSSION

CONDITION

Concussion is a brain injury that most often occurs after a blow to the head. Also known as mild traumatic brain injury, concussion is the most common sports-related head injury.

With concussions, although there is no obvious structural abnormality, the brain does not work normally.
After a concussion, your brain may be “stunned” or “shocked” and, until it has fully recovered, remains more susceptible to further damage if it is injured again.
Most concussions get better in less than a week but sometimes it takes longer.
All concussions should be evaluated by a doctor.
More serious brain injuries, some that can kill, can have similar symptoms.

Causes

Concussion can be caused by a direct blow to the head or by a force impacting another part of the body that is subsequently transmitted to the brain. Concussions can occur with sudden slowing down or stopping, such as when a moving car comes to an abrupt halt during an accident. Specific risk factors for concussion include:

being under age 18
having had a previous concussion or head injury
having a learning disability
using poor tackling technique in football (head tackling)
participating in contact sports
being involved in an auto accident or other traumatic event.

Symptoms and Signs

Most people experience confusion and memory problems right away or within 15 to 20 minutes. Headache, blurry vision, balance problems and emotional instability also are common.

Other symptoms that frequently occur include:
- vacant stare
- slurred speech
- disorientation
- problems focusing
- slowness to answer questions or follow instructions
- repeated asking of the same questions
- problems remembering events before and after the injury
- nausea
- vomiting.
Concussions are sometimes mild and, days after the injury, you may notice symptoms such as those listed below. Many of these symptoms become obvious and can get worse when you return to school or work:
- tiredness
- lightheadedness
- problems sleeping
- persistent, low-grade headache
- sensitivity to light and/or sound
- problems concentrating or thinking
- problems finding the right word when talking
- irritability and frustration
- anxiety, nervousness and feeling “down” or depressed.
Loss of consciousness (passing out) may or may not occur.
Symptoms can be immediate or delayed from minutes to days.

In children, parents may notice irritability or a change in behavior or in eating or sleeping patterns.

PREVENTION

Although helmets in contact sports prevent some head injuries, many athletes wearing helmets still get concussions.

WHEN TO CALL YOUR DOCTOR

Call 911 and get to an emergency room RIGHT AWAY if:

You are alone and in severe pain.
You have a severe headache, you are throwing up or you have passed out.
You have numbness, tingling or weakness in your arms and/or legs.
Your pupils are of unequal size or you have double vision.
You can’t talk or think properly.
You have seizures (passing out with shaking of arms and legs).
You have severe neck pain or other serious injuries that are cause for concern.

You should not drive with a head injury.

Call your doctor right away (day or night) if:

You have a headache that is getting worse.
You are having a hard time remembering things.
You have increasing nausea and want to throw up.
Your vision is blurry or you are having problems focusing your eyes.
You are getting more tired and sleepy.
You have a medical problem that makes you prone to bleed.
You have other concerns or injuries.

Call your doctor during regular office hours if:

You have had a head injury or a mild concussion. All head injuries and concussions, no matter how minor, should be evaluated by a doctor within 24 to 48 hours.
You were injured during a sports activity, were evaluated by a doctor on the sideline who thinks you are okay and you are not experiencing any of the above problems.
You have only a mild headache that is not increasing.
You have no problems with your vision, nerves (numbness and tingling), muscle strength or balance.
You had brief symptoms that all resolved within 15 minutes and you are feeling much better.

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SELF-CARE AT HOME

Don’t do anything after a concussion that requires exercise, physical exertion or intense mental activity until you have been checked by a doctor and have been told it is okay.
Stay around other people who can watch you, especially for the first 24 hours after the injury.
Do not do any manual labor or jobs that require good balance (such as that rely on the use of ladders or involve your being in high places) until cleared by a doctor.
Acetaminophen (Tylenol®) is safest to use for headaches. (See the label for dose and risks.)

FOR MORE INFORMATION

REFERENCES

American College of Sports Medicine, American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, , American Medical Society for Sports Medicine, American Orthopaedic Society Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine: Concussion (mild traumatic brain injury) and the team physician: a consensus statement. Medicine. Med Sci Sports Exerc 38(2):358-9, 2006.
McCrory P, et al: Summary and Agreement Statement of the 2nd International conference on concussion in sport, Prague 2004. Clin J Sport Med 15(2)48-56, 2005.
Putukian M and Madden C: Head injuries. In Mellion M, Walsh WM, Madden C: The Team Physician’s Handbook, Hanley & Belfus, Inc, Philadelphia, p354-64, 2002.

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Authored by Christopher Madden, M.D.

Favorably reviewed by The American Medical Society for Sports Medicine

http://amssm.org

Disclaimer: This content is reviewed periodically and is subject to change as new healthcare information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.