Concussion

A concussion is a common traumatic brain injury that alters your brain functions.

It is characterized by headache, and disturbances in concentration, memory, cognition, balance and coordination.

Concussion is often caused by a blow to the head, however it can also occur due to rotational forces when the head and upper body are violently shaken (shaken baby syndrome).

Most concussions do not produce loss of consciousness, that’s why some people with concussion don’t even realize it. Concussions are a common brain related sports injury.

While concussions are a mild injury, some extent of brain damage is always present. Rest and supportive treatments can provide complete recovery to the injured people.

The symptoms of concussion generally subside within days, weeks but sometimes longer. Common symptoms after a concussive traumatic brain injury are:

• Headache or a feeling of pressure in the head
• Temporary loss of consciousness
• Confusion
• Amnesia (memory loss) surrounding the traumatic event
• Dizziness
• Ringing in the ears
• Nausea and Vomiting
• Slurred speech
• Delayed response
• Fatigue

Some immediate or sometimes delayed symptoms of concussions are:

• Problems with concentration and memory
• Irritability and other personality changes
• Sensitivity to light and noise
• Sleep disturbances
• Psychological adjustment problems
• Depression, anxiety or emotional lability
• Taste and smell disturbances

Symptoms in children

Young kids are very prone to sustain concussions. But infants and toddlers may not be able to properly describe the symptoms which makes the diagnosis more difficult.

Following symptoms might hint at concussion in children: Appearing confused, easy tiring, irritability, balance problems and unsteady walking, excessive crying, change in eating or sleeping patterns, loss of interest in activities previously enjoyed like playing with toys.

When to see a doctor

Visit your doctor as soon as you start experiencing symptoms, no matter how mild thet may appear. According to The American Academy of Pediatrics, you need to visit your child’s doctor if your child receives anything more than a light bump on the head.

Seek emergency care if you or your child receives blow on the head and have the following symptoms:

• Repeated vomiting
• A loss of consciousness for than 30 seconds
• A headache that worsens
• Changes in behavior such as irritability, impulsiveness, emotional lability
• Confusion or disorientation, such as difficulty recognizing people or places
• Slurred speech or other changes in speech
• Seizures
• Double or disturbed vision and dilated pupils or pupils of unequal sizes
• Reduced mental function or coordination

A concussion is caused by impact-related brain injury. This can occur from sudden shaking, and sudden acceleration of the head movements.

Your brain is a delicate organ that has protective layers around it, called meninges and a fluid inside the skull that act as a cushion to prevent injury due to normal bumps and blows.

However, when a violent blow hits your head, your brain can slide back and forth forcefully against the inner walls of your skull. Likewise, sudden acceleration or deceleration of the head like in a car crash or violent shaking also can cause brain injury.

Concussion can also lead to bleeding in and around the brain. Bleeding in your brain is fatal. Therefore, anyone who sustains a brain injury needs emergency and prolonged care to watch out for the symptoms which develop later.

Making a diagnosis of concussion is done by performing several tests.

Often concussion symptoms remain subtle which might the reason for neglecting or underestimating the condition and its probable complications.

Here are some tips for proper diagnosis of the condition:

What you can do

List any of your or your child’s symptoms, and its severity, duration.

You may ask questions to your doctor:

• Do I have a concussion?
• When will symptoms start improving?
• When can I return back to my workplace, school?
• Can I drive a car or use high operating machine?

What to expect from your doctor

Your doctor can ask you following questions:

• Do you play contact sports?
• How did you sustain this injury?
• What symptoms did you experience immediately after the injury?
• Did you lose consciousness after the injury?
• Did you have seizures?
• Have you experienced nausea or vomiting, headache since the injury?
• Did you sustain such injury in the past?
• Did you experience any problem with concentration, memory, mood and balance after the trauma?

What you can do in the meantime

• You are advised to rest as much as possible.
• Avoid any strenuous physical activity like exercising, weight lifting or even walking.
• Minimize the activities that require focus and attention.
• Take acetaminophen (not aspirin or ibuprofen) to ease the headache.

Your doctor may recommend following tests for diagnosis:

• Neurological examination: Your doctor can look for any neurological deficits that you may have sustained due to the injury. S/he may examine your vision, hearing, strength and sensation, balance, coordination, and reflexes.
• Cognitive testing: This testing is used to determine any changes in your mental processing (cognition). Your doctor can test your memory, concentration, ability to recall information like your phone number, problem solving ability.
• Imaging tests: If symptoms are severe or worsen over time, brain imaging is used to determine if bleeding or swelling has occurred in your brain.
• A cranial computerized tomography (CT) scan is done to assess the brain right after injury. It is a standard test for brain injury assessment that uses X-rays to obtain cross-sectional images of your skull and brain.
• Magnetic resonance imaging (MRI) uses magnetic field and radio waves to create detailed images of your brain, which might help your doctor to look for bleeding in your brain
• Observation: As there brain injury can be fatal and often concussions don’t produce immediate severe symptoms, an overnight observation after a concussion is recommended.

The most suitable approach for a concussion treatment is to get rest, both physical and mental.

• Avoid physical and mental stress.
• Do not resume your sports or other activities before the brain heal completely.
• Increase the level of activity gradually as the symptoms improve over time.
• If you have headache, take a pain reliever like acetaminophen but not ibuprofen and aspirin (they may increase risk of bleeding).

Some preventive measures for concussion are:

• Wear protective helmets during sports like bicycling, motorcycling, snowboarding or engaging in any recreational activity that may result in head injury.
• Wear a seat belt: During a road traffic accident, tightened seat belt may prevent injury to your head.
• Be careful to avoid falling.
• Protecting your children: Fall could be a major cause of head injury in your children. Lower this risk by blocking off stairways and installing window guards.
• Exercising regularly: For elderly people, falls may be prevented by building strong leg muscles.

There are several risks and complications associated with concussion.

Risks

• High-risk sport, such as football, hockey, soccer, rugby, boxing or other contact sport could result in head injury.
• Road traffic accidents account for a major part cause of head injury. Wear helmets, tighten seat belts, follow traffic rules, and don’t over-speed to minimize the risk.
• Being a soldier in a battle
• Victim of physical abuse
• Falling, especially in young children and older adults.

Potential complications of concussion

• Epilepsy: Head injury doubles your risk of developing epilepsy within the first five years after the injury.
• Delayed effects of repetitive brain injuries: Studies reveal that multiple concussive brain injuries acquired over a long period of time can lead to degenerative neurological disorders like Alzheimer’s disease.
• Post-concussion syndrome: Some people experience symptoms like headaches, dizziness and thinking difficulties a few days after a concussion. These symptoms can last for weeks to a few months after a concussion.
• Post-traumatic headaches: Some people experience headaches within a week to a few months after a brain injury.
• Post-traumatic vertigo: The feelings of dizziness may last for days, week or months after a brain injury.
• Second impact syndrome: It is a rare condition in which a person receives a second concussion before the first concussion has properly healed. It may result in rapid and usually fatal brain swelling (cerebral edema). Therefore, people with concussion are advised not to expose themselves to the risk before the symptoms completely resolve.