Learn about the symptoms, treatment, and recovery process of concussions on Meri Sehat, your trusted source for healthcare information.

Concussion

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Iqra Mazhar

Overview

A concussion is a kind of traumatic brain injury due to a blow or bump to the head that disrupts brain function. 
&nbsp;

Concussions are usually not life-threatening but they can cause serious symptoms, including loss of consciousness and an altered mental state, which may require treatment.

Concussions are common in contact sports like football or soccer. However, the majority of people recover completely.

The CDC estimates that between 2001 and 2009, 173,285 patients under 19 received treatment for concussions due to sports and recreational activities<a href="#accordion">[1]</a>.

<ul>
	<li>
	Mild Concussion
	</li>
</ul>

This is also referred to as a grade 1 concussion. It is the most common type of concussion, characterized by headache, dizziness, nausea, and difficulty concentrating. There is no loss of consciousness and symptoms usually last less than 15 minutes. 
&nbsp;

<ul>
	<li>
	Moderate Concussion
	</li>
</ul>

This type of concussion is also known as a grade 2 concussion. It involves a longer period of confusion and a brief loss of consciousness. Symptoms include brief <a href="https://merisehat.pk/disease/amnesia-17164">amnesia</a>, irritability, and ringing in the ears that usually resolve within a few weeks. 
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<ul>
	<li>
	Severe Concussion
	</li>
</ul>

This is also referred to as a grade 3 concussion. It is characterized by a loss of consciousness for 5 minutes or more. The patient also experiences severe vomiting, speech difficulty, and amnesia for more than 24 hours. Recovery can take weeks or months.

Concussions are categorized according to the severity of the condition: 
&nbsp;

Signs and Symptoms

The cerebrospinal fluid inside the skull protects it from everyday jolts and bumps. When a powerful blow strikes the head, neck, or upper body, such as during a car accident, it can cause sudden acceleration or deceleration of the brain. That is, the brain slides back and forth against the inner walls of the skull quite forcefully during a concussion.

These injuries disrupt brain function for a short period and may result in bleeding inside or around the brain which can be fatal.

Generally, the signs and symptoms of the condition are subtle and do not appear right away. Symptoms may last for a few days, weeks, or even months, and include the following:

<ul>
	<li>Headache</li>
	<li>Intense ringing in the ears</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Tiredness or drowsiness</li>
	<li>Blurry vision</li>
	<li>Confusion</li>
	<li>Amnesia</li>
	<li>Dizziness</li>
	<li>Temporary loss of consciousness (occasionally)</li>
	<li>Slurred speech</li>
	<li>Delayed response</li>
	<li>Forgetfulness, such as asking the same question repeatedly</li>
</ul>

&nbsp;

Some concussion symptoms may appear immediately, while others may appear days later, such as:

<ul>
	<li>Complaints about concentration and memory</li>
	<li>Irritability and other behavioral changes</li>
	<li>Light and noise sensitivity</li>
	<li>Sleep disruptions</li>
	<li>Depression and difficulties with psychological adjustment</li>
	<li>Taste and odor disorders 
	&nbsp;</li>
</ul>

<h5>Symptoms In Children</h5>

Head trauma is very common in young children. However, concussions can be difficult to detect because infants and toddlers cannot express their feelings. These symptoms may include:

<ul>
	<li>Dazed appearance or blank stare</li>
	<li>Lethargic and easily tired</li>
	<li>Irritation and grumpiness</li>
	<li>Unsteady walking and loss of balance</li>
	<li>Changes in eating and sleeping habits</li>
	<li>Disinterest in favorite toys</li>
	<li>Excessive crying</li>
	<li>Vomiting</li>
	<li><a href="https://merisehat.pk/disease/absence-seizures">Seizures</a></li>
</ul>

&nbsp;

Babies don&rsquo;t present with the usual symptoms that can be observed in children and adults. A concussion can be suspected if a baby shows the following signs:

<ul>
	<li>A visible bruise or bump on their head</li>
	<li>Dilated pupils</li>
	<li>Vomiting</li>
	<li>Drowsiness </li>
	<li>Crying when their neck or head is moved</li>
	<li>Irritability </li>
	<li>Seizures 
	&nbsp;</li>
</ul>

Seek immediate medical assistance if someone with a concussion has:

<ul>
	<li>Seizures</li>
	<li>Slurred speech</li>
	<li>Constant vomiting</li>
	<li>Trouble waking up</li>
	<li>A history of multiple concussions</li>
</ul>

It&rsquo;s crucial to see a doctor if the symptoms don&rsquo;t improve or if the symptoms get worse after a few days. In rare cases, concussions can lead to permanent brain damage. 
&nbsp;

Causes

A bump or violent jolt to the head or a blow to the body that causes the head to forcefully jerk forward, backward, or to the side can cause a concussion. This usually occurs in:

<ul>
	<li>Car accidents, such as car crashes or being hit by a bike or car</li>
	<li>Activities that have a high risk of falls and head injuries, such as horse riding, diving, skiing, and cycling</li>
	<li>Contact-sport injuries such as when playing football, ice hockey, soccer, basketball, and wrestling</li>
	<li>Fights and assaults </li>
	<li>Explosion that causes the person to fall or get hit in the head with foreign objects such as shrapnel or bullet entering the skull </li>
</ul>

Severe head trauma can lead to skull fracture that causes sharp edges of the bone to harm the brain. 
&nbsp;

Diagnosis

A healthcare provider will assess the symptoms, review the medical history, and perform a neurological examination. In addition to blood and urine tests, they may also order the following tests:

&nbsp;

<ul>
	<li>Neurological Examination: This is to assess the patient&rsquo;s vision, hearing, strength and sensation, balance, coordination, and reflexes.</li>
	<li>Cognitive Testing: This is to assess the patient&rsquo;s memory, concentration, and ability to recall information.</li>
	<li>Imaging Tests: This is to determine whether the injury is severe and has caused bleeding or swelling in the skull.</li>
</ul>

&nbsp;

The standard test for assessing the brain immediately after injury in adults is a computerized cranial tomography (CT) scan. A CT scan uses a series of X-rays to produce cross-sectional images of the skull and brain.

CT scans are only used in children with a suspected concussion if certain criteria are met, such as the type of injury or signs of a skull fracture. This is done to protect young children from radiation exposure.

Magnetic resonance imaging (MRI) may be suggested to detect brain changes that may occur after a concussion. It uses powerful magnetic and radio waves to create detailed images of the brain.

An EEG may be needed if seizures continue. 
&nbsp;

<ul>
	<li>Balance Assessment: This is to assess how well the part of the brain that controls movement is functioning. 
	&nbsp;</li>
</ul>

&nbsp;NOTE: The patient needs to be hospitalized overnight for observation to ensure that the symptoms do not worsen. 
&nbsp;

Treatment

<h5>Physical And Mental Rest</h5>

Relative rest is the best way to allow the brain to recover in the first few days after a concussion.

This usually involves limiting activities that require thinking and mental concentration for the first two days after the trauma. E.g., video games, reading, schoolwork, and using a computer.

Likewise, physical activities that can aggravate, such as general physical exertion, sports, or any vigorous movements, should also be avoided.

However, lying in a dark room and avoiding all stimuli does not help recovery and, therefore, is not recommended. Activities that do not significantly worsen the patient&rsquo;s situation are encouraged.

The doctor usually advises to shorten the school days or workdays, take breaks during the day, and reduce the school workloads or assignments. They may also recommend different therapies, such as vision rehabilitation, balance rehabilitation, or cognitive rehabilitation for thinking and memory issues. 
&nbsp;

<h5>Return To Routine Activity</h5>

As the symptoms improve, the individual can gradually incorporate more thinking-intensive activities, such as doing more schoolwork or work assignments or increasing their time at school.

The healthcare provider will advise when to resume light physical activity such as riding a stationary bike or light jogging is safe.

Resuming sports activity too soon increases the risk of another brain injury. 
&nbsp;

<h5>Pain Relief</h5>

Headaches are common in the days and weeks after a concussion. The doctor may prescribe a pain reliever, such as acetaminophen, to manage pain. Other pain relievers, such as aspirin and ibuprofen, should be avoided because they increase the risk of bleeding[4]. 
&nbsp;

<h5>Hydration</h5>

Since concussions cause vomiting, it can leave a person dehydrated. This is why it is recommended to drink plenty of water. 
&nbsp;

<h5>Surgery</h5>

If a concussion causes bleeding, swelling, or any other serious injury to the brain, the doctor may consider surgery. 
&nbsp;

Potential complications include<a href="#accordion">[5]</a>: 
&nbsp;

<ul>
	<li>&nbsp;Post-Traumatic Headaches</li>
</ul>

Concussion-related headaches can last up to 7 days after a brain injury. 
&nbsp;

<ul>
	<li>&nbsp;Post-Traumatic Vertigo</li>
</ul>

Some people experience spinning or dizziness for days, weeks, or months after a brain injury. 
&nbsp;

<ul>
	<li>&nbsp;Post-Concussive Syndrome</li>
</ul>

15-20% of people may experience symptoms such as headaches, dizziness, and difficulty thinking for more than 3 weeks. These symptoms are called persistent post-concussive symptoms if they last longer than 3 months. 
&nbsp;

<ul>
	<li>&nbsp;Cumulative Effects Of Multiple Brain Injuries</li>
</ul>

Currently, research is being conducted to investigate the effects of repeated head injuries that do not result in symptoms, i.e., sub-concussive injury. There is no conclusive evidence that repeated brain injuries contribute to cumulative effects. 
&nbsp;

<ul>
	<li>&nbsp;Second Impact Syndrome</li>
</ul>

A second concussion that occurs before the signs and symptoms of the first concussion have resolved may result in rapid and usually fatal brain swelling. Athletes especially should never return to sports if they are still experiencing signs and symptoms of a previous concussion. 
&nbsp;

The following activities and factors may increase the risk of a concussion<a href="#accordion">[5]</a> <a href="#accordion">[6]</a>:

<ul>
	<li>Being a combat soldier</li>
	<li>Gender; males have a higher rate of concussion, while females report a higher incidence in soccer and basketball</li>
	<li>Type of sport, with sports like baseball, volleyball, softball, and gymnastics being considered low risk.</li>
	<li>Previously suffered a concussion</li>
	<li>BMI greater than 27 kg/m<a href="#accordion">[2]</a></li>
	<li>Elderly and children under 4 have a greater risk of falls</li>
	<li>Adolescents due to sports-related or bike accidents</li>
	<li>Victims of physical abuse 
	&nbsp;</li>
</ul>

Because a concussion is unexpected, it is difficult to avoid. However, several precautionary measures can help reduce the risk of traumatic brain injury. 
&nbsp;

<ul>
	<li>Wear safety equipment. Participating in high-contact, high-risk sports like football, hockey, boxing, and rugby can increase the chances of getting a concussion.</li>
	<li>Similarly, skateboarding, snowboarding, horseback riding, and rollerblading can all cause trauma to the brain in case of an accident. Wearing protective headgear, padding, and mouth and eye guards helps prevent traumatic head injuries.</li>
	<li>A bike helmet, for instance, can reduce the risk of traumatic brain injury by 85%. Athletes can also wear a new C-shaped collar-like device called the Q-Collar. It applies compressive pressure to the neck and increases blood volume to reduce brain movement caused by head hits.</li>
	<li>All equipment should fit properly and should be well-maintained.</li>
	<li>Drive and ride wisely. Always wear a seatbelt, follow posted speed limits, and avoid drugs and alcohol, which can impair reaction time.</li>
	<li>Don&#39;t get into a fight. Concussions are common during an assault, and men are more likely than women to report traumatic head injuries.</li>
	<li>Reduce the number of trip and fall hazards at home and workplace settings. Ensure the floors and hallways are clutter-free and that the place is well-lit.</li>
	<li>Exercise regularly. It helps build stronger leg muscles and improves balance, which can help avoid falling.</li>
	<li>Use home security measures to keep the children safe. For instance, install window guards and barricade stairwells. 
	&nbsp;</li>
</ul>
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A recent study explored the link between concussions and the development of new psychopathologies or persistent mental health issues since there is little data available regarding it.<a href="#accordion">[3]</a> 
&nbsp;

&nbsp;The main result was the identification of mental health issues, such as psychopathologies and psychiatric illnesses, during medical visits in emergency rooms, hospitals, or primary care settings. Secondary outcomes that were identified in health care or vital statistics databases included admissions to mental health facilities, self-harm medical visits, and suicide deaths.

&nbsp;This shows that concussion is linked to a higher incidence of mental health problems, psychiatric hospitalization, and self-harm among kids and teenagers aged 5-18 compared to those who suffered an orthopedic injury. 
&nbsp;
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Key Points

<ul>
	<li>A concussion is a type of traumatic brain injury that occurs when the brain inside the skull is shaken or jolted.</li>
	<li>Concussions can occur due to a blow to the head or body, such as in sports or car accidents, falls, or other injuries.</li>
	<li>Headache, dizziness, confusion, nausea, sensitivity to light or noise, and difficulty concentrating are all symptoms of concussion. 
	&nbsp;</li>
</ul>
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[1] Sahler CS, Greenwald BD. Traumatic brain injury in sports: a review. Rehabil Res Pract. 2012;2012.

[2] Bodin D, Yeates KO, Klamar K. Definition and classification of concussion. In: Pediatric and adolescent concussion: Diagnosis, management, and outcomes. Springer; 2011. p. 9–19.

[3] Ledoux A-A, Webster RJ, Clarke AE, Fell DB, Knight BD, Gardner W, et al. Risk of mental health problems in children and youths following concussion. JAMA Netw open. 2022;5(3):e221235--e221235.