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Concussion

more about Concussion


  • A brief loss of consciousness, usually measured in seconds; thought to be due to a sudden twisting of the brain on its axis.  The twisting briefly impairs the reticular activating system, which keeps the individual awake.  The unconscious person naturally has no memory for the period when he was unconscious, and may also lose memory for the events surrounding the concussion.
  • There is thought to be no identifiable damage to the brain in a concussion.
  • In some grading systems of concussion, loss of consciousness is not a requirement for mild concussion; only a head injury is required, with some mental confusion.

  • Brief loss of consciousness
  • Mental confusion, drowsiness, or any other brief neurologic impairment may follow this.
  • Memory loss may occur.
  • Nausea or vomiting may occur.

  • Minor head injury

  • Generally, there is history of brief loss of consciousness, followed by some of the above symptoms.  If the patient does not recall loss of consciousness, others may have observed it, or observed the patient's mental confusion.
  • Physical exam is generally non-specific.  If the patient is examined soon after the event, one may see brief neurologic impairment.

  • Participation in sports
  • Auto accidents and other Trauma
  • Fighting

  • Gently lower the patient to the ground, if this has not already been done.  Protect the patient from further injury.  Assess the airway, breathing, and circulation.  Consider the possibility of simultaneous neck injury (cervical spine injury).  Call 911 if needed.
  • If the patient is under close observation at home, see Complications heading.
  • A physician generally will not permit the use of any pain reliever with sedative properties (such as a narcotic) in the first few days, since it may depress the level of consciousness and may make assessments more difficult.

  • Generally, none.
  • Cervical spine injury may simultaneously occur, and may be more serious than the concussion itself.
  • Long lasting headache
  • Long lasting weakness, impairment of concentration, brain symptoms, inability to work, which is known as Post-Concussive Syndrome
  • The patient needs to be under close observation at home for up to 3-4 days, if not admitted to a hospital, since hidden neurologic injury or bleeding into the brain may not be immediately obvious, and may declare itself hours to days later.  The decision as to the necessity of hospitalization, or the length of observation needs to be made by a physician.  If the patient is under close observation at home, it is necessary to awaken the patient every few hours to full alertness, make sure the patient is oriented, and check briefly that neurologic signs are intact.  A physician will show family members how to do this.  It is desirable to check the pupil size at these periodic checks, to make sure there is no inequality of pupil size, since this may indicate serious brain swelling.
  • The complications would likely be from hidden neurologic or vascular injury, and not from the concussion itself.
  • Boxers who have repeated concussions may show permanent neurologic signs from these events.  It is thought that such boxers might have microscopic areas of brain injury to account for the permanent signs.

  • If the infant, child, or adolescent has a minor head injury and lost consciousness or was acting dazed, this might be a concussion, even if the person seems fine afterwards.
  • The concussion should be reported to a physician, since it may lead to further symptoms, such as long lasting headaches, memory loss, decreased alertness, apathetic behavior, or weakness.
  • There might really be a more serious injury, such as bleeding inside the skull, or a cervical spine injury.  The physician can assess this for your child.

  • Syncope (fainting) from any cause; Hysterical Syncope
  • Postural hypotension
  • Hypoglycemia
  • Headache, Seizure
  • More serious head injuries may give loss of consciousness and neurologic impairment of a more marked nature.




more about Concussion


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