MRI of brain showing right frontal epidural hematoma
A concussion is a brain injury...
...and all brain injuries are serious.
A concussion can be caused by a blow to the head, a jolt to the body, or any sudden force that results in a rapid acceleration/deceleration of the brain inside the skull. Made up of a soft tofu-like substance, the impact of the brain against the rigid inside walls of the skull can cause a change in neurological function and a host of symptoms depending on which part of the brain was injured.
The terms "ding" or "bell rung" minimize concussions. While most do heal within a few weeks, an athlete who returns to play before a concussion has completely resolved risks re-injuring an already injured brain, which can have catastrophic consequences.
Adolescents seem most vulnerable to a rapid brain swelling known as second impact syndrome. Additionally, multiple concussions suffered prior to complete resolution of a previous injury can result in prolonged symptoms lasting weeks, months, or years. Much controversy still remains around the issues of second impact syndrome and the effects of multiple concussions.
Know how to minimize the risk of a complicated recovery if you suspect a concussion. Most importantly, do not rule out a concussion without an exam by an experienced physician.
Signs Reported By Observers:
- Appears dazed or stunned
- Is confused about assignment or position
- Forgets an instruction
- Is unsure of game, score, or opponent
- Moves clumsily
- Answers questions slowly
- Loses consciousness (even briefly)
- Shows mood, behavior, or personality changes
- Can’t recall events prior to hit or fall
- Can’t recall events after hit or fall
Symptoms Reported by Athlete:
- Headache or “pressure” in head
- Nausea or vomiting
- Balance problems or dizziness
- Double or blurry vision
- Sensitivity to light
- Sensitivity to noise
- Feeling sluggish, hazy, foggy, or groggy
- Concentration or memory problems
- Confusion
- Does not “feel right” or is “feeling down"
Most concussions do not result in emergency care. However, if symptoms worsen, you notice behavioral changes or any of the following, seek care urgently:
headaches that worsenseizuresneck painvery drowsy, can't be awakenedrepeated vomitingincreasing confusion or irritabilityweakness, numbness in arms and legsunable to recognize people/placesless responsive than usual
A negative MRI or CT scan does not mean a brain injury did not occur. A concussion is "a software problem, not a hardware problem," in other words, they are rarely detectable through the use of either of these diagnostic tests.
However, CT scans and MRIs are valuable in ruling out more severe problems such as hematomas (see MRI above at opening of this section). CT scans can add significant amounts of radiation to one's overall lifetime accumulation, so make sure they are warranted.
Loss of consciousness is uncommon, but if over 30 seconds, serious brain injury should be suspected.
AAN Position Statement, 2010: Any Athlete Suspected of Having Concussion Should Be Removed from Play
The American Academy of Neurology has published a position statement calling for any athlete who is suspected of having a concussion to be removed from play until the athlete is evaluated by a neurologist or physician with training in the evaluation and management of sports concussion.
The request is one of five recommendations approved by the AAN’s Board of Directors that targets policymakers who determine policy procedures for when an athlete suffers from concussion while participating in a sporting activity. The statement was drafted by the Academy’s Sports Neurology Section.
The Sports Neurology Section was asked to draft a position statement on sports concussion, given the high profile this issue has been given by the media in recent months. The heightened media attention has corresponded with increased state legislative activity on head injury among student athletes, as well as new research on the issue itself. As many neurologists work directly with patients who have been diagnosed and treated for concussions that occurred while participating in sports, policymakers, the media, and athletic programs look to the Academy for its perspective.
Click below for the NEJM, 2010, algorithm regarding Traumatic Brain Injury, from "Traumatic Brain Injury -Football, Warfare and Longterm Effects", DeKosky, S et al. Sept, 30 2010, NEJM.
[Edited from: ACE Post-Concussion Home/School Instructions, Children's National Medical Center, Washington DC and NEJM 2010.]
