Is a common injury to the brain and is often referred to a traumatic brain injury.
When it occurs in sports it can also be referred to as a mild traumatic brain injury [MTBI].
The brain has cerebrospinal fluid, which protects the brain. During a concussion, this absorption or protection may not be adequate. The forces causing the concussion, causing movement of the brain and the resulting injury.
Areas of brain most commonly affected are the midbrain and diencephalon.
Other areas affected include:
1.) Brain stem
2.) Fornix
3.) Corpus callosum
4.) Temporal lobe
5.) Frontal lobe.
The result of the injury can cause loss of brain function, cognitive and emotional symptoms.
Repeated concussions can cause additional problems including:
1.) Brain damage
2.) Dementia
3.) Second-impact syndrome.
4.) Memory loss
5.) Coma
6.) Death
It is believed that over 6 per 1,000 receive concussions every year.
It is still being evaluated whether actual brain damage is done with a single concussion. Currently the classic definition indicates; no structural damage.
Therefore, symptoms are caused by a change in the functionality of the brain.
Symptoms can therefore resolve when treatment is administered properly.
Common modalities of injury:
1.) Car accidents
2.) Bicycle accidents
3.) Sport injuries
4.) Falls
5.) Fights
6.) Soldier injuries including nearby explosions
Symptoms:
Physical
- Headache
- Dizziness
- Blurred vision
- Vomiting
- Nausea
- Seizures
- Ringing of ears
- Sensitivity of bright lights
- Loss of coordination
- Difficulty with balancing
Cognitive and Emotional
- Confusion
- Difficulty with attention
- Disorientation
- Loss of Consciousness
- Post-traumatic Amnesia
- Lethargy
- Inappropriate emotions
- Restlessness – can be in children
- Irritability
Diagnosis
- Physical exam
- Neurological exam
- Duration of unconsciousness
- Glasgow Coma Scale
- CT scan
- SPECT
- PET scans
Under-reporting of Concussions
Often concussions are not diagnosed following an injury.
This can als0 be seen in sport injuries. This increases the risk for additional injuries or permanent symptoms.
Grading a Concussion
Cantu guidelines:
Grade 1 – No loss of Consciousness
- Post traumatic amnesia less than 30 minutes
Grade 2 - Loss of Consciousness less than 5 minutes
- Post traumatic amnesia from 30 minutes to 24 hours
Grade 3 - Loss of Consciousness greater than 5 minutes
- Post traumatic amnesia lasting longer than 24 hours
Colorado Medical Society Guidelines:
Grade 1 - Confusion
- No loss of consciousness
Grade 2 – Confusion
- Post traumatic amnesia
- No loss of consciousness
Grade 3 – Any loss of consciousness
American Academy of Neurology Guidelines:
Grade 1 – Confusion
- Symptoms lasting less than 15 minutes
- No loss of consciousness
Grade 2 - Symptoms lasting longer than 15 minutes
- No loss of consciousness
Grade 3 - Loss of Consciousness
Grade 3a - Coma lasting for seconds
Grade 3b - Coma lasting for minutes
Treatment
. Rest
. Observation
. Sleep
. They usually can go away without treatment
. Very small number need brain surgery to release the pressure build-up.
. IBU can be used but Tylenol is often preferred.
. Do not drink alcohol
. Do not take drugs unless been approved by your Doctor