Patient's Complete Guide to Concussion

Overview of Concussion

A concussion is the commonest type of mild traumatic brain injury, caused by jolt, blow, or bump to the head resulting in temporary loss of brain function.

Signs and Symptoms of Concussion

A concussion is the commonest type of ‘mild traumatic brain injury (mTBI)’, that is caused by direct jolt, blow, or bump to the head resulting in a sudden back and forth movement of the head and brain. This shaking causes some chemical changes in the brain along with damaging to the brain cells.
Concussions need immediate medical attention as it can be life-threatening!!
The word concussion is derived from a Latin word,concutere’, meaning ‘to shake violently’. The violent shaking of the head can alter the mental state i.e. unconsciousness.  The Urdu meaning of concussion is,دماغی چوٹ’.
Traumatic brain injuries are often used interchangeably with concussions. They vary in severity from mild to long lasting symptoms depending on the injury level. Head injury can occur to anyone by an accident or in any routine activity. But it’s more likely to happen in sports.

Occurrence

According to the Center for Disease Control and Prevention (CDC), the incidence of concussions is 1.4 to 3.8 million cases per year. The occurrence of traumatic brain injuries is more common in old people aged above 75, young people aged 15-24 years and children aged 0-4 years.
The high risk of concussion is present in sports such as football and soccer. Athletes also have an increased risk of concussions. According to the report of Brain Injury Research Institute, “concussion affects 1.6 to 3.8 million athletes while most of the cases are left undiagnosed and underreported”.

Do not confuse concussion with contusion!

Both concussion and contusions belong to traumatic brain injury but differ in condition. Concussions affect your brain (widespread trauma) physically as well as functionally whereas, contusions are head bruises due to the blood vessel injury that leaks blood in the surrounding area (localized trauma).

Types of Concussion

The signs and symptoms of concussion vary with severity and time. Sometimes symptoms of concussion do not appear at the time of injury but may show up after some time.

The signs and symptoms may last for days, weeks or longer.

Common sign and symptoms of a concussion:

  • Headache
  • Confusion
  • Amnesia (loss of memory)
  • Nausea
  • Vomiting
  • Blurry vision
  • Fatigue
  • Drowsiness

Signs and symptoms that a concussed person can feel:

  • Lack of concentration
  • Memory complaints
  • Photosensitivity
  • Sleep disturbances
  • Irritability
  • Loss of smell and taste senses for the time being
  • Cannot tolerate noise
  • Depression

Signs and symptoms observed by the witness in a concussed person:

  • Slurred speech
  • Dazed appearance
  • Forgetfulness (usually asking same questions about the accident)
  • Temporary unconsciousness
  • Delayed response
  • Ringing in the ears

Signs of concussion in children

Brain trauma or injuries are very common in children aged up to 4 years. However, the signs of concussion in children are difficult to suspect because they cannot explain on their own. Some of the signs and symptoms that provide clue to a doctor include:

  • Irritability
  • Crankiness
  • Listlessness (lethargy)
  • Loss of balance in walking
  • Dizziness
  • Vomiting
  • Excessive crying
  • Seizures
  • Sleep disturbances
  • Lack of interest in daily activities or playing

What is concussion vomiting?

Vomiting is the most important sign of a concussion or neurological injury. Most of the concussed people experience this symptom but not all. Sometimes it longs for days depending on the severity of an injury.

Long-term effects of concussion

Long-term effects of concussion are rarely found. Most of the symptoms resolve within a week or few. About 20% people experience long-term effects of concussion i.e. more than 6 weeks. Nonetheless, the more concussion history you have, the more you suffer long- term concussion effects.
Symptoms of long-term concussion include; post traumatic headache, post traumatic dizziness, irritability, memory problems, concentration problems, sleep disturbances, depression and loss of smell and taste senses.
Be cautious!! Take proper treatment and rest after a concussion until the brain injury heals. Because if you get a second concussion before the healing of the first one, you might have a chance of getting “second impact syndrome” that can cause severe brain swelling or even fatal. Always consult your doctor before resuming your sports or exercises.

Post-concussion syndrome

Post-concussion syndrome refers to the long-lasting symptoms followed by a concussion. A condition develops when symptoms persist for more than four weeks. The symptoms of post-concussion syndrome (PCS) include; headaches, ringing in the ears, photosensitivity, alcohol intolerance, impaired memory, dizziness, anxiety and loss of concentration.
Post-concussion syndrome is treated with certain medicines and more importantly with psychotherapy or counselling to deal with neurological symptoms.

Can a concussion occur by a hit to the jaw or chin?

Yes! A sudden hit to the jaw or chin can violently move the head back and forth that causes a concussion.

Causes of Concussion

Concussions are ranked into three grades based on their severity;

  • Mild: grade 1 type, no unconsciousness and last less than 15 minutes
  • Moderate: grade 2 type, no loss of consciousness and last more than 15 minutes
  • Severe: grade 3 type, loss of consciousness for a few seconds and lasts longer.

Risk Factors of Concussion

Your brain is made up of soft tissues having a gelatin-like consistency and cushioned by cerebrospinal fluid (CSF). It is covered in a protective shell of the skull.
But a sudden or violent bump to the head or upper body causes the brain to move back and forth against the skull walls. The violent bumps at different angles to the head with its consequence injury is shown here.
The sudden back and forth movement occurs by accidents such as, car crash, motor biking without helmet and during sports. Such brain injuries disrupt the brain function and develop symptoms of concussion for a certain period of time. They may cause bleeding inside your brain and symptoms may prolong in such conditions.

The bleeding inside your brain could be fatal!!!

Traumatic brain injuries need timely recognition and emergency response. Appropriate response by your healthcare provider is much needed in early diagnosis and treatment to avoid the late stage complications.

Prevention

Some factors increase the risk for a concussion or head injury, they include:

  • Falls particularly in old people and children (most common cause of concussion)
  • Accidents that cause bump or blow to the head i.e. bicycle, car, motorbike
  • Military service
  • Physical abuse
  • Hit on a head by any object
  • An earlier concussion history
  • Contact sports
  • Lack of supervision in contact sports
  • Lack of safety gear in sports

Diagnosis

The risk of getting brain or head injuries can be reduced by following preventions:

  • Wear seat belt while driving
  • Wear helmet on motorbike
  • Never drive when you drunk alcohol
  • Do not use ladder if you feel dizzy that can affect your balance
  • Some medicines have side-effects of dizziness. Do not perform physical activity or sports after using these medicines
  • Make sure your vision is correct (check your eyesight twice a year)
  • Remove extra clutter in your home that can cause falls especially for older people and children

Treatment of Concussion | When to Consult a Doctor

Concussion is mainly diagnosed by the doctor’s investigation. Your doctor will ask you some questions about the injury. A doctor will ask:

  • How you got an injury
  • History of head injuries
  • Medical history
  • History of medicines
  • Alcohol usage
  • Symptoms of injury
  • Memory tests to check the brain function
  • Physical examination

A doctor will perform your physical examination including; blood pressure, pulse rate, reflexes, light sensitivity, vision, memory tests and your response after injury. A doctor may repeatedly ask the same questions or perform a physical examination after an interval to make sure of your condition.

  • Imaging tests

If you have mild symptoms then, the doctor will not recommend further tests. But if your symptoms are getting worse and your physical examination is abnormal then, the doctor will prescribe you some tests to monitor the injury site. The imaging tests include

  • CT scan (computed tomography): inside image of your brain
  • MRI (magnetic resonance imaging): image of your brain
  • Electroencephalogram: monitor brain waves

Healthcare Providers

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Speciality for Concussion

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