Concussion (TBI)

Introduction

A concussion is a traumatic brain injury (TBI) that occurs from a direct hit to the head. Concussions can also occur when the head or body is forcefully shaken. Brain injuries can lead to temporary confusion, headaches, and much more. Concussions may cause a loss of consciousness but not always, which is why many concussions go undiagnosed.

Long-term brain damage and death may occur if a concussion is not treated properly, especially if a second concussion were to occur. The goal of treatment is to allow the brain to heal, and then gradually increase physical and mental stress until the patient reaches their normal activity level and can safely return to sports.

At the first sign of injury, immediately do the following:

• Stop participating in the activity.
• Check for signs and symptoms of a concussion (see below).
• Get a concussion evaluation and cognitive test as soon as possible
• Allow time for recovery before returning to normal activities.

Anatomy

The brain has a texture similar to gelatin. It is surrounded by fluid that cushions the brain from hitting the skull from everyday bumps and movement. When a concussion occurs, the brain is jolted against the skull, causing friction and inflammation. In severe cases, a concussion can cause severe swelling or bleeding, which can be fatal.

Following a TBI, there is a change in brain chemistry. It can take weeks for the brain to achieve a normal chemical balance again. Overstimulation of the brain during the recovery period can lead to permanent changes in brain function and cognitive decline.

Causes

More than half of concussions in kids are due to falls. Head-on collisions during sports such as football and soccer can also lead to a concussion. Concussions can also happen to someone who has been involved in a car wreck, bike accident, or fight.

A history of concussions can increase your risk for subsequent head injury, which is likely to be more severe than the first. This is called second impact syndrome.

Symptoms

Recognizing the signs of a concussion is challenging but critical for an optimal recovery. Onset of concussion symptoms may be delayed or occur immediately following the event. Symptoms may last for days or weeks, sometimes longer. Confusion is the primary symptom that may indicate a concussion. The patient has trouble recalling the events prior to the injury.

Common concussion symptoms include:

• Confusion
• Memory loss or temporary amnesia
• Drowsiness or inability to wake up
• Headache or pressure in the head
• Ringing in the ears (tinnitus)
• Dizziness (vertigo)
• Nausea or vomiting

Symptoms that are considered severe include:

• Loss of consciousness for 30 seconds or longer
• Headache pain that won’t go away or worsens
• Inability to control movements and balance
• Blurred vision
• Hypersensitivity to light or noise
• Loss of smell/taste/hearing/vision
• Abnormal behavior: short attention span, difficulty following directions, irritability, disorientation
• Numbness in face/extremities

Diagnosis

For the best possible outcome, early diagnosis of a concussion is critical. You should have an appropriate concussion evaluation and cognitive testing performed at the first sign of injury.

During a concussion evaluation, the doctor will check for problems with vision, hearing, reflexes, balance and coordination, strength, and memory. You will be asked questions about what happened in the events leading up to the injury and immediately following the impact. It also important to assess any behavioral changes that might be related to a concussion. A concussion specialist should be consulted for further testing if there are any concerns.

Cognitive testing may be performed using a computer-based program, which collects baseline data for athletes in many US high schools at the beginning of the season. In the event of a concussion, the same test can be repeated to help monitor progress during recovery.

In some cases, a CT scan or MRI may be used if symptoms persist or do not improve. These imaging techniques are used to look for bleeding or extensive swelling in the brain.

Treatment

The brain will heal with adequate rest, both physical and mental. Avoid physical activity – even brisk walking and weightlifting – and anything that requires focus or concentration, like school work, video games, driving, texting, and watching TV, until the brain is fully healed. Bright lights and loud sounds can also be stimulating to the brain, and should be avoided. Take acetaminophen (Tylenol®) for headaches, but avoid taking ibouprofen (Advil®), which might increase the risk of bleeding.

The goal of treatment is to allow the brain to heal while gradually increasing the amount of physical and mental stress you can endure without inducing concussion symptoms. Post-concussion symptoms can occur for weeks or months after the injury for some people. Returning to play too quickly can have devastating consequences if a repeat injury occurs.

All 50 states in the US have “return to play” laws to protect athletes from returning to sports too soon. Return-to-play programs are based on a 5-step progression plan that starts with returning to school/work, then light activity, moderate activity, heavy non-contact activity, practice and full contact activity, and finally, competition-level activity. You must remain symptom-free to advance to the next step.

Concussion care is complex and should only be done by a qualified provider with advanced training and experience. If you are experiencing balance/coordination issues, special rehabilitation programs for concussions may be available through qualified physical therapists, athletic trainers, or sports medicine physicians.

Prevention

The best way to prevent a concussion is to take appropriate safety measures to avoid head injury. This would include always wearing protective head gear while playing contact sports, cycling, skiing, etc., and buckling up with a seat belt at all times when driving, or in a car.

If there is any chance that you or your child has a concussion, seek medical attention. Proper evaluation of a concussion can prevent serious complications if another concussion were to occur.