What is Concussion?
Concussion is a common type of traumatic brain injury which occurs due to an impact or trauma to the head. It is not a life-threatening injury, but can cause both long-term and short-term problems. A concussion is caused due to a closed-head type of injury and does not involve injuries where there is bleeding under the skull or into the brain. Concussion can temporarily affect the brain function causing headache, change in or loss of consciousness, tinnitus, dizziness etc. A concussion can be mild, moderate or severe.
Causes of Concussion
The cause of concussion can be a forceful blunt trauma resulting from a fall, sports activities, car accidents, being hit on the head with a blunt object. Jarring of the brain in any direction may result in loss of consciousness. The duration of loss of consciousness may indicate the severity of the concussion. Concussions need not always involve loss of consciousness. Many patients suffering from concussion don't lose consciousness, but may see complete see black or white color or stars. Sometimes, patients may not be aware that they have concussion.
Symptoms of Mild Concussion
- Changes in mental alertness or feeling of confusion or being spaced out.
- There may be some memory loss.
- There may be some mild tinnitus (ringing in the ears).
- Some dizziness may be present.
- Headache may be present.
- Pain and swelling is felt where the patient had hit his head or at the point of trauma/impact.
- Patient, however, will have a normal balance and does not lose consciousness in mild concussion.
Symptoms of Moderate Concussion
- There is mental confusion.
- There is definite posttraumatic memory loss.
- Moderate amount of tinnitus.
- Moderate amount of dizziness or headache.
- There is moderate disturbance in the balance.
- There may be nausea and vomiting.
- Patient will suffer from loss of consciousness for around or less than 5 minutes.
Symptoms of Severe Concussion
- Mental confusion for more than 5 minutes.
- Patient suffers from severe tinnitus, dizziness or headache.
- Persistent retrograde amnesia where the patient has memory loss of the events before the concussion.
- Patient loses consciousness for more than 5 minutes.
- There may be increase in blood pressure (hypertension) with decrease in the heart rate.
- Patient may see flashing lights
- Muscle weakness may be present on one or both sides.
- Pupils may be unequal in size with strange eye movements.
- Slurred speech.
Investigations for Concussion
- Physical exam.
- Neurological exam to look for changes in pupil size, coordination, thinking ability, coordination and reflexes.
- EEG (in case of persistent seizures.)
- Head CT scan.
- MRI of the head.
Treatment of Concussion
- The athlete should withdraw from sports activities immediately.
- The athlete/patient should be monitored and not left alone.
- Athlete/patient should seek professional medical care.
- Athlete/patient should avoid contact sports for at least 3 weeks.
- If patient suffers from repeated concussions, then this may be an indication of retirement from contact sports altogether.
- Self care treatment involves ice application for 20-30 minutes and should be repeated every 2-3 hours. Ice should not be applied directly to the skin, but should be applied using a wash cloth. Ice application help in decreasing the size of the swelling.
- Rest should be taken.
- Patient should take adequate fluids.
- Mild analgesics such as acetaminophen (Tylenol) may be given.
- If there are any cuts present, they are numbed with lidocaine, either via injection or topical application. The doctor then cleans the cut with a saline solution or an iodine solution and looks for any foreign bodies and hidden injuries. The wound is then closed with stitches (sutures), skin staples or sometimes using skin glue known as cyanoacrylate (Dermabond).
- After the treatment, the patient should follow-up regularly with his/her primary care physician or a specialist, such as a neurologist. These follow-ups are important to diagnose more subtle problems of concussion such as memory deficits, changes in personality and cognition, as these may not be evident at the time of actual injury.
Returning to Sports
- The athlete should make a gradual return to training and sports activities under the supervision of a sports injury specialist.
- If the athlete is symptom free, then he/she can start light exercises, walking or stationary cycling.
- After this, the athlete can start sports specific activities which do not involve contact such as running. In case of returning symptoms, the athlete should discontinue or stop the sports activities.
- In the next stage, athlete can start on-field practice, but again it should not involve any contact. If the athlete experiences any symptoms, then he should return to the previous stage.
- After the consent of the sports specialist, the athlete can start on-field practice with contact. The severity of the concussion is the deciding factor for the amount of time taken to get to this stage.