Introduction
A concussion is a type of traumatic brain injury (TBI) caused by a direct blow to the head or forceful shaking of the body. This injury can lead to temporary cognitive and physical issues, including confusion and headaches. Not all concussions result in a loss of consciousness, which is why many go undiagnosed.
If left untreated, concussions can lead to long-term brain damage or even death, especially if a second concussion occurs before full recovery. Treatment focuses on allowing the brain to heal before gradually reintroducing physical and mental activity. The key to recovery is recognizing the signs early and giving the brain the necessary rest.
Anatomy
The brain is soft and has a gelatin-like texture, surrounded by fluid that cushions it from minor impacts. When a concussion happens, the brain is jolted, hitting the inside of the skull, leading to friction and inflammation. In severe cases, this can cause dangerous swelling or bleeding, which may be life-threatening.
After a concussion, there’s a shift in brain chemistry, which can take weeks to return to normal. Overstimulation during this recovery period can lead to long-term cognitive issues, making rest and gradual activity resumption crucial.
Causes
The most common cause of concussions in children is falls. Sports such as football, soccer, and hockey are also frequent causes, along with car accidents, bike crashes, and physical altercations.
Having had a previous concussion increases the risk of a second, more severe concussion. This is known as second impact syndrome and can have devastating consequences if not managed properly.
Symptoms
Identifying concussion symptoms early is key to preventing long-term damage. Symptoms may appear immediately or develop hours after the injury and can last from days to weeks. Confusion is often the first sign, with the person struggling to remember events before the injury.
Common symptoms include
- Confusion
- Memory loss
- Drowsiness or difficulty waking
- Headache or head pressure
- Dizziness or vertigo
- Nausea and vomiting
More severe symptoms include
- Loss of consciousness for over 30 seconds
- Persistent or worsening headache
- Difficulty with balance and movement
- Sensitivity to light or noise
- Abnormal behavior or disorientation
- Loss of senses such as smell, taste, or hearing
Diagnosis
Early diagnosis is essential for a successful recovery. A doctor will evaluate vision, hearing, balance, reflexes, and memory to determine if a concussion has occurred. They will also assess changes in behavior and cognitive abilities.
Cognitive tests, often computer-based, are common in schools and sports programs, allowing for baseline comparisons after an injury. In more serious cases, imaging tests like CT scans or MRIs may be used to rule out bleeding or severe swelling in the brain.
Treatment
The main treatment for a concussion is rest. Both physical and mental activities should be avoided, including exercise, schoolwork, and screen time, until the brain has healed. Bright lights and loud sounds should also be minimized.
Pain relief can be managed with acetaminophen (Tylenol®), but ibuprofen (Advil®) should be avoided, as it may increase the risk of bleeding. Gradual reintroduction of activity is key, starting with light tasks and slowly progressing to more demanding physical and mental activities.
All US states have “return to play” laws that require athletes to follow a specific progression before returning to sports. This progression involves a 5-step plan, ensuring that athletes are symptom-free at each stage before advancing.
Concussion recovery is complex and should be managed by a healthcare provider with experience in treating brain injuries. Special rehabilitation programs may be necessary for those experiencing balance or coordination issues.
Prevention
The best way to prevent concussions is to take proactive safety measures, such as wearing helmets during sports and always using a seatbelt while in a vehicle. Avoiding head injuries through proper precautions is key.
If a concussion is suspected, seek medical attention immediately. Proper evaluation and treatment are essential to prevent complications, especially if there is a risk of repeated head injury.
