Concussion

What is a Concussion?

The term “Concussion” refers to the mild traumatic brain injury that temporarily affects your brain function. This condition may occur after an impact or injury to your head and causes your brain to slide back and forth forcefully against the inner walls of your skull. Finally, this results in an alteration of mental status that can lead you to become unconscious. But you shouldn’t mix up between concussion and contusion. A concussion especially affects your brain, but contusion refers to a bruise that can occur on your head and typically not a serious condition.

Concussion mainly occurs from direct trauma or heavy injuries to the head, such as from falling, getting hit, car accidents, gunshot, or sports. The mechanism of injury involves a rapid acceleration-deceleration of the head, such as blast injuries or whiplash injuries. In severe cases, bleeding may also present as an external sign of head trauma ¹. Additional risk factors of concussion include alcohol consumption and a previous history of concussion.

Symptoms of a concussion vary according to the severity and duration of the injury. Typical signs of a concussion include memory problems, confusion, dizziness, headache, nausea, double or blurred vision, tiredness, drowsiness, balance problem, sensitivity to light or noise, etc. Typical symptoms of a concussion last 2 weeks in adults and 4 weeks in children. Research estimates that about 10% of sports-related concussions among children occur with loss of consciousness ².

How do Neurosurgeons typically diagnose a concussion?

According to the University of Pittsburgh’s Brain Trauma Research Center, sports-related concussion cases accounts for almost 300,000 cases in the United States every year ³. The Center for Disease Control and Prevention (CDC) reports about 2.87 million traumatic brain injury cases in the United States in 2014. The higher incidence of traumatic brain injury occurs in older aged over 75 years, children aged less than 4 years, and individuals aged between 15 to 25 years ⁴.

Whenever you faced some above symptoms after an initial injury, consult with your physician first. Your physician will take your history by asking a variety of questions about how the injury occurred, the location of the injury, and perform a physical examination to see the symptoms. You need to report any unusual experiences or symptoms to your doctor. He will perform some neurological examination to observe your vision, balance, hearing, strength, reflexes, cognitive test, etc. Later he will suggest to do some clinical tests. The clinical test includes brain imaging tests such as MRI and CT scans of your brain to check for serious injuries ¹. Sometimes, your doctor may perform an electroencephalogram to monitor the brain waves.

How do Neurosurgery Specialists most commonly treat a Concussion?

The treatment of a concussion depends upon the severity of your symptoms. You may require surgical intervention or other medical procedures if you develop bleeding, swelling, or have a serious injury in the brain. But most concussions don’t require any surgery or other intervention. Treatment protocol for this condition includes ⁴:

1. Physical and mental rest: The standard treatment for concussion should comprise plenty of rest. Relative rest helps to allow your brain to recover gradually. You also need to avoid some physical activities that might increase your symptoms, like physical exertion, sports, any vigorous movements, etc.
2. Medications: If you have a headache, your doctor may recommend having analgesics like ibuprofen to manage pain, paracetamol (acetaminophen) to reduce the risk of intracranial hemorrhage
3. Surgery: Surgery may require less than 1% of patients with traumatic brain injury to treat.

The potential complications of concussion include post-traumatic headache, post-traumatic vertigo, second impact syndrome, post-concussion syndrome such as headaches, dizziness and thinking difficulties, etc ⁵. You need to do a regular check-up if you have the risk factors of concussion and consult with your doctor immediately for further advice.

References

1. Dompier, T. P. et al. Incidence of concussion during practice and games in youth, high school, and collegiate American football players. JAMA Pediatr. 169, 659–665 (2015).
2. Kimbler, D. E., Murphy, M. & Dhandapani, K. M. Concussion and the adolescent athlete. J. Neurosci. Nurs. 43, 286–290 (2011).
3. Cartwright, C. Pediatric athletic concussion. J. Neurosci. Nurs. 46, 313 (2014).
4. Harmon, K. G. et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br. J. Sports Med. 47, 15–26 (2013).
5. Schmidt, J. D. et al. Age at First Concussion Influences the Number of Subsequent Concussions. Pediatr. Neurol.81, 19–24 (2018).