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Concussion

(Closed Head Injury; Head Trauma; Mild Traumatic Brain Injury)

Definition

A concussion is an injury to your brain. The brain does not work right for a while after a concussion. You may have problems with things like memory, balance, concentration, judgement, and coordination.
Your brain will need time to heal after a concussion. Most will have a full recovery with the proper rest and monitoring.

Causes

A concussion is caused by a sudden, violent jolt to the brain. It may be caused by:
  • A blow to the head
  • Severe jarring or shaking—like a bad fall
  • Abruptly coming to a stop—most common in car accidents
How a Concussion Occurs
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Concussions most often occur with events that involve:
  • Motor vehicles
  • Bicycles
  • Skates, skateboards, and scooters
  • Sports and recreation
  • Falling down
  • Firearms
  • Physical violence such as
    • Assault and battery
    • Domestic violence
    • Child abuse

Risk Factors

Factors that may increase your chance of a concussion include:
  • A previous concussion or head injury
  • Participation in contact sports like football or boxing
  • Work that involves farming, logging, or construction where the potential for a head injury is high
  • Being in a car accident

Symptoms

A concussion can cause symptoms that may last for days, weeks, or even longer.
Symptoms may include:
  • Confusion
  • Loss of memory about the accident
  • Low-grade headache or neck pain
  • Nausea
  • Trouble:
    • Remembering things
    • Paying attention or concentrating
    • Organizing daily tasks
    • Making decisions and solving problems
  • Slowness in thinking, acting, speaking, or reading
  • Feeling fatigued or tired
  • Change in sleeping pattern:
    • Sleeping much longer than usual
    • Trouble sleeping
  • Loss of balance
  • Feeling light-headed or dizzy
  • Increased sensitivity to:
    • Sounds
    • Lights
    • Distractions
  • Blurred vision or eyes that tire easily
  • Loss of sense of taste or smell
  • Ringing in the ears
  • Mood changes:
    • Feeling sad, anxious, or listless
    • Becoming easily irritated or angry for little or no reason
    • Lacking motivation
Symptoms that may appear in a child with a concussion include:
  • Listlessness or tiring easily
  • Irritability or crankiness
  • Changes in:
    • Eating or sleeping patterns
    • Play
    • Behavior
    • School performance
  • Lack of interest in favorite toys or activities
  • Loss of new skills, such as toilet training
  • Loss of balance, unsteady walking

Diagnosis

The doctor will ask you about your symptoms and how the injury occurred. The doctor may also ask others who witnessed the accident to describe what happened and how you reacted. A physical exam will be done. It will often include brief tests for strength, sensation, balance, reflexes, and memory.
If your doctor suspects a different type of head injury, you may have a:
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the head
  • MRI scan—a test that uses magnetic waves to make pictures of structures inside the head

Treatment

The goal of treatment is to allow the brain to heal. The brain can heal on its own with rest and avoiding activities that may be harmful while it heals.

Mental and Physical Rest

You brain will need full rest. This means avoiding physical activities and decreasing mentally demanding tasks. At first you will need to avoid all activities that need concentration like work or schoolwork. For children this also includes video games, watching television, computer activities, or texting.
Your doctor will ask you to gradually add in mental and physical activities once your initial symptoms are gone at rest. Your doctor will assess your symptoms, balance, cognition and tolerance to your current activity at each stage of recovery. The doctor will use this information to know if you will need further rest or if you are ready to progress to the next step.
Follow your doctor's directions on when you should return to work or school. Following the recommended schedule will help to speed your recovery.

Prevent Further Damage

The brain is more vulnerable to injuries while it is healing. Some steps to consider include:
  • Avoid certain medicines—especially aspirin, blood thinners, and medicines that cause drowsiness
    • Talk to your doctor about any medication you are taking.
    • Do not take any new medication without your doctor's permission until your concussion is fully healed. This includes over-the-counter medication and supplements.
  • Avoid use of alcohol and illegal drugs.
  • Avoid activities that might jolt or jar your head—re-injury can lead to more severe or long-term symptoms
    • Never return to a sports activity until your doctor has given you permission.
    • When you are cleared to do so, gradually return to sports.
    • Ask when it's safe to drive a car, ride a bike, work, or use heavy equipment.
  • Avoid a second head injury in children and adolescents (second impact syndrome)
    • Even a mild second head injury in children and adolescents can lead to serious damage to the brain. This can lead to unconsciousness and even death.
    • Follow your child's doctor's recommendation of when it is safe to return to contact sports or other activities.
If you are diagnosed as having a concussion, follow your doctor's instructions.
If you are diagnosed as having a concussion, follow your doctor's instructions.

Prevention

To prevent vehicle accidents and head injuries associated with car accidents:
  • Do not drink alcohol and drive.
  • Do not take medicines that may make you sleepy, especially when driving or using heavy equipment.
  • Obey speed limits and other driving laws.
  • In vehicles, always use seatbelts and child safety seats. Only use child safety seats when traveling. Do not use them outside of the vehicle.
To prevent concussions with recreational activities and sports:
  • Wear a helmet when:
    • Riding a bike or motorcycle
    • Playing a contact sport like football or hockey
    • Using skates, scooters, and skateboards
    • Catching, batting, or running bases in baseball or softball
    • Riding a horse
    • Skiing or snowboarding
  • Wear mouth guards, face guards, pads, and other safety gear while playing sports.
To prevent accidents at home that can lead to concussions:
  • Make sure your child's play surface is soft and free of rocks, holes, and debris.
  • Use handrails when walking up and down stairs—teach your child to do so
  • Have safety gates by stairs and safety guards by windows
  • Use grab bars in the bathroom
  • Place non-slip mats in the bathroom
  • Keep walkways clear to avoid tripping
  • Make sure rooms and hallways are well-lit

RESOURCES

America Association of Neurological Surgeons http://www.aans.org

American Family Physicians http://familydoctor.org

Center for Disease Control and Prevention Injury Prevention and Control http://www.cdc.gov/concussion

Nemours Kids Health http://kidshealth.org

CANADIAN RESOURCES

Brain Injury Association of Alberta http://www.biaa.ca

Ontario Brain Injury Association http://www.obia.on.ca

References

Can you recognize a concussion? American Academy of Physical Medicine and Rehabilitation website. Available at: http://www.aapmr.org/patients/conditions/neurologic/brain/Pages/concuss.aspx. Accessed July 9, 2009.

Concussion and mild traumatic brain injury. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 6, 2012. Accessed August 24, 2012.

Harmon KG. Assessment and management of concussion in sports. Am Fam Physician. 1999;60(3):887-894.

Halstead ME, Walter KD, Council on Sports Medicine and Fitness. American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents. Pediatrics. 2010 Sep;126(3):597-615. full-text

Kirkwood MW, Yeates KO, Wilson PE. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics. 2006;117(4):1359-1371.

Pearce JM. Observations on concussion: a review. Eur Neurol. 2008;59(3-4):113-119.

Ro YS, Shin SD, Holmes JF, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: a multicenter prospective study. Acad Emerg Med. 2011;18(6):597-604.

Sports-related concussion information for athletes. Wesleyan University Athletic Injury Care website. Available at: http://www.wesleyan.edu/athletics/injurycare/concussions.html. Updated January 2007. Accessed July 9, 2009.

Traumatic brain injury. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/TraumaticBrainInjury/index.html. Updated April 2008. Accessed July 9, 2009.

Traumatic brain injury. National Center for Injury Prevention and Control website. Available at: http://www.cdc.gov/TraumaticBrainInjury/index.html. Updated April 2008. Accessed July 9, 2009.

What is neurosurgery: concussion. American Association of Neurological Surgeons website. Available at: http://www.neurosurgerytoday.org/what/patient%5Fe/concussion.asp. Published November 2005. Accessed July 9, 2009.

10/5/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Parikh SN, Wilson L. Hazardous use of car seats outside the car in the United States, 2003-2007. Pediatrics. 2010;126(2):352-357.

12/10/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Bakhos LL, Lockhart GR, Myers R, Linakis JG. Emergency department visits for concussion in young child athletes. Pediatrics. 2010;126(3):e550-556.

Revision Information

  • Reviewer: Peter Lucas, MD
  • Review Date: 09/2012 -
  • Update Date: 00/93/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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