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Concussion

Concussion

Definition

Concussion is a trauma-induced change in mental status, with confusion and amnesia, and with or without a brief loss of consciousness.

Description

A concussion occurs when the head hits or is hit by an object, or when the brain is jarred against the skull with sufficient force to cause temporary loss of function in the higher centers of the brain. The injured person may remain conscious or lose consciousness briefly and is disoriented for some minutes after the blow.

Demographics

According to the Centers for Disease Control and Prevention, approximately 300,000 people sustain mild to moderate sports-related brain injuries each year, most of them young men between 16 and 25 years of age.

The risk of concussion from football is extremely high, especially at the high school level. Studies show that approximately one in five players suffer concussion or more serious brain injury during their brief high-school careers. The rate at the collegiate level is approximately one in 20. Rates for hockey players are not known as certainly but are believed to be similar.

Causes and symptoms

Causes

Most concussions are caused by motor vehicle accidents and sports injuries . In motor vehicle accidents, concussion can occur without an actual blow to the head. Instead, concussion occurs because the skull suddenly decelerates or stops, which causes the brain to be jarred against the skull. Contact sports , especially football, hockey, and boxing, are among those most likely to lead to concussion. Other significant causes include falls, collisions, or blows due to bicycling, horseback riding, skiing, and soccer.

Concussion and lasting brain damage is an especially significant risk for boxers, since the goal of the sport is, in fact, to deliver a concussion to the opponent. For this reason, the American Academy of Neurology has called for a ban on boxing. Repeated concussions over months or years can cause cumulative head injury . The cumulative brain injuries suffered by most boxers can lead to permanent brain damage. Multiple blows to the head can cause punch-drunk syndrome or dementia pugilistica, as evidenced by Muhammad Ali, whose Parkinson's is a result of his career in the ring.

Young children are likely to suffer concussions from falls or collisions on the playground or around the home. Child abuse is, unfortunately, another common cause of concussion.

Symptoms

Symptoms of concussion include the following:

  • headache
  • disorientation as to time, date, or place
  • confusion
  • dizziness
  • vacant stare or confused expression
  • incoherent or incomprehensible speech
  • lack of coordination or weakness
  • amnesia for the events immediately preceding the blow
  • nausea or vomiting
  • double vision
  • ringing in the ears

These symptoms may last from several minutes to several hours. More severe or longer-lasting symptoms may indicate more severe brain injury. The person with a concussion may or may not lose consciousness from the blow; if he does lose consciousness, it will be for several minutes at the most. Prolonged unconsciousness indicates more severe brain injury.

The severity of concussion is graded on a three-point scale, used as a basis for treatment decisions.

  • Grade 1: no loss of consciousness, transient confusion, and other symptoms that resolve within 15 minutes
  • Grade 2: no loss of consciousness, transient confusion, and other symptoms that require more than 15 minutes to resolve
  • Grade 3: loss of consciousness for any period

Days or weeks after the accident, the person may show signs of the following:

  • headache
  • poor attention and concentration
  • memory difficulties
  • anxiety
  • depression
  • sleep disturbances
  • light and noise intolerance

The occurrence of such symptoms is called "post-concussion syndrome."

When to call the doctor

A doctor should be consulted whenever a head injury causes any of the symptoms noted above.

Diagnosis

It is very important for those attending an individual with a concussion to pay close attention to the person's symptoms and progression immediately after the accident. The duration of unconsciousness and degree of confusion are very important indicators of the severity of the injury and help guide the diagnostic process and treatment decisions.

A doctor, nurse, or emergency medical technician may make an immediate assessment based on the severity of the symptoms; a neurologic exam of the pupils, coordination, and sensation, and brief tests of orientation, memory, and concentration. Those with very mild concussions may not need to be hospitalized or have expensive diagnostic tests. Questionable or more severe cases may require computed tomography scan (CT) or magnetic resonance imaging (MRI) scans to look for brain injury.

Treatment

The symptoms of concussion usually clear quickly and without lasting effect, if no further injury is sustained during the healing process. Guidelines for returning to sports activities are based on the severity of the concussion.

A grade 1 concussion can usually be treated with rest and continued observation alone. The person may return to sports activities that same day, but only after examination by a trained professional, and after all symptoms have completely resolved. If the person sustains a second concussion of any severity that same day, he or she should not be allowed to continue contact sports until he or she has been symptom-free, during both rest and activity, for one week.

A person with a grade 2 concussion must discontinue sports activity for the day, should be evaluated by a trained professional, and should be observed closely throughout the day to make sure that all symptoms have completely cleared. Worsening of symptoms or continuation of any symptoms beyond one week indicates the need for a CT or MRI scan. Return to contact sports should only occur after one week with no symptoms, both at rest and during activity, and following examination by a physician. Following a second grade 2 concussion, the person should remain symptom-free for two weeks before resuming contact sports.

A person with a grade 3 concussion (involving any loss of consciousness, no matter how brief) should be examined by a medical professional either on the scene or in an emergency room. More severe symptoms may warrant a CT or MRI scan, along with a thorough neurological and physical exam. The person should be hospitalized if any abnormalities are found or if confusion persists. Prolonged unconsciousness and worsening symptoms require urgent neurosurgical evaluation or transfer to a trauma center. Following discharge from professional care, the person is closely monitored for neurological symptoms that may arise or worsen. If headaches or other symptoms worsen or last longer than one week, a CT or MRI scan should be performed. Contact sports are avoided for one week following unconsciousness of only seconds, and for two weeks for unconsciousness of a minute or more. A person receiving a second grade 3 concussion should avoid contact sports for at least a month after all symptoms have cleared and then engage in the sport only with the approval of a physician. If signs of brain swelling or bleeding are seen on a CT or MRI scan, the athlete should not return to the sport for the rest of the season, or even indefinitely.

For someone who has sustained a concussion of any severity, it is critically important that he or she avoid the possibility of another blow to the head until well after all symptoms have cleared to prevent second-impact syndrome. The guidelines above are designed to minimize the risk of this syndrome.

Prognosis

Concussion usually leaves no lasting neurological problems. Nonetheless, symptoms of post-concussion syndrome may last for weeks or even months.

Studies of concussion in contact sports have shown that the risk of sustaining a second concussion is even greater than it was for the first if the person continues to engage in the sport.

While concussion usually resolves on its own without lasting effect, it can set the stage for a much more serious condition. Second impact syndrome occurs when a person with a concussion, even a very mild one, suffers a second blow before fully recovering from the first. The brain swelling and increased intracranial pressure can lead to a potentially fatal result. More than 20 such cases have been reported since the syndrome was first described in 1984.

Prevention

Many cases of concussion can be prevented by using appropriate protective equipment. This includes seat belts and air bags in automobiles and helmets in all contact sports. Helmets should also be worn while bicycling, skiing, or horseback riding. Soccer players should avoid heading the ball when it is kicked at high velocity from close range. The surfaces immediately below and surrounding playground equipment should be covered with soft material, either sand or special matting.

Parental concerns

The value of high-contact sports such as boxing, football, or hockey should be weighed against the high risk of brain injury during a young person's participation in the sport. Steering a child's general enthusiasm for sports into activities less apt to produce head impacts may reduce the likelihood of brain injury. Children participating in any contact sport or activity that can cause brain injury should always wear a helmet.

Resources

BOOKS

Hergenroeder, Albert C., and Joseph N. Chorley. "Head and Neck Injuries." In Nelson Textbook of Pediatrics, 17th ed. Edited by Richard E. Behrman, et al. Philadelphia: Saunders, 2003, pp. 23134.

Hodge, Charles J. "Head Injury." In Cecil Textbook of Medicine, 22nd ed. Edited by Lee Goldman, et al. Philadelphia: Saunders, 2003, pp. 22412.

Parker, Rolland S. Concussive Brain Trauma: Neurobehavioral Impairment and Maladaptation. Lakeland, FL: CRC Press, 2000.

Ropper, Allan H. "Traumatic Injuries of the Head and Spine." In Harrison's Principles of Internal Medicine, 15th ed. Edited by Eugene Braunwald, et al. New York: McGraw Hill, 2001, pp. 243441.

PERIODICALS

Iverson, G. L., et al. "Cumulative effects of concussion in amateur athletes." Brain Injury 18, no. 5 (2004): 43343.

Lovell, M., et al. "Return to play following sports-related concussion." Clinics in Sports Medicine 23, no. 3 (2004): 42141.

Ryan, L. M., and D. L. Warden. "Post concussion syndrome." International Review of Psychiatry 15, no. 4 (2004): 3106.

Wisniewski, J. F., et al. "Incidence of cerebral concussions associated with type of mouth guard used in college football." Dental Traumatology 20, no. 3 (2004): 1439.

ORGANIZATIONS

American Academy of Emergency Medicine. 611 East Wells Street, Milwaukee, WI 53202. Web site: <www.aaem.org/>.

American Academy of Family Physicians. 11400 Tomahawk Creek Parkway, Leawood, KS 662112672. Web site: <www.aafp.org/>.

American Academy of Neurology. 1080 Montreal Avenue, St. Paul, MN 55116. Web site: <www.aan.com/>.

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 600071098. Web site: <www.aap.org/default.htm>.

American College of Emergency Physicians. PO Box 619911, Dallas, TX 752619911. Web site: <www.acep.org/>.

Brain Injury Association. 105 North Alfred Street, Alexandria, VA 22314. Web site: <www.biausa.org/Sportsfs.htm>.

International Brain Injury Association. 1150 South Washington Street, Suite 210, Alexandria, VA 22314. Web site: <www.internationalbrain.org/>.

WEB SITES

"Concussion." American Academy of Family Physicians. Available online at <www.aafp.org/afp/990901ap/990901e.html> (accessed December 8, 2004).

"Concussion." University of Missouri School of Medicine. Available online at <www.muhealth.org/~neuromedicine/concussion.shtml> (accessed December 8, 2004).

"Facts about Concussion and Brain Injury and Where to Get Help" Centers for Disease Control and Prevention. Available online at <www.cdc.gov/doc.do?id=0900f3ec8000d38c> (accessed December 8, 2004).

"Head Injury." MedlinePlus. Available online at <www.nlm.nih.gov/medlineplus/ency/article/000028.htm> (accessed December 8, 2004).

L. Fleming Fallon, Jr., MD, DrPH

KEY TERMS

Amnesia A general medical term for loss of memory that is not due to ordinary forgetfulness. Amnesia can be caused by head injuries, brain disease, or epilepsy, as well as by dissociation. Includes: 1) Anterograde amnesia: inability to retain the memory of events occurring after the time of the injury or disease which brought about the amnesic state. 2) Retrograde amnesia: inability to recall the memory of events which occurred prior to the time of the injury or disease which brought about the amnesic state.

Parkinson's disease A slowly progressive disease that destroys nerve cells in the basal ganglia and thus causes loss of dopamine, a chemical that aids in transmission of nerve signals (neurotransmitter). Parkinson's is characterized by shaking in resting muscles, a stooping posture, slurred speech, muscular stiffness, and weakness.

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Concussion

Concussion

Definition

Concussion is a trauma-induced change in mental status, with confusion and amnesia, and with or without a brief loss of consciousness.

Description

A concussion occurs when the head hits or is hit by an object, or when the brain is jarred against the skull, with sufficient force to cause temporary loss of function in the higher centers of the brain. The injured person may remain conscious or lose consciousness briefly, and is disoriented for some minutes after the blow. According to the Centers for Disease Control and Prevention, approximately 300,000 people sustain mild to moderate sports-related brain injuries each year, most of them young men between 16 and 25.

While concussion usually resolves on its own without lasting effect, it can set the stage for a much more serious condition. "Second impact syndrome" occurs when a person with a concussion, even a very mild one, suffers a second blow before fully recovering from the first. The brain swelling and increased intracranial pressure that can result is potentially fatal. More than 20 such cases have been reported since the syndrome was first described in 1984.

Causes and symptoms

Causes

Most concussions are caused by motor vehicle accidents and sports injuries. In motor vehicle accidents, concussion can occur without an actual blow to the head. Instead, concussion occurs because the skull suddenly decelerates or stops, which causes the brain to be jarred against the skull. Contact sports, especially football, hockey, and boxing, are among those most likely to lead to concussion. Other significant causes include falls, collisions, or blows due to bicycling, horseback riding, skiing, and soccer.

The risk of concussion from football is extremely high, especially at the high school level. Studies show that approximately one in five players suffer concussion or more serious brain injury during their brief high-school careers. The rate at the collegiate level is approximately one in 20. Rates for hockey players are not known as certainly, but are believed to be similar.

Concussion and lasting brain damage is an especially significant risk for boxers, since the goal of the sport is, in fact, to deliver a concussion to the opponent. For this reason, the American Academy of Neurology has called for a ban on boxing. Repeated concussions over months or years can cause cumulative head injury. The cumulative brain injuries suffered by most boxers can lead to permanent brain damage. Multiple blows to the head can cause "punch-drunk" syndrome or dementia pugilistica, as evidenced by Muhammaed Ali, whose parkinsonism is a result of his career in the ring.

Young children are likely to suffer concussions from falls or collisions on the playground or around the home. Child abuse is, unfortunately, another common cause of concussion.

Symptoms

Symptoms of concussion include:

  • headache
  • disorientation as to time, date, or place
  • confusion
  • dizziness
  • vacant stare or confused expression
  • incoherent or incomprehensible speech
  • incoordination or weakness
  • amnesia for the events immediately preceding the blow
  • nausea or vomiting
  • double vision
  • ringing in the ears

These symptoms may last from several minutes to several hours. More severe or longer-lasting symptoms may indicate more severe brain injury. The person with a concussion may or may not lose consciousness from the blow; if so, it will be for several minutes at the most. More prolonged unconsciousness indicates more severe brain injury.

The severity of concussion is graded on a three-point scale, used as a basis for treatment decisions.

  • Grade 1: no loss of consciousness, transient confusion, and other symptoms that resolve within 15 minutes.
  • Grade 2: no loss of consciousness, transient confusion, and other symptoms that require more than 15 minutes to resolve.
  • Grade 3: loss of consciousness for any period.

Days or weeks after the accident, the person may show signs of:

  • headache
  • poor attention and concentration
  • memory difficulties
  • anxiety
  • depression
  • sleep disturbances
  • light and noise intolerance

The occurrence of such symptoms is called "post-concussion syndrome."

Diagnosis

It is very important for those attending a person with concussion to pay close attention to the person's symptoms and progression immediately after the accident. The duration of unconsciousness and degree of confusion are very important indicators of the severity of the injury and help guide the diagnostic process and treatment decisions.

A doctor, nurse, or emergency medical technician may make an immediate assessment based on the severity of the symptoms; a neurologic exam of the pupils, coordination, and sensation; and brief tests of orientation, memory, and concentration. Those with very mild concussions may not need to be hospitalized or have expensive diagnostic tests. Questionable or more severe cases may require computed tomography scan (CT) or magnetic resonance imaging (MRI) scans to look for brain injury.

Treatment

The symptoms of concussion usually clear quickly and without lasting effect, if no further injury is sustained during the healing process. Guidelines for returning to sports activities are based on the severity of the concussion.

A grade 1 concussion can usually be treated with rest and continued observation alone. The person may return to sports activities that same day, but only after examination by a trained professional, and after all symptoms have completely resolved. If the person sustains a second concussion of any severity that same day, he or she should not be allowed to continue contact sports until he or she has been symptom-free, during both rest and activity, for one week.

A person with a grade 2 concussion must discontinue sports activity for the day, should be evaluated by a trained professional, and should be observed closely throughout the day to make sure that all symptoms have completely cleared. Worsening of symptoms, or continuation of any symptoms beyond one week, indicates the need for a CT or MRI scan. Return to contact sports should only occur after one week with no symptoms, both at rest and during activity, and following examination by a physician. Following a second grade 2 concussion, the person should remain symptom-free for two weeks before resuming contact sports.

A person with a grade 3 concussion (involving any loss of consciousness, no matter how brief) should be examined by a medical professional either on the scene or in an emergency room. More severe symptoms may warrant a CT or MRI scan, along with a thorough neurological and physical exam. The person should be hospitalized if any abnormalities are found or if confusion persists. Prolonged unconsciousness and worsening symptoms require urgent neurosurgical evaluation or transfer to a trauma center. Following discharge from professional care, the patient is closely monitored for neurological symptoms which may arise or worsen. If headaches or other symptoms worsen or last longer than one week, a CT or MRI scan should be performed. Contact sports are avoided for one week following unconsciousness of only seconds, and for two weeks for unconsciousness of a minute or more. A person receiving a second grade 3 concussion should avoid contact sports for at least a month after all symptoms have cleared, and then only with the approval of a physician. If signs of brain swelling or bleeding are seen on a CT or MRI scan, the athlete should not return to the sport for the rest of the season, or even indefinitely.

For someone who has sustained a concussion of any severity, it is critically important that he or she avoid the possibility of another blow to the head until well after all symptoms have cleared to prevent second-impact syndrome. The guidelines above are designed to minimize the risk of this syndrome.

Prognosis

Concussion usually leaves no lasting neurological problems. Nonetheless, symptoms of post-concussion syndrome may last for weeks or even months.

Studies of concussion in contact sports have shown that the risk of sustaining a second concussion is even greater than it was for the first if the person continues to engage in the sport.

Prevention

Many cases of concussion can be prevented by using appropriate protective equipment. This includes seat belts and air bags in automobiles, and helmets in all contact sports. Helmets should also be worn when bicycling, skiing, or horseback riding. Soccer players should avoid heading the ball when it is kicked at high velocity from close range. Playground equipment should be underlaid with soft material, either sand or special matting.

The value of high-contact sports such as boxing, football, or hockey should be weighed against the high risk of brain injury during a young person's participation in the sport. Steering a child's general enthusiasm for sports into activities less apt to produce head impacts may reduce the likelihood of brain injury.

Resources

BOOKS

Evans, R. Neurology and Trauma. W. B. Saunders Co., 1996.

ORGANIZATIONS

American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (612) 695-1940. http://www.aan.com.

KEY TERMS

Amnesia A loss of memory that may be caused by brain injury, such as concussion.

Parkinsonism A neurological disorder that includes a fine tremor, muscular weakness and rigidity, and an altered way of walking.

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concussion

concussion This word originally meant severe shaking, or the shock of an impact, but has come to mean the effect of such violence on the brain. The immediate effect of such an impact — usually when the moving head meets an immovable object, most commonly the ground — is unconsciousness. After a mild injury this lasts only a minute or so and the person is then dazed or confused for a few more minutes before recovering normal consciousness; occasionally recovery may take hours. After more severe impact injury, the patient may remain in coma for many days and remain confused for many more days thereafter. In either event there will be no memory for the moment of impact, often for a period immediately before this, and always for the period of unconsciousness and confusion: this is known as post-traumatic amnesia.

For many years ‘concussion’ was applied only to mild injuries, when it was assumed that the brief loss of consciousness was due to temporary chemical or electrical events resulting from the mechanical forces acting on the brain. It is now recognized that the effect of the jelly-like brain being distorted by these forces is to stretch or even tear delicate nerve fibres, resulting in some permanent damage. After mild injury this is very limited, but after more severe impact there is more severe and more widespread damage to fibres. There can therefore be both mild and severe concussion and it is misleading to ask ‘Was it only concussion?’

After only mild concussion there are often symptoms for several days, sometimes weeks — headache, fatigue, dizziness, and poor concentration. In a few patients these post-concussional symptoms give rise to anxiety and other psychological symptoms that can aggravate and prolong the organically-impaired function that the patient suffers. In contact sports there is the risk of repeated concussions, and the small amount of damage sustained each time can be cumulative. Moreover, soon after one concussion the brain may be more susceptible to a second blow, and this is why most sports have rules about waiting 2–3 weeks before playing again, for example after concussion on the football field or in the boxing ring. The repeated concussions over a period of years that boxers can experience may result in progressive brain damage, evident in altered mental function and control of the limbs — the so-called ‘punch-drunk’ syndrome. This is now rare, as there are stringent regulations to limit exposure to such a hazard.

Bryan Jennett


See also boxing; coma.

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Concussion

CONCUSSION

DEFINITION


Concussion is a change in mental status caused by trauma (shock). It is accompanied by confusion, loss of memory, and, sometimes, loss of consciousness.

DESCRIPTION


A concussion occurs when the head hits or is hit by an object. A concussion can also occur when the brain is pushed against the skull with a strong force. In such cases, parts of the brain that control mental function may be damaged. The injured person may become disoriented (confused) and may briefly lose consciousness.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that about three hundred thousand people experience mild to moderate concussions each year as a result of sports injuries. Most of these people are men between the ages of sixteen and twenty-five.

A concussion usually gets better without any long-term effect. On rare occasions, it is followed by a more serious injury called second-impact syndrome. Second-impact syndrome occurs when the head receives a second blow before the original concussion totally healed. Brain swelling may increase, resulting in a fatal condition. Since 1984, more than twenty people have died from second-impact syndrome.

CAUSES


Motor vehicle accidents and sports injuries are the major causes of concussion. In motor vehicle accidents, concussion can occur without an actual blow to the head. Instead, concussion occurs when the vehicle starts or stops suddenly. In such a case, the brain is pushed strongly against the skull. Contact sports, especially football, hockey, and boxing, are leading causes of concussion. Other significant causes are falls, collisions, or injuries due to bicycling, horseback riding, skiing, and soccer.

The risk of concussion from football is extremely high, especially at the high school level. Research shows that about 1 in 5 high school football players suffer concussion or more serious brain injury at some point during their high school football career. The comparable rate at the college level is 1 in 20.

Concussion and lasting brain damage is also very common among boxers. After all, the goal of this sport is to knock out an opponent, that is, to give him or her a concussion. For this reason, the American Academy of Neurology (a group of doctors who specialize in problems of the nervous system) has called for a ban on boxing.

Concussion: Words to Know

Amnesia:
Loss of memory sometimes caused by a brain injury, such as concussion.
Parkinson's disease:
A disorder of the nervous system that includes shaking, muscular weakness, stiffness, and problems with walking.

Repeated concussions over many months or years can eventually cause more serious brain injury. For example, boxers can develop a form of permanent brain damage called "punch drunk" syndrome or dementia pugilistica (pronounced dih-MEN-sha pyoo-juh-LIS-tuh-kuh). Perhaps the best known example is the great boxer Muhammad Ali. Ali eventually developed Parkinson's disease (see Parkinson' disease entry), believed to be caused by head injuries sustained while he was active as a boxer.

Young children are likely to suffer concussions from falls or bumps on the playground or at home. Child abuse is another common cause of concussion.

SYMPTOMS


Symptoms of concussion include:

  • Headache
  • Disorientation (confusion) as to time, date, or place
  • Dizziness
  • Vacant stare or confused expression
  • Speech that is difficult to understand
  • Lack of coordination or weakness
  • Amnesia (loss of memory) about events just preceding the blow
  • Nausea or vomiting
  • Double vision
  • Ringing in the ears

These symptoms may last from several minutes to several hours. More severe or longer-lasting symptoms may indicate more severe brain injury. If a person loses consciousness, it will be for several minutes at the most. If unconsciousness last for a longer period, a more serious form of brain injury may have occurred.

Doctors use a three-point system to determine the seriousness of a concussion. This system helps them to choose the appropriate treatment.

  • Grade 1: No loss of consciousness, brief confusion, and other symptoms that clear up within 15 minutes.
  • Grade 2: No loss of consciousness, brief confusion, and other symptoms that clear up in more than 15 minutes.
  • Grade 3: Loss of consciousness for any period of time.

Days or weeks after the original concussion, certain symptoms may reoccur. These symptoms are called post-concussion syndrome. They include:

  • Headache
  • Loss of ability to concentrate and pay attention
  • Anxiety
  • Depression
  • Sleep disturbance
  • Inability to tolerate light and noise.

DIAGNOSIS


Anyone who receives a concussion must be watched very carefully after the accident. It is important to notice how long unconsciousness lasts and how

serious the symptoms seem to be. These signs are indications of how serious the brain injury was, and are important in deciding how to treat the patient.

A medical professional can decide how serious a concussion is with some simple tests. He or she may examine the pupils of the patient's eyes, test the patient's coordination and sense of feeling, and observe his or her memory, orientation, and concentration. Patients with mild concussions do not require hospitalization or further tests. Those with more serious injuries may need some form of brain test, such as a computer-aided tomographic (CAT) scan.

TREATMENT


The symptoms of concussion usually clear up quickly and without lasting effects. Medical specialists decide how soon a person can return to sports activities based on the severity of his or her injury. All treatment plans are designed to prevent a second blow to the head during recovery. A second blow may cause very serious long-term brain damage.

A Grade 1 concussion is usually treated with rest and continued observation only. The person can return to sports activities the same day if a medical professional approves and all symptoms are gone. If a second concussion occurs on the same day, the person should not be allowed to continue contact sports until he or she is free of symptoms for one week.

A person with a Grade 2 concussion must discontinue sports activities for the day. He or she must be observed by a medical professional and be observed throughout the day until all symptoms have disappeared. If symptoms become worse or continue beyond a week, further brain tests, such as a CAT scan, may be necessary. The person cannot return to contact sports until one week after symptoms have disappeared and a medical professional has given permission.

A person with a Grade 3 concussion should be seen immediately by a medical professional. If symptoms are severe, brain tests and hospitalization may be necessary. Prolonged unconsciousness and worsening symptoms require immediate examination by a neurologist.

A neurologist is a doctor who specializes in problems of the nervous system. The patient should be carefully observed after discharge from medical care. If symptoms reappear or become worse, further neurological tests may be necessary.

A person with a Grade 3 concussion should avoid contact sports for at least a month after all symptoms have disappeared. If brain tests indicate that brain swelling or bleeding has occurred, the athlete should give up contact sports for the season and, if symptoms are bad enough, indefinitely.

PROGNOSIS


There are usually no long-term effects of concussion. However, symptoms of post-concussion syndrome may last for weeks or months. The risk of a second concussion in contact sports is even higher than the risk for a first concussion. For that reason, a person who has received a concussion needs to avoid contact sports until the first concussion has entirely cleared up.

PREVENTION


Many cases of concussion can be prevented by using certain types of protective equipment. These include seat belts and air bags in cars, and helmets in contact sports. Helmets should also be worn when bicycling, skiing, or horseback riding. Soft material, such as sand or matting, should be placed under playground equipment.

Young people should think about the value of high-contact sports, such as boxing, football, and hockey, compared to their risk for head injuries. They may decide to take part in sports activities that are fun to participate in, but less risky to one's health.

FOR MORE INFORMATION


Books

Gronwall, D. M. A., Philip Wrightson, and Peter Waddell. Head InjuryThe Facts: A Guide for Families and Care-Givers. New York: Oxford University Press, 1998.

Stoler, Diane Roberts. Coping With Mild Traumatic Brain Injury. Garden City Park, NY: Avery Publishing Group, 1998.

Organizations

American Academy of Neurology. 1080 Montreal Avenue St. Paul, MN 551162325. (800) 8791960.

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"Concussion." UXL Complete Health Resource. . Retrieved April 27, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/news-wires-white-papers-and-books/concussion

Concussion

Concussion

What Causes Concussion?

What Happens to People with Concussion?

Do People with Concussion Need Medical Treatment?

What Is Postconcussion Syndrome?

How Do People Prevent Concussion?

Resources

Concussion, or brain concussion, is an injury to the brain caused by a blow to the head or by violent jarring or shaking. It is a form of head trauma that often involves loss of consciousness, which may be momentary or may last for several hours. Brain concussion is a common injury that may sometimes have serious consequences.

KEYWORDS

for searching the Internet and other reference sources

Brain stem

Consciousness

Coma

Most people who watch sporting events on television have seen team physicians run out to the playing field to examine athletes who receive blows to the head. The doctors often ask the injured players if they know where they are or what day of the week it is. That is one way that doctors find out whether people have concussion.

What Causes Concussion?

A blow to the head, an injury, a fall, or sudden severe shaking may cause the brain to hit the inside of the skull. If the impact affects the consciousness centers in the brain stem*, then the person with concussion loses consciousness. This may happen if, for example, one boxers knockout punch makes the other boxers head accelerate sharply, or if someones head decelerates suddenly, as when it strikes the ground during a fall.

* brain stem
is the part of the brain that connects to the spinal cord. The brain stem controls the basic functions of life, such as breathing and blood pressure.

Sports are among the most common causes of concussion, and sports with the most physical contact, such as football, boxing, and hockey, are most likely to produce head injuries that involve concussion. Concussions may also occur during collisions or falls in basketball, soccer, and baseball, or while riding motorcycles or bicycles.

About half of all head injuries are caused by motor vehicle accidents. A large percentage of these accidents involve drivers who have been drinking alcohol. Other causes include fights and industrial accidents.

What Happens to People with Concussion?

Concussion does not always cause complete loss of consciousness. People who get mild concussions may be temporarily stunned or dazed. They may feel dizzy, light-headed, or confused for a brief time. With loss of consciousness may also come nausea or vomiting, numbness, blurred vision or temporary blindness, or amnesia, which means loss of memory for events just before or just after the injury that caused the concussion. The longer the period of unconsciousness, the more severe the symptoms may be, which is why a doctor should examine people with concussion

as soon as possible. The symptoms of concussion usually do not last long, but in rare cases they may persist for several weeks or longer.

Do People with Concussion Need Medical Treatment?

Permanent brain damage does not normally result from a single mild concussion, but a doctor must first make sure that there has not been a more serious head injury, such as contusion (bruise) or laceration of the brain. The doctor usually asks about the injury that caused the concussion and notes the persons signs and symptoms.

Sometimes people worry that it is unsafe to fall asleep after a concussion, but doctors usually advise a period of bed rest, either at home or in a hospital, and no sports or riding a bicycle until recovery is complete. If headache is a symptom, the doctor may suggest pain medication. People with concussion should not drink alcohol or take sedatives*.

* sedatives
are medications that calm people and reduce excitement and irritability.

If unconsciousness, headache, or drowsiness return several hours or days after the injury, it is important to see the doctor again. The doctor may recommend hospital treatment or may diagnose postconcussion syndrome. People who have had a concussion are at higher risk of severe injury, or even sudden death, if they get a second concussion within a short time after the first injury. Under these circumstances, avoiding possible head trauma becomes vitally important.

What Is Postconcussion Syndrome?

Headache, dizziness, and other symptoms of concussion usually go away in a few minutes or days. Occasionally, however, they may persist much longer, even for years. The person may complain of a group of symptoms including not only headache and dizziness, but also confusion, poor memory, anxiety, sleeplessness, irritability, lack of energy, and depression. A person with this group of lasting symptoms following a concussion is said to have postconcussion syndrome*.

* syndrome
means a group or pattern of symptoms that occur together.

Although postconcussion syndrome is not well understood, many medical researchers believe it may be the result of subtle changes in the brain that do not show up in medical tests. Because brain tests are normal, people sometimes believe that postconcussion syndrome is due to psychological factors or that people with postconcussion syndrome are faking their symptoms, especially if they are attempting to win damages in a lawsuit. This may be so in some cases, but often postconcussion symptoms exist in the absence of a lawsuit or persist after a settlement has been reached.

How Do People Prevent Concussion?

Wearing a helmet

Wearing a helmet is the best way to prevent a concussion in most situations where it might occur. Boxers are at high risk to receive this type of injury, and that is why they always wear protective headgear during training matches. The same is true in football, hockey, and other sports where there is a lot of physical contact, or where falls are likely. Bicycle and motorcycle riders also need to wear helmets to protect against serious head injury in case of a fall or collision.

Seat belts, air bags, and designated drivers

In automobile accidents, seat belts and air bags can prevent riders from banging their heads against the windshield or dashboard. Many accidents can be prevented if adults who drink alcohol designate (choose) a nondrinking friend to drive them home after they have been drinking; this person is called a designated driver.

What does punch drunk mean?

Boxers are sometimes called punch drunk if they develop slurred speech and poor concentration after receiving repeated punches and blows to the head during their careers. Repeated concussions can cause an accumulation of injuries to the brain and may result in permanent damage.

See also

Amnesia

Trauma

Resources

Kulstad, Scott. Sports Medicine for Young Athletes: A Guide for Parents; Teachers, and Coaches. Minneapolis, MN: Institute for Athletic Medicine, Fairview Press, 1998. A useful book that includes a section on concussions.

Levy, Allan M., and Mark L. Fuerst. Sports Injury Handbook: Professional Advice for Amateur Athletes. New York: John Wiley and Sons, 1993. Covers head and neck injuries, with separate chapters on sports with the highest risks of concussion.

Micheli, Lyle J., with Mark Jenkins. The Sports Medicine Bible: Prevent, Detect, and Treat Your Sports Injuries Through the Latest Medical Techniques. New York: Harper Perennial, 1995. Discusses head injuries and preventive measures.

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concussion

con·cus·sion / kənˈkəshən/ • n. 1. temporary unconsciousness caused by a blow to the head. The term is also used loosely of the aftereffects such as confusion. 2. a violent shock as from a heavy blow.

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concussion

concussion (kŏn-kush-ŏn) n. a condition caused by injury to the head, characterized by headache, confusion, and amnesia. These symptoms may be prolonged and constitute a post-concussional syndrome. See also (cerebral) contusion, punch-drunk syndrome.

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concussion

concussion violent agitation XV; injury due to the shock of a blow, etc. XVI. — L. concussiō, -ōn-, f. concuss-, pp. stem of concutere dash together, shake violently, f. CON- + quatere shake (cf. QUASH); see -ION.

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