A concussion is an injury to the brain that causes impairment of normal brain function as the result of a forceful blow to the head. Simply put, a concussion is an injury to the brain tissue. Depending on the force of the injury the concussion can have variable types and duration of symptoms.
The brain is a soft structure contained within the rigid, hard confines of the skull. When the head is struck, the brain risks being injured because of the force is absorbed by the brain tissue. When the brain is injured, normal signal pathways that send messages to and from our brain are interrupted.
Awareness of concussion and the severity of this injury has increased dramatically. In the past, doctors used words to minimize the significance of the injury ("getting your bell rung"). That type of language conveys a lack of understanding of the potential severity of the injury. Anytime a concussion occurs, the brain has been injured, and the injured individual require prompt assessment by a healthcare professional with up-to-date knowledge of these injuries.
Signs of Concussion
There are dozens of signs of a concussion, some of the more common include:
- Loss of consciousness
- Visual disturbance (blurred vision, double vision)
- Slurred speech
When should special tests, such as a CAT scan, be performed?
It is not entirely clear when imaging of the head is absolutely necessary following a concussion, but there are a few guidelines that are helpful. Imaging should be considered:
- if there is loss of consciousness
- if there is concern that a skull fracture may be present, or
- if there is any evidence of a focal neurologic deficit.
If an athlete has a head injury, followed by a so-called "lucid interval," a period of time or normal function followed by loss of consciousness or worsening neurologic function, they should have some type of diagnostic imaging. Also, if an athlete's symptoms continue to worsen, diagnostic imaging should be considered.
An athlete should never be left alone following a concussion -- they should be re-evaluated by a responsible caregiver regularly for a period of 12-24 hours. If this cannot be done safely, in-patient observation (hospitalization) can be considered.
Returning to Sports
Anytime an athlete sustains a concussion they should not return to athletic activity on the day of the injury. In the past, the recommendation was that if athletes recovered quickly they could return to play on the day of the injury--this is no longer considered acceptable. Athletes who sustain a concussion should be removed from sports.
One of the more recent developments in concussion management is that while a patient is having symptoms, they should allow their brain to rest. This means athletes should not only stay away from sports, but also activities that require concentration. Brain rest includes avoiding reading, academic activities, television, or other activities requiring concentration. One doctor describe effective brain rest as "being as bored as you could be."
All patients who sustain a concussion must not return to sports until evaluated by someone trained in management of these injuries. The management of concussions has been rapidly changing, and not all doctors are educated in the most up-to-date management. Foremost, any athlete should not return to play until ALL symptoms have resolved. Even a mild symptoms should exclude a player from returning to competition.
Once all symptoms have resolved, athletes should gradually resume athletic activity under supervision. Any development of concussion symptoms should be a sign the brain injury is not fully recovered, and the athlete should rest for a longer duration.
Athletes who sustain multiple concussions must not return to play until properly evaluated. If multiple concussion have occurred, or if the symptoms of the concussion do not resolve, there should be consideration of removing the athlete from further participation.