Concussion

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 24, 2016
StartDiseasesConcussion

Concussion describes a process whereby the brain rapidly moves within the cerebrospinal fluid in which it sits, usually as a result of head or bodily trauma. Concussions cause neurological problems that are usually not life-threatening but may be serious.

Contents

Definition & Facts

The word “concussion” is derived from Latin roots: words meaning both “to shake with great force” or “to smash together violently." Concussions are classified by medical staff in accordance to severity of the condition. Concussions are also known as mild traumatic brain injuries (MTBI) or “mild brain injury."

When one suffers a concussion, one typically loses certain specific brain functions. The injury will usually resolve itself in a healthy patient after approximately three weeks of a doctor-mediated rest schedule, although occasionally there are complications which cause persistence of symptoms.

Symptoms & Complaints

Symptoms of concussion almost always appear quickly after the initial event of the causal injury. Occasionally, people suffer a concussion without even being fully aware of the condition's manifestation. This is because the less injurious variety of concussion can easily be mistaken for a particularly bad headache or migraine, especially if the patient's threshold for pain is above average.

A few things are certain about the nature of an individual suffering from a concussion: those affected usually complain of headache, nausea, dizziness, vomiting, loss of balance or motor coordination, and low-level aphasia. Patients also comment on extreme sensitivity to light, blurred vision, double vision, and ringing of the ears.

Concussed patients are severely disoriented, confused, and inattentive. The patient may lose consciousness now and again, but that alone does not determine the severity of the concussion if the loss of awareness is transient.

Amnesia of the events following the concussion is normal. It is also normal for patients with concussions to stare blankly with flat affect, to repeat similar questions unnecessarily, and to speak incoherently or with slurring speech. Lastly, patients with a concussion have been known to display an overly emotional response which does not correlate to logical behaviors. Observed patients have conveyed anything from unprovoked anger, tearfulness, paranoia-like fear, and more. Affected children tend to be more lethargic and cranky.

Causes

There are many ways a person can acquire a MTBI; any impact forceful enough to forgo the protective layer of cerebrospinal fluid in the brain can cause any number of unnatural brain movements within the skull. Because of the variable nature of MTBI, the concussive injury can affect brain physiology anywhere from days to years depending on the nature of the damage done. Regardless, whenever a patient has a concussion, there are many metabolic factors that must be taken into account.

There almost definitely will be an impairment of neurotransmission in one way or another. Given each patient's individual medical history, this could cause many different phenomena in each patient's body and brain after the trauma has subsided. MTBI is known as a “diffuse” brain injury, meaning that the malady is spread out over many axons. Comparatively opposite is the “focal” brain injury, in which the affected area is much smaller and more isolated.

There is heavy debate as to whether MTBI is a strictly functional or structural phenomenon. This is important because doctors must be able to differentiate between a concussion and something more serious, such as a brain hemorrhage.

Diagnosis & Tests

Medical professionals are capable of diagnosing MTBI based upon a few criteria, such as: duration of unconsciousness, persistence of vomiting, levels of disorientation and consciousness, and pupil size. If there is concern over intracranial bleeding or skull integrity, doctors often rely on brain imaging techniques such as MRIs or CT scans such that they expediently clear up any anomalous diagnostic information.

Even after the patient has been discharged from professional medical care, it is sometimes the responsibility of the friends or family of the patient to awaken the patient in the middle of the night and ask them a series of questions in order to measure the patient's reaction time. These questions generally pertain directly to the patient: asking when the patient's birthday is, what day of the week it is, or what they had for breakfast the preceding day. Doctors also suggest testing the patient's basic math skills during this time to measure baseline brain function and efficiency.

Treatment & Therapy

The initial symptoms of MTBI usually subside within a week to 10 days. This period of time is usually longer in children and teenagers. Regardless of age, those with MTBI are customarily prescribed both physical and cognitive rest. This means reducing the time spent on activities requiring elevated attention or cognition (i.e: video games, text messaging, etc). If the condition worsens, medical experts will carry out a barrage of tests to rule out cervical fractures and the like.

Those with MTBI are usually prescribed any number of OTC analgesics, such as ibuprofen or paracetamol, but are urged to stay away from alcohol and drugs that have not been approved by the medical staff themselves. Patients with MTBI are also urged to stay away from any strenuous physical activity that may put them back at risk. This is because people who have had one concussion are statistically more at-risk to have another during their lifetime.

Prevention & Prophylaxis

Using the correct safety gear at the right time can exponentially lower the likelihood of injury. This includes wearing protective gear such as helmets when playing sports and riding bicycles. Each sport has different safety techniques for avoiding head injury, such as learning proper in-fielding technique while playing baseball and learning how to avoid collisions. Children are advised to play on playgrounds with soft surfaces.