From the Guidelines
A concussion is defined as a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces, resulting in a graded set of clinical syndromes that may or may not involve loss of consciousness, with symptoms typically including headache, confusion, dizziness, nausea, sensitivity to light or noise, balance problems, and difficulty concentrating or remembering. This definition is based on the most recent and highest quality study available, which emphasizes the importance of considering the clinical, pathological, and biomechanical injury constructs in defining the nature of a concussive head injury 1. The symptoms of a concussion can vary widely, but common features include:
- Headache
- Dizziness
- Nausea
- Unsteadiness/loss of balance
- Feeling “dinged” or stunned or “dazed”
- Seeing stars or flashing lights
- Ringing in the ears
- Double vision
- Sleepiness
- Sleep disturbance
- Fatigue
- Slowed thinking
- Difficulties with attention, concentration, memory, or executive functions
- Changed emotional responsivity
- Irritability
- Quickness to anger
- Disinhibition
- Emotional lability 1. It's essential to note that concussions don't usually show up on standard imaging tests like CT scans or MRIs because the damage occurs at the cellular level, and recovery requires physical and cognitive rest, with a gradual return to normal activities under medical supervision 1. The brain is particularly vulnerable during recovery, and a second concussion before full healing can cause more severe damage, which is why proper diagnosis and management are essential, as highlighted in the most recent guidelines 1.
From the Research
Definition of a Concussion
A concussion is defined as a mild traumatic brain injury caused by direct or indirect external trauma to the head, resulting in shear stress to brain tissue from rotational or angular forces 2. It is also known as a brain injury associated with rapid brain movement and characteristic clinical symptoms, with no associated objective biomarkers or overt pathologic brain changes 3.
Key Characteristics
- Concussions can affect a variety of clinical domains, including physical, cognitive, and emotional or behavioral 2.
- Signs and symptoms are nonspecific, and a temporal relationship between an appropriate mechanism of injury and symptom onset must be determined 2.
- Headache is the most common symptom of a concussion 2.
- Concussions can occur across the lifespan and can be caused by excessive force to the head, either through direct impact or force transmission through the body and neck 4.
Diagnosis and Management
- Diagnosis involves eliminating concern for cervical spine injury and more serious traumatic brain injury before diagnosis is established 2.
- Tools to aid diagnosis and monitor recovery include symptom checklists, neuropsychological tests, postural stability tests, and sideline assessment tools 2.
- Initial management involves brief cognitive and physical rest, patient education and reassurance, and symptom management 2.
- Individuals recover from concussion differently, and rigid guidelines have been abandoned in favor of an individualized approach 2.