From the Guidelines
Concussion complications to watch for include worsening symptoms like severe headache, repeated vomiting, slurred speech, seizures, increasing confusion, unusual behavior, loss of consciousness, or one pupil larger than the other, which may indicate a more serious brain injury requiring immediate medical attention, as highlighted in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. In the days following a concussion, it is essential to monitor for persistent symptoms lasting beyond 10-14 days (post-concussion syndrome), including ongoing headaches, dizziness, fatigue, irritability, anxiety, insomnia, difficulty concentrating, and memory problems. Some key complications to be concerned about include:
- Severe or worsening headache
- Repeated vomiting
- Altered mental status
- Seizure
- Neurological signs and symptoms
- Skull fracture, which are associated with an increased risk of life-threatening brain injury such as epidural hematoma, subdural hematoma, open skull fracture, or brain edema, as noted in the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Children and adolescents are particularly vulnerable to second impact syndrome, a rare but potentially fatal complication that occurs when a second concussion happens before the first has healed. Long-term concerns include potential cognitive impairment and an increased risk of neurodegenerative conditions like chronic traumatic encephalopathy (CTE) with repeated concussions, as discussed in the context of nonpharmacological treatment of persistent postconcussion symptoms in adults 1. Recovery requires physical and cognitive rest initially, followed by a gradual return to normal activities under medical supervision, with the understanding that the brain is especially vulnerable after injury because energy metabolism is disrupted, and additional strain can worsen damage and delay healing. It is crucial to follow guidelines such as those provided by the American Heart Association and American Red Cross for the management and return to activity after a concussion, emphasizing the importance of individualized assessment and supervision by a healthcare professional 1.
From the Research
Complications of Concussion
The following are potential complications that may arise from a concussion:
- Post-concussion syndrome (PCS), a group of disorders that requires specific forms of therapy 2
- Neurological symptoms, such as headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity 3
- Cognitive impairment, including problems with memory, attention, and processing speed 3, 4
- Emotional sequelae, including depression, anxiety, and mood disturbances 2, 3
- Sleep disturbances, including insomnia and sleep disorders 3, 4
- Increased risk of further injury or prolonged recovery if the athlete returns to play too quickly 5, 6
Risk Factors for Complications
Certain factors may increase the risk of complications from a concussion, including:
- Age over 40 years 3
- Lower educational, intellectual, and socioeconomic level 3
- Female gender 3
- Alcohol abuse 3
- Prior head injury 3
- Multiple trauma 3
Diagnosis and Prognosis
The Immediate Post-Concussion Assessment and Cognitive Test (ImPACT) is a widely used neurocognitive assessment that can diagnose and track recovery from concussions 4. The Severity Index (SI), a novel metric derived from ImPACT scores, can predict persistence of concussion at follow-up and estimate recovery time 4.