Can I diagnose a concussion based on symptoms like headache, dizziness, and confusion after a traumatic event?

Diagnosing Concussion Based on Symptoms

Yes, you can diagnose a concussion based on symptoms like headache, dizziness, and confusion after a traumatic event, as these are classic manifestations of concussion, and a concussion is primarily a clinical diagnosis that does not require imaging or laboratory tests to confirm.

Clinical Diagnostic Criteria

Concussion is diagnosed based on the presence of typical symptoms following a traumatic event. According to international guidelines, the following symptoms and signs are indicative of concussion 1:

Physical Symptoms

• Headache
• Dizziness
• Nausea
• Unsteadiness/loss of balance
• Visual disturbances (seeing stars, flashing lights)
• Sensitivity to light and noise

Cognitive Symptoms

• Confusion
• Feeling "foggy"
• Difficulty concentrating
• Memory problems
• Slow to answer questions

Behavioral/Emotional Signs

• Irritability
• Emotional changes
• Personality changes
• Inappropriate behavior

Important Diagnostic Considerations

1. Loss of consciousness is NOT required for diagnosis

   • Only a minority of concussions involve loss of consciousness 1
   • If LOC lasts longer than 30 seconds, consider more significant injury 1

2. Neuroimaging is typically normal

   • CT and MRI results are generally normal with concussion 1
   • Imaging is used to rule out more serious injuries, not to diagnose concussion

3. Symptom assessment tools

   • Use standardized scales like the Post-Concussion Symptom Scale 1
   • These provide objective documentation of symptoms

Red Flags Requiring Immediate Attention

Watch for signs of more serious injury requiring emergency evaluation 1:

• Repeated vomiting
• Worsening headache
• Focal neurologic deficits
• Seizures
• Increasing confusion or sleepiness

Postconcussion Syndrome

Be aware that 5-20% of patients may develop persistent symptoms lasting beyond the typical 7-10 day recovery period 2:

• Physical symptoms may persist
• Cognitive difficulties may continue
• Emotional/behavioral changes may remain

Diagnostic Pitfalls to Avoid

1. Relying solely on standard orientation questions

   • Time, place, person questioning is less reliable than memory assessment 1
   • Use specific concussion assessment tools like Maddock's questions or SAC

2. Dismissing symptoms without traumatic event

   • Always connect symptoms to a preceding traumatic event
   • Rule out other causes of similar symptoms

3. Overlooking vestibular causes of dizziness

   • Post-concussive dizziness may have peripheral vestibular causes 3
   • Proper evaluation can identify treatable conditions

Follow-up Recommendations

For patients diagnosed with concussion:

• Physical and cognitive rest until symptoms resolve 1
• Gradual return to activities
• Monitor for persistent symptoms
• Provide clear discharge instructions at 6th-7th grade reading level 1

Remember that concussion symptoms typically resolve within 7-10 days in most cases, but some patients may take weeks to months to recover fully 1.