What are the signs and symptoms of a concussion?

Signs and Symptoms of Concussion

A concussion presents with a graded set of clinical syndromes across physical, cognitive, emotional, and sleep domains, requiring immediate removal from activity and evaluation by a healthcare professional before return to play.

Physical Signs and Symptoms

• Headache - Most frequently reported symptom 1
• Dizziness/Balance problems - Common symptom affecting equilibrium 1
• Nausea and vomiting - May indicate more severe injury if persistent 1
• Visual disturbances - Including sensitivity to light, blurred vision 1, 2
• Sensitivity to noise - Auditory hypersensitivity 1
• Fatigue - Persistent tiredness not relieved by rest 1
• Numbness or tingling - Sensory disturbances 1

Cognitive Signs and Symptoms

• Confusion - Disorientation, inability to process information 1
• Memory problems - Both retrograde (before injury) and anterograde (after injury) amnesia 1
• Difficulty concentrating - Inability to focus on tasks 1
• Mental "fogginess" - Feeling slowed down mentally 1, 2
• Difficulty remembering - Short-term memory issues 1

Emotional Signs and Symptoms

• Irritability - Increased agitation or frustration 1
• Emotional lability - Mood swings 1
• Nervousness/Anxiety - Heightened worry or fear 1
• Sadness - Depressed mood 1

Sleep Disturbances

• Drowsiness - Excessive sleepiness 1
• Sleeping more than usual - Hypersomnia 1
• Trouble falling asleep - Insomnia 1
• Loss of sleep - Disrupted sleep patterns 1

Warning Signs Requiring Immediate Medical Attention

• Loss of consciousness - Occurs in less than 10% of concussions but may indicate more serious injury 1, 2
• Worsening headache - Particularly if severe or progressively worsening 1, 2
• Repeated vomiting - May indicate increased intracranial pressure 1, 2
• Seizures - Post-traumatic seizure activity 1, 2
• Altered mental status - Significant confusion or disorientation 1, 2
• Visual changes - May indicate more serious injury 1, 2
• Skull deformities - Visible swelling or depression 1

Important Clinical Considerations

• Concussion is a functional rather than structural injury, typically with normal neuroimaging studies 1
• Loss of consciousness occurs in less than 10% of concussions but is an important indicator of potential severity 1
• Mental fogginess may predict slower recovery 1
• Female athletes report higher rates of concussion than males in similar sports 1
• Symptoms typically resolve within 3-6 months in most patients, but can persist longer in a minority 3
• Risk factors for prolonged symptoms include age over 40, lower educational level, female gender, alcohol abuse, and prior head injury 3

Assessment Approach

1. Evaluate for retrograde and anterograde amnesia by asking about events before and after injury 1
2. Use a postconcussion symptom scale to document baseline symptoms and track recovery 1, 2
3. Assess for signs of severe head injury requiring emergency medical services activation 1
4. Maintain cervical spine stabilization if loss of consciousness occurred or neck injury is suspected 1, 2

Management Protocol

1. Immediate removal from activity (play/sports) 1, 2
2. No return to activity until evaluated by a healthcare professional 1, 2
3. Physical and cognitive rest for 24-48 hours in the acute phase 2
4. Graduated return-to-play protocol once asymptomatic 2
5. Clearance by a physician with concussion management experience before return to contact sports 2

Remember that concussion symptoms may be present at baseline in some individuals (e.g., concentration difficulties in patients with attention-deficit disorder), which must be considered when evaluating symptoms 1.