From the Guidelines
A concussion is a type of mild traumatic brain injury (mTBI) caused by a rapid movement of the head and brain, resulting in symptoms such as headache, nausea, impaired balance, and difficulties concentrating.
Key Characteristics of Concussion
- Caused by a rapid movement of the head and brain, such as a blow to the head or a fall 1
- Symptoms include headache, nausea, impaired balance, difficulties concentrating, confusion, emotional lability, and fatigue 1
- Can be associated with an increased risk of life-threatening brain injury, such as epidural hematoma, subdural hematoma, open skull fracture, or brain edema 1
Diagnosis and Management
- Diagnosis is typically based on symptom-based tools, but these require specific training and there is no validated scoring system for concussion identification in the first aid setting 1
- Removal from activity (play/sports) is recommended immediately if signs and symptoms of a concussion are present, and the person should not return to activity until evaluated by a health care professional 1
- EMS should be activated if signs or symptoms of severe head injury are present, such as loss of consciousness, worsening headache, vomiting, altered mental status, seizures, visual changes, swelling, or deformities of the scalp 1
Long-term Effects
- Repeated concussions may lead to long-term difficulties with memory, concentrating, fatigue, headache, and other neurological sequelae 1
- There is a risk of developing long-term neurodegenerative conditions, such as chronic traumatic encephalopathy (CTE) 1
From the Research
Definition of Concussion
- A concussion is a type of mild traumatic brain injury (mTBI) that is prevalent among athletes across a wide variety of sports 2, 3.
- The exact mechanism of a concussion is unknown, but it is currently accepted that the acceleration and deceleration of the brain is the insult causing disturbances in activity 2.
- Concussion is a well-recognized clinical entity, however, its pathophysiologic basis remains a mystery 4.
Symptoms of Concussion
- The most common symptoms of concussions include dizziness, nausea, vomiting, and headaches 2.
- Concussions can also lead to permanent changes such as chronic traumatic encephalopathy (gradual degeneration of brain tissue), which can lead to personality changes and memory deficits 2.
- Symptoms and signs of concussion usually resolve within 10 days, with most patients recovering in 48-72 hours 3.
Management and Treatment of Concussion
- Management of concussion includes rapid removal from play, symptomatic treatment, and return to learn/play recommendations 5.
- Treatment generally involves physical and cognitive rest, with a gradual return to activities, whereas prolonged rest may actually worsen outcomes 3.
- Evidence-based treatments have emerged to treat post-concussion symptom generators, including sub-symptom threshold aerobic exercise, cervical physical therapy, vestibular therapy, vision therapy, cognitive rehabilitation, cognitive behavioral therapy, pharmacological management, or a combination of treatments 6.
Long-Term Complications of Concussion
- The physiological changes present after a concussion have the potential to develop into long-term complications such as academic difficulty, cognitive decline, gut microbiome changes, gait changes, and increased risk of lower extremity injury 2.
- Inappropriate management of concussion may lead to recurrent concussions, prolonged recovery, and potential long-term consequences 5.