Concussion (TBI)

Introduction

A moderately traumatic brain injury that impairs brain function is called a concussion. Headaches and issues with focus, memory, balance, mood, and sleep are among the frequently transient effects. A head or body impact linked to a change in brain function is typically the cause of concussions.

Concussions do not happen to everyone who is struck in the head or body. While most concussions do not result in unconsciousness, some do. The most frequent cause of concussions is falls. Athletes who participate in contact sports like soccer or American football are also susceptible to concussions.

Most people who get a concussion recover completely. As soon as an injury is detected, take the following action: Give up on the activity. Obtain a cognitive test and concussion evaluation as soon as you can. Give yourself time to heal before getting back to your regular activities. A concussion that is not correctly treated might result in death or permanent brain damage, particularly if it occurs the second time.

Anatomy

The texture of the brain is like gelatin. The fluid that surrounds it protects the brain from impacting the skull from normal movement and bumps. The brain is jostled against the skull during a concussion, which results in friction and inflammation. In extreme situations, a concussion may result in life-threatening bleeding or edema. The chemistry of the brain changes after a traumatic brain injury. Restoring a proper chemical equilibrium in the brain can take weeks. Cognitive decline and irreversible alterations in brain function can result from overstimulating the brain during the healing phase.

Causes

The brain rolls back and forth against the skull’s inner walls during a concussion. A severe hit to the head, neck, or upper body may result in this powerful movement. The head’s abrupt acceleration or deceleration could possibly be the cause. This could occur in a car accident, a bike tumble, or a contact with another athlete.

These motions damage the brain and impair its ability to operate, generally temporarily. Bleeding in or around the brain from a mild traumatic brain injury can occasionally result in prolonged sleepiness, confusion, and even death. Following a brain injury, everyone should be closely watched and should seek emergency medical attention if their symptoms worsen.

Falls are the cause of over half of pediatric concussions. In sports like football and soccer, head-on collisions can potentially result in a concussion. Concussions can also occur to those who have been in a fight, a vehicle accident, or a bike accident. Having a history of concussions can make you more susceptible to a more serious head injury down the road. We call this second impact syndrome.

Symptoms

Although it can be difficult, recognizing the symptoms of a concussion is essential for the best possible recovery. Symptoms of a concussion may appear soon after the incident or later. The duration of symptoms can range from a few days to many weeks. The main symptom that could point to a concussion is confusion. The patient finds it difficult to remember what happened before the injury.

Common concussion symptoms include:

Confusion
Memory loss or temporary amnesia
Drowsiness or inability to wake up
Headache or pressure in the head
Ringing in the ears (tinnitus)
Dizziness (vertigo)
Nausea or vomiting

Symptoms that are considered severe include:

Loss of consciousness for 30 seconds or longer
Headache pain that won’t go away or worsens
Inability to control movements and balance
Blurred vision
Hypersensitivity to light or noise
Loss of smell, taste, hearing, or vision
Abnormal behavior: short attention span, difficulty following directions, irritability, disorientation
Numbness in face/extremities

Diagnosis

Early detection of a concussion is essential for the best result. As soon as an injury appears, you should have a proper concussion evaluation and cognitive tests done. The doctor will assess for vision, hearing, reflexes, balance and coordination, strength, and memory issues during a concussion evaluation.

You will be questioned regarding the circumstances that preceded the injury and the immediate aftermath of the impact. Assessing any behavioral changes that may be connected to a concussion is also crucial. If there are any concerns, more testing should be discussed with a concussion specialist.

A computer-based program that gathers baseline data for athletes in many US high schools at the start of the season can be used for cognitive assessment. The same test can be administered again after a concussion to track recovery progress. If symptoms do not go away or continue, an MRI or CT scan may be done. These imaging methods are employed to check for brain hemorrhage or significant edema.

The Complications

Concussion complications could include:

Traumatic brain injury headaches: Concussion-related headaches can linger in some people for days or weeks following a brain injury.
Vertigo after trauma: For days or weeks following a brain injury, some people feel as though they are spinning or dizzy.
Post-concussion syndrome, another name for persistent post-concussive symptoms: A few individuals may experience some symptoms that persist longer than anticipated. Some symptoms that may persist longer include headaches, lightheadedness, and cognitive difficulties. Persistent post-concussive symptoms are those that last longer than three months.
Consequences of repeated brain damage: Researchers are looking into the impact of subconcussive injuries, which are repetitive head strikes that don’t cause symptoms. The impact of these recurrent brain injuries on brain function is still unknown.
Syndrome of second impact: Rarely, fast brain swelling may occur if you have a second concussion before the symptoms of your first concussion subside. This may result in death. It’s crucial for athletes to avoid playing sports again while still dealing with concussion symptoms.

Treatment

Getting enough physical and mental rest will help the brain repair. Avoid anything that demands focus or concentration, such as driving, playing video games, watching TV, texting, or doing schoolwork, as well as physical activities like weightlifting and vigorous walking, until the brain has completely recovered.

Avoid loud noises and bright lights, as they can also stimulate the brain. For headaches, take Tylenol® (acetaminophen) instead of ibouprofen (Advil®), as the latter may increase bleeding risk. The objective of treatment is to gradually increase the amount of mental and physical stress you can withstand without experiencing concussion symptoms while allowing the brain to heal.

Some people may experience symptoms of a concussion weeks or months after the accident. If an injury recurs, going back to play too soon might have disastrous results. “Return to play” rules are in place in all 50 US states to prevent athletes from playing sports too soon. The foundation of return-to-play programs is a five-step progression plan that begins with going back to work or school, followed by light, moderate, and heavy non-contact, practice, and full contact activities, and ends with competition-level activity. To move on to the next phase, you must continue to be symptom-free.

Care for concussions is complicated and should only be administered by a trained professional with extensive experience. Sports medicine doctors, athletic trainers, or certified physical therapists may offer specialized concussion rehabilitation programs if you are having trouble with balance or coordination.

Prevention

Taking the right precautions to prevent head injuries is the best approach to preventing a concussion.

This would entail always wearing protective headgear when engaging in contact sports, cycling, skiing, etc.
Always fasten your seat belt when operating a motor vehicle.
Seek medical help if you or your child have any danger of suffering a concussion.
If another concussion happens, proper evaluation can help avoid major consequences.