Concussion
Definition
Concussion is a trauma-induced change in mental status, with confusion and amnesia, and with
or without a brief loss of consciousness.
Description
A concussion occurs when the head hits or is hit by an object, or when the brain is jarred against
the skull, with sufficient force to cause temporary loss of function in the higher centers of the
brain. The injured person may remain conscious or lose consciousness briefly, and is disoriented
for some minutes after the blow. According to the Centers for Disease Control and Prevention,
approximately 300,000 people sustain mild to moderate sports-related brain injuries each year,
most of them young men between 16 and 25.
While concussion usually resolves on its own without lasting effect, it can set the stage for a
much more serious condition. "Second impact syndrome" occurs when a person with a
concussion, even a very mild one, suffers a second blow before fully recovering from the first.
The brain swelling and increased intracranial pressure that can result is potentially fatal. More
than 20 such cases have been reported since the syndrome was first described in 1984.
Causes and symptoms
Causes
Most concussions are caused by motor vehicle accidents and sports injuries. In motor vehicle
accidents, concussion can occur without an actual blow to the head. Instead, concussion occurs
because the skull suddenly decelerates or stops, which causes the brain to be jarred against the
skull. Contact sports, especially football, hockey, and boxing, are among those most likely to
lead to concussion. Other significant causes include falls, collisions, or blows due to bicycling,
horseback riding, skiing, and soccer.
The risk of concussion from football is extremely high, especially at the high school level.
Studies show that approximately one in five players suffer concussion or more serious brain
injury during their brief high-school careers. The rate at the collegiate level is approximately one
in 20. Rates for hockey players are not known as certainly, but are believed to be similar.
Concussion and lasting brain damage is an especially significant risk for boxers, since the goal of
the sport is, in fact, to deliver a concussion to the opponent. For this reason, the American
Academy of Neurology has called for a ban on boxing. Repeated concussions over months or
years can cause cumulative head injury. The cumulative brain injuries suffered by most boxers
can lead to permanent brain damage. Multiple blows to the head can cause "punch-drunk"
syndrome or dementia pugilistica, as evidenced by Muhammaed Ali, whose parkinsonism is a
result of his career in the ring.
Young children are likely to suffer concussions from falls or collisions on the playground or
around the home. Child abuse is, unfortunately, another common cause of concussion.
Symptoms
Symptoms of concussion include:
• headache
• disorientation as to time, date, or place
• confusion
• dizziness
• vacant stare or confused expression
• incoherent or incomprehensible speech
• incoordination or weakness
• amnesia for the events immediately preceding the blow
• nausea or vomiting
• double vision
• ringing in the ears
These symptoms may last from several minutes to several hours. More severe or longer-lasting
symptoms may indicate more severe brain injury. The person with a concussion may or may not
lose consciousness from the blow; if so, it will be for several minutes at the most. More
prolonged unconsciousness indicates more severe brain injury.
The severity of concussion is graded on a three-point scale, used as a basis for treatment
decisions.
• Grade 1: no loss of consciousness, transient confusion, and other symptoms that resolve
within 15 minutes.
• Grade 2: no loss of consciousness, transient confusion, and other symptoms that require
more than 15 minutes to resolve.
• Grade 3: loss of consciousness for any period.
Days or weeks after the accident, the person may show signs of:
• headache
• poor attention and concentration
• memory difficulties
• anxiety
• depression
• sleep disturbances
• light and noise intolerance
The occurrence of such symptoms is called "post-concussion syndrome."
Diagnosis
It is very important for those attending a person with concussion to pay close attention to the
person's symptoms and progression immediately after the accident. The duration of
unconsciousness and degree of confusion are very important indicators of the severity of the
injury and help guide the diagnostic process and treatment decisions.
A doctor, nurse, or emergency medical technician may make an immediate assessment based on
the severity of the symptoms; a neurologic exam of the pupils, coordination, and sensation; and
brief tests of orientation, memory, and concentration. Those with very mild concussions may not
need to be hospitalized or have expensive diagnostic tests. Questionable or more severe cases
may require computed tomography scan (CT) or magnetic resonance imaging (MRI) scans to
look for brain injury.
Treatment
The symptoms of concussion usually clear quickly and without lasting effect, if no further injury
is sustained during the healing process. Guidelines for returning to sports activities are based on
the severity of the concussion.
A grade 1 concussion can usually be treated with rest and continued observation alone. The
person may return to sports activities that same day, but only after examination by a trained
professional, and after all symptoms have completely resolved. If the person sustains a second
concussion of any severity that same day, he or she should not be allowed to continue contact
sports until he or she has been symptom-free, during both rest and activity, for one week.
A person with a grade 2 concussion must discontinue sports activity for the day, should be
evaluated by a trained professional, and should be observed closely throughout the day to make
sure that all symptoms have completely cleared. Worsening of symptoms, or continuation of any
symptoms beyond one week, indicates the need for a CT or MRI scan. Return to contact sports
should only occur after one week with no symptoms, both at rest and during activity, and
following examination by a physician. Following a second grade 2 concussion, the person should
remain symptom-free for two weeks before resuming contact sports.
A person with a grade 3 concussion (involving any loss of consciousness, no matter how brief)
should be examined by a medical professional either on the scene or in an emergency room.
More severe symptoms may warrant a CT or MRI scan, along with a thorough neurological and
physical exam. The person should be hospitalized if any abnormalities are found or if confusion
persists. Prolonged unconsciousness and worsening symptoms require urgent neurosurgical
evaluation or transfer to a trauma center. Following discharge from professional care, the patient
is closely monitored for neurological symptoms which may arise or worsen. If headaches or
other symptoms worsen or last longer than one week, a CT or MRI scan should be performed.
Contact sports are avoided for one week following unconsciousness of only seconds, and for two
weeks for unconsciousness of a minute or more. A person receiving a second grade 3 concussion
should avoid contact sports for at least a month after all symptoms have cleared, and then only
with the approval of a physician. If signs of brain swelling or bleeding are seen on a CT or MRI
scan, the athlete should not return to the sport for the rest of the season, or even indefinitely.
For someone who has sustained a concussion of any severity, it is critically important that he or
she avoid the possibility of another blow to the head until well after all symptoms have cleared to
prevent second-impact syndrome. The guidelines above are designed to minimize the risk of this
syndrome.
Prognosis
Concussion usually leaves no lasting neurological problems. Nonetheless, symptoms of post-
concussion syndrome may last for weeks or even months.
Studies of concussion in contact sports have shown that the risk of sustaining a second
concussion is even greater than it was for the first if the person continues to engage in the sport.
Prevention
Many cases of concussion can be prevented by using appropriate protective equipment. This
includes seat belts and air bags in automobiles, and helmets in all contact sports. Helmets should
also be worn when bicycling, skiing, or horseback riding. Soccer players should avoid heading
the ball when it is kicked at high velocity from close range. Playground equipment should be
underlaid with soft material, either sand or special matting.
The value of high-contact sports such as boxing, football, or hockey should be weighed against
the high risk of brain injury during a young person's participation in the sport. Steering a child's
general enthusiasm for sports into activities less apt to produce head impacts may reduce the
likelihood of brain injury.
Resources
Books
Evans, R. Neurology and Trauma. W. B. Saunders Co., 1996.
Organizations
American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (612) 695-1940.
[Link]
Key terms
Amnesia — A loss of memory that may be caused by brain injury, such as concussion.
Parkinsonism — A neurological disorder that includes a fine tremor, muscular weakness and
rigidity, and an altered way of walking.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
concussion /con·cus·sion/ (kon-kush´un) a violent shock or jar, or the condition resulting from
such an injury.
concussion of the brain loss of consciousness, transient or prolonged, due to a blow to the
head; there may be transient amnesia, vertigo, nausea, weak pulse, and slow respiration.
concussion of the labyrinth deafness with tinnitus due to a blow on or explosion near the ear.
pulmonary concussion mechanical damage to the lungs caused by an explosion.
concussion of the spinal cord transient spinal cord dysfunction caused by mechanical injury.
Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of
Elsevier, Inc. All rights reserved.
con·cus·sion (k n-k sh n)
n.
1. A violent shaking or jarring.
2. An injury to a soft structure, especially the brain, produced by a violent blow and followed by a
temporary or prolonged loss of function.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin
Company. Published by Houghton Mifflin Company. All rights reserved.
concussion
[konkush′ən]
Etymology: L, concutere, to shake violently
1 damage to the brain caused by a violent jarring or shaking, such as a blow or an explosion.
2
Usage notes: informal.
See brain concussion.
Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.
concussion
a violent jar or shock, or the condition that results from such an injury.
brain concussion
loss of consciousness, transient or prolonged, due to a blow to the head; breathing often is
unusually rapid or slow. Outward evidence of the injury may include bleeding, sometimes from
the nose, and contusions (bruises). There may be residual signs such as local paralysis on
recovery.
spinal cord concussion
may lead to temporary paresis or spinal shock, with possible local paralysis continuing after
partial recovery.
concussion stunner
a sharp blow to the head sufficient to cause stunning may be used as a prelude to euthanasia or,
in laboratory animals, as a means of euthanasia on its own.
Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved
concussion
Neurology A severe brain injury, due to a violent blow or shaking, which is characterized by
immediate and transient impairment of brain function and one or more of the following: loss of
consciousness, amnesia, seizure, or a change in mental status, which may be accompanied by
defects in cognition, vision, equilibrium. See Transient ischemic attack. Cf Contusion Sports
medicine A traumatically induced alteration in mental status; impairment of brain function
caused by injury to the head; speed and degree of recovery depend on severity of the brain
injury. See Labryinthine concussion.
Concussion–per Colorado medical society
Grade I Mild concussion 'Having the bell rung', 'head ding' Confusion without amnesia or loss
of consciousness; difficult to detect Management Remove from game, examine immediately for
amnesia, postconcussive symptoms; return to game in no less than 20 minutes; three grade I
concussions should end player's season; no contact sports for ≥ 3 months
Grade II Moderate concussion Confusion with amnesia, no loss of consciousness; post-
traumatic and retrograde amnesia may occur in severe cases; athlete should be evaluated for 24
hours Management Remove permanently from game; examine repeatedly for intracranial
problems; return to practice ≥ 1 week; return to playing ≥ 1 month or end athlete's season; season
ends if ≥ 3 grade II concussions or abnormality by CT or MRI
Grade III Severe concussion Loss of consciousness Management Transport to hospital with
cervical spine immobilization; full neurologic examination; return to practice ≥ 2 weeks; return
to play ≥ 1 month or end athlete's season; season ended if ≥ 2 grade II concussions or any
abnormality by CT or MRI
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill
Companies, Inc.
Patient discussion about Cerebral Concussion.
Q. What is a concussion? How do you treat it? My child fell and hit his head and passed out.
We went to the hospital and they say it’s a concussion and he’ll be fine. Can some one explain
what it is exactly?
A. When your brain gets hit hard- this is concussion. But there’s a nice short video about it with
a nice pediatrician that explains it:
[Link]
Read more or ask a question about Cerebral Concussion
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