What is a concussion? According to the American Academy of Neurology (AAN), a concussion is defined as a "trauma to the head which induces alteration in mental status that may or may not involve loss of consciousness." Confusion and amnesia are the hallmarks.
Concussions are essentially blows to the head that can occur in sports or in daily life. The major causes of concussions outside of the playing field are car accidents, falls and assaults. Your brain is soft tissue encased in the hard bone structure of the head. As a person sustains a blow to the head, the brain sloshes around inside. The jostling back and forth disrupts the neurons needed for normal function by interrupting the relay of impulses between the brain and the brain stem. This disturbance in neurological function is temporary, and the time it takes to return to normal function helps physicians gauge the severity of the injury.
"A concussion is not the same as bruising of the brain," says Dr. Wendy Jamison, chief of neurology at East Jefferson General Hospital (EJGH). "Bruising or any bleeding of the brain is a much more serious and potentially life-threatening condition that needs to be looked for if symptoms do not improve or if the patient experiences problems that suggest focal injury to the brain, such as seizure, loss of vision or weakness in any of the limbs."
Concussions are usually graded on a severity scale accepted by the AAN and the National Athletic Trainer's Association. A concussion can be rated a Grade 1, 2 or 3, with Grade 3 being the most serious. Assigning a grade level to a concussion is not always clear-cut and is based on observing the individual for symptoms.
Some common and immediate symptoms include dizziness, headaches, nausea or vomiting, memory loss about events before or after the trauma, and unresponsiveness from the patient. In the days and weeks following the impact, an individual can have chronic headaches, fatigue, emotional or personality changes, trouble sleeping, depression and an inability to concentrate.
"The only treatment for a concussion is time and rest," Jamison says. "You can treat the symptoms with medication but the concussion simply needs time to heal. Most people recover fine, but until they do, they should be monitored closely to make sure symptoms are not worsening."
Someone who sustains a concussion should not go to sleep for a few hours after the injury, because if they are asleep, the person monitoring them may not be able to recognize worsening symptoms, she says. If the patient complains of extreme sleepiness, it may be a sign of a more significant problem, Jamison adds. Once the patient goes to sleep, the doctor recommends they be awakened hourly for the first 24 hours to determine whether the symptoms are getting worse.
Since diagnosing a concussion is done primarily through observation, it is a judgment call on when a concussion needs additional medical testing. The common guideline is that a Grade 3, and in many cases, a Grade 2 concussion, requires that the patient be transported to an emergency room for diagnostic testing. The reason for a CAT scan or an MRI is mainly to rule out something more serious.
"When looking at the cranial CT or MRI scans, I am trying to see if the injury has left a footprint on the brain," says Dr. John Joslyn, EJGH chief of radiology. "I want to make sure there are no signs of bleeding, edema or abnormal fluid. Many times, scans of patients with concussions show no abnormality."