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Brain Concussion

Concussion (Brain)

A brain concussion is a still incompletely defined syndrome of traumatic brain injury (TBI) that causes a spectrum of symptoms without evident structural damage to the brain. A headache, cognitive deficits, emotional instability, sleep disturbances, and an overall change in mental state after trauma are highly suggestive signs of a concussion. Through several tests, the diagnosis is primarily made on clinical grounds, whereas imaging studies may be used to rule out more severe forms of injury.


Presentation

Because the definition of a concussion denotes a mechanical injury of the brain without visible structural damage on imaging studies, the physician makes the diagnosis solely on clinical criteria and the findings from the clinical presentation [1] [2] [3] [4]. Head trauma prior to the onset of symptoms is a mandatory step in the development of a concussion and headaches, often accompanied by dizziness, are described as the two most frequent findings in these individuals [1] [2] [3] Nausea, vomiting, and changes in the state of consciousness can be encountered as well [1] [2] [5]. Furthermore, a concussion is known for producing various neurological changes that are primarily related to behavior and cognition - emotional lability, depression, and irritability are main patterns of mood disorders, whereas forgetfulness, memory loss, transient amnesia, reduced reaction times, and deficits in attention might also be present [1] [2] [3] [4] [5]. Visual impairment and a sense of numbness are reported by some studies, whereas altered sleep may eventually appear in the form of insomnia [1] [2] [3] [4]. In rare cases, convulsions and significant motor deficits right after head trauma can constitute the clinical picture of a concussion [1] [2].

Nausea
  • Symptoms of concussion usually fall into four categories: Thinking/ Remembering Physical Emotional/ Mood Sleep Difficulty thinking clearly Headache Fuzzy or blurry vision Irritability Sleeping more than usual Feeling slowed down Nausea or vomiting (early[cdc.gov]
  • Repeated vomiting or nausea. Slurred speech. Look very drowsy or cannot wake up. Have one pupil (the black part in the middle of the eye) larger than the other. Have convulsions or seizures. Cannot recognize people or places.[cdc.gov]
  • Head trauma prior to the onset of symptoms is a mandatory step in the development of a concussion and headaches, often accompanied by dizziness, are described as the two most frequent findings in these individuals Nausea, vomiting, and changes in the[symptoma.com]
  • Typical symptoms include headache, nausea and dizziness; these may remain for a week or two. Some patients may experience transient loss of inability to create new memories or other brief impairment of mental functioning. Treatment is symptomatic.[ncbi.nlm.nih.gov]
  • They can include nausea, headaches, dizziness, impaired concentration, memory problems, extreme tiredness, intolerance to light and noise, and can lead to anxiety and depression.[headway.org.uk]
Blurred Vision
  • Typically, concussion patients demonstrate some combination of the following symptoms: Nausea Vomiting Fatigue Feeling light-headed or dizzy Trouble getting things organized Blurred vision or eyes that get tired easily Headaches or ringing in the ears[braininjury-explanation.com]
  • Any of these could be a sign of traumatic brain injury: confusion or feeling dazed clumsiness slurred speech nausea or vomiting headache balance problems or dizziness blurred vision sensitivity to light sensitivity to noise sluggishness ringing in ears[webmd.com]
  • vision Sensitivity to noise or light Ringing in the ears Nausea or vomiting It’s important to keep in mind that signs of a concussion might show up days or weeks after the accident.[brain-injury-law-center.com]
Headache
  • A headache, cognitive deficits, emotional instability, sleep disturbances, and an overall change in mental state after trauma are highly suggestive signs of a concussion.[symptoma.com]
  • That said, if symptoms persist — headaches, nausea, dizziness, balance problems, confusion — after you have gotten medical care, call your healthcare provider again.[brainline.org]
  • Some concussions will develop into “Post-concussion syndrome” which is a complex disorder in which a number of post-concussion symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the initial injury[nicklauschildrens.org]
  • Contact your health care professional or emergency department right away if you experience these danger signs after a bump, blow, or jolt to your head or body: Headache that gets worse and does not go away.[cdc.gov]
  • The people checking on you should take you to an emergency department right away if you have: Headache that gets worse and does not go away. Weakness, numbness, or decreased coordination. Repeated vomiting or nausea. Slurred speech.[cdc.gov]
Confusion
  • For example, in the first few minutes after the injury, someone might be just slightly confused or appear a little bit dazed. But an hour later, he or she might become confused or unable to recall what was going on before the injury.[utswmed.org]
  • Immediately after the accident, the person may be confused, not remember what happened or have nausea, blurry vision, or dizziness. The person may appear fine at first but show symptoms hours or days later.[mayfieldclinic.com]
  • Symptoms include loss of consciousness, confusion, memory difficulties, and other signs of brain dysfunction. Diagnosis is clinical with neuroimaging done as needed.[merckmanuals.com]
  • That said, if symptoms persist — headaches, nausea, dizziness, balance problems, confusion — after you have gotten medical care, call your healthcare provider again.[brainline.org]
  • Affects from a concussion can range from mild to severe and may include one or more of the following symptoms: Changes in vision; Confused; Feeling drowsy; Feeling of "lost time;" Hard to arouse; Headache; Loss of consciousness; Memory loss (amnesia)[uab.edu]
Dizziness
  • To make a diagnosis, professionals look at many variables that might indicate trauma, ranging from changes in balance to memory lapses and dizziness.[brainline.org]
  • Some concussions will develop into “Post-concussion syndrome” which is a complex disorder in which a number of post-concussion symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the initial injury[nicklauschildrens.org]
  • Head trauma prior to the onset of symptoms is a mandatory step in the development of a concussion and headaches, often accompanied by dizziness, are described as the two most frequent findings in these individuals Nausea, vomiting, and changes in the[symptoma.com]
  • Sometimes symptoms such as headaches, dizziness, etc. will linger for some weeks. Recovery may take longer for those who have had a previous head injury, the elderly, and those with substance abuse problems.[brainfoundation.org.au]
  • Typical symptoms include headache, nausea and dizziness; these may remain for a week or two. Some patients may experience transient loss of inability to create new memories or other brief impairment of mental functioning. Treatment is symptomatic.[ncbi.nlm.nih.gov]
Irritability
  • Furthermore, a concussion is known for producing various neurological changes that are primarily related to behavior and cognition - emotional lability, depression, and irritability are main patterns of mood disorders, whereas forgetfulness, memory loss[symptoma.com]
  • In a mild concussion may be that the person in question for some time suffer from residual symptoms such as: Fatigue Headache Dizziness Concentration problems Tinnitus Anxiousness Quickly irritated; irritability, tearfulness or feeling down Sensitive[braininjury-explanation.com]
  • Post-concussion syndrome can include physical, cognitive, and emotional problems, including: Headache Dizziness Difficulty concentrating or completing tasks Irritability The sense that you “just don’t feel like yourself” All of these symptoms can make[concussion.weillcornell.org]
  • Move slowly and constantly be aware of your surroundings Do not climb stepladders or work from heights Stress, irritability, sadness and anxiety are common and normal reactions to having to cope with your symptoms and the changes in your lifestyle Find[brainstreams.ca]
  • Symptoms of concussion usually fall into four categories: Thinking/ Remembering Physical Emotional/ Mood Sleep Difficulty thinking clearly Headache Fuzzy or blurry vision Irritability Sleeping more than usual Feeling slowed down Nausea or vomiting (early[cdc.gov]
Amnesia
  • There is often a brief period (seconds or minutes) of retrograde amnesia, meaning a loss of memory for the events immediately prior to the concussion.[weillcornellbrainandspine.org]
  • […] concussion is known for producing various neurological changes that are primarily related to behavior and cognition - emotional lability, depression, and irritability are main patterns of mood disorders, whereas forgetfulness, memory loss, transient amnesia[symptoma.com]
  • A period of amnesia, or not recalling what has happened, is essential to the diagnosis of concussion.[brainfoundation.org.au]
  • It may be accompanied by transient loss of consciousness and amnesia. Typical symptoms include headache, nausea and dizziness; these may remain for a week or two.[ncbi.nlm.nih.gov]
  • Affects from a concussion can range from mild to severe and may include one or more of the following symptoms: Changes in vision; Confused; Feeling drowsy; Feeling of "lost time;" Hard to arouse; Headache; Loss of consciousness; Memory loss (amnesia)[uab.edu]

Workup

The diagnostic workup of cases in whom a concussion is suspected must encompass a detailed history and a thorough physical examination [1] [2] [4]. The physician must determine the exact events that preceded the onset of complaints and exclude their presence prior to head trauma, as the clinical presentation could be similar to exercise-induced fatigue and consequent headaches or migraines [1] [2]. If the initial injury occurred days or weeks ago, patients should be asked about their sleeping patterns, whether they experience memory loss, or if new-onset epilepsy may have developed [1]. The physical examination is crucial for assessing the level of consciousness and awareness of the patient, but also for evaluating the cognitive status and other neurological insults that might have occurred. Because a concussion is currently classified as a form of traumatic brain injury (although this topic has become a matter of significant discussion) [6], imaging studies need to be employed in order to rule out more serious damage. Apart from the examination of the skull, plain radiography provides little benefit in patients with a suspected concussion, which is why computed tomography (CT) is used as the cornerstone of diagnostics [1] [2] [6]. Magnetic resonance imaging (MRI) and MR spectroscopy are used as even more advanced methods to reveal pathological changes in the brain that are not visible on CT [1] [2] [5].

Treatment

  • That is why we tailor each treatment plan to your individual needs.[intermountainhealthcare.org]
  • Evidence-based approach to treatment – Applied research aimed at identifying factors that enhance clinical outcomes after head injury is a key part of the Concussion and Brain Injury Clinic.[prohealthcare.org]
  • Noran Clinic has board-certified neurologists who also specialize in the treatment of concussion and traumatic brain injury. The clinic employs state-of-the-art diagnostic testing, treatment and individualized plans of care for our patients.[noranclinic.com]
  • Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team. The vision care professional can play an important role in the rehabilitation effort.[braininjuries.org]
  • Over time, and especially with treatment, these symptoms will get better. Long-term effects of concussions are very rare.[concussion.weillcornell.org]

Prognosis

  • Almost invariably the prognosis of brain concussion is good.[ncbi.nlm.nih.gov]
  • We know that you have questions about your symptoms and prognosis, and our accomplished team of highly trained specialists is here to provide you with the answers you need.[barrowneuro.org]
  • The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Biobehav Rev . 2012;36(6):1510-31. Complete Listing of References[sports-health.com]
  • Prognosis Most people recover completely, with no lasting problems. Sometimes symptoms such as headaches, dizziness, etc. will linger for some weeks.[brainfoundation.org.au]
  • Prognosis Most people who sustain a concussion or mild TBI are back to normal often in a week or two and almost always within a few months. But others can have long-term problems either from the concussion or from injury to surrounding soft tissues.[brainline.org]

Etiology

  • Significant controversy exists over the etiology of this condition, although it is thought to be secondary to loss of autoregulation of cerebral blood flow in an already injured brain.[emedicine.medscape.com]

Epidemiology

  • WebMD REFERENCES: Boston Children's Hospital: "Head or Brain Injury" eMedicineHealth: "Concussion" Medscape: "Classification and Complications of Traumatic Brain Injury" Medscape: "Skull Fracture" Medscape: "Traumatic Brain Injury (TBI) -- Definition, Epidemiology[onhealth.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Pathophysiology explains the affects of a concussion or brain injury to the physical brain. We look at traumatic injuries from macroscopic, microscopic and molecular views. This is my particular speciality area.[xlntbrain.com]
  • Pathophysiology is still being clarified, but brain dysfunction is thought to involve excitotoxicity, which is neuronal damage caused by excessive release of excitatory neurotransmitters, particularly glutamate.[merckmanuals.com]
  • : Boston Children's Hospital: "Head or Brain Injury" eMedicineHealth: "Concussion" Medscape: "Classification and Complications of Traumatic Brain Injury" Medscape: "Skull Fracture" Medscape: "Traumatic Brain Injury (TBI) -- Definition, Epidemiology, Pathophysiology[onhealth.com]

Prevention

  • Centre for Disease Control and Prevention.[canchild.ca]
  • Molecular View Brain trauma causes changes in the neurons, preventing the brain from working normally, including: Inability to regulate electrolytes which prevents the brain cells from operating properly.[xlntbrain.com]
  • In addition, we have led the nation in creating new and fun ways to help prevent and address concussions in high school and youth sports.[barrowneuro.org]
  • The Centers for Disease Control and Prevention (CDC) defines concussion as a traumatic brain injury (TBI) caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.[biausa.org]

References

Article

  1. West TA, Marion DW. Current Recommendations for the Diagnosis and Treatment of Concussion in Sport: A Comparison of Three New Guidelines. J Neurotrauma. 2014;31(2):159-168.
  2. Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257.
  3. Shaw NA. The neurophysiology of concussion. Prog Neurobiol. 2002;67(4):281-344.
  4. Kutcher JS, Giza CC. Sports Concussion Diagnosis and Management. Continuum (Minneap Minn). 2014;20(6 Sports Neurology):1552-1569.
  5. Signoretti S, Lazzarino G, Tavazzi B, Vagnozzi R. The pathophysiology of concussion. PM R. 2011;3(10 Suppl 2):S359-368.
  6. Sharp DJ, Jenkins PO. Concussion is confusing us all. Pract Neurol. 2015;15(3):172-186.

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Last updated: 2019-07-11 21:42