Treating Concussions
What is a Concussion?
A concussion is an injury to the brain. It is usually caused by a blow to the head, but may occur with severe jarring of the body. Although loss of consciousness may occur, it usually does not. Concussions occur most commonly in contact sports such as football and hockey.
Don't Ignore a Mild Concussion
Even a mild concussion is a serious brain injury that should not be taken lightly. Medical experts emphasize that there's no such thing as a "minor concussion," and while one concussion may not cause permanent damage, a second concussion soon after the first can be deadly or permanently disabling, even if it's not a strong impact.
What to Look For
Concussions can affect memory, balance, speech, and coordination. A person with a concussion may seem confused or unable to remember what happened right before or after the injury. To check for a concussion, paramedics and trainers often ask the injured person simple questions, like what year it is, to see if their brain function is altered.
What are the Signs of a Concussion?
Signs and Symptoms
Following a concussion, the athlete may experience a number of problems, including:
- Headache
- Dizziness
- Blurred vision
- Unsteadiness and loss of balance
- Confusion
- Memory loss
- Difficulty concentrating
- Ringing ears
- Nausea
- Vomiting
- Sensitivity to light
- Loss of smell or taste
For Parents
The parent of an athlete who has suffered a concussion should take this injury seriously. Check on your child regularly, until he/she feels normal. The following symptoms are concerning and further evaluation by a physician should be sought immediately:
- Neck stiffness
- Severe headache
- Difficulty walking or speaking
- Frequent vomiting
- Worsening confusion
- Seizures or convulsions
- Extreme fatigue or unusual sleepiness
Symptoms of a concussion may resolve quickly or may persist for weeks, months or longer. An athlete should not return to sports until the symptoms have resolved and a doctor has cleared them. Returning to activities too soon following a concussion increases the likelihood of recurrent concussions and possibly more severe and even catastrophic injury. Repeated concussions could cause some permanent damage to the brain.
Grading Concussions and Syndromes
Grading the concussion is a helpful tool in the management of the injury (see Cantu Guidelines below) and depends on:
- Presence or absence of loss of consciousness
- Duration of loss of consciousness
- Duration of post-traumatic memory loss
- Persistence of symptoms, including headache, dizziness, lack of concentration, etc.
Some team physicians and trainers evaluate an athlete's mental status by using a five-minute series of questions and physical exercises known as the Standardized Assessment of Concussion (SAC). This method, however, may not be comprehensive enough to pick up subtle changes.
According to the Cantu Guidelines, Grade I concussions are not associated with loss of consciousness, and post-traumatic amnesia is absent or is less than 30 minutes in duration. Athletes may return to play if no symptoms are present for one week.
Players who sustain a Grade II concussion lose consciousness for less than five minutes or exhibit post-traumatic amnesia between 30 minutes and 24 hours in duration. They may also return to play after one week of being asymptomatic.
Grade III concussions involve post-traumatic amnesia for more than 24 hours or unconsciousness for more than five minutes. Players who sustain this grade of brain injury should be sidelined for at least one month, after which they can return to play if they are asymptomatic for one week.
Following repeated concussions, a player should be sidelined for longer periods of time and possibly not allowed to play for the remainder of the season.
People who suffer a head injury may suffer from side effects that persist for weeks or months. This is known as post-concussive syndrome. Symptoms include memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia, or excessive drowsiness. Patients with post-concussive syndrome should avoid activities that put them at risk for a repeated concussion. Athletes should not return to play while experiencing these symptoms. Athletes who suffer repeated concussions should consider ending participation in the sport.
Second Impact Syndrome results from acute, sometimes fatal brain swelling that occurs when a second concussion is sustained before complete recovery from a previous concussion. This causes vascular congestion and increased intracranial pressure, which may be difficult or impossible to control. The risk for second impact syndrome is higher for sports such as boxing, football, ice or roller hockey, soccer, baseball, basketball, and snow skiing.