What is a Concussion
A concussion is a form of minor traumatic brain injury which can result from a direct hit to the head or a whiplash type injury. It may or may not result in loss of conciousness. Typically the injury results in microtrauma to the cells of the brain which cause an energy crisis for the brain when it starts dealing with the healing and inflammation of those cells.
Signs, symptoms, testing and red flags
Signs and Symptoms
Direct hit to the head, whiplash injury
Loss of conciousness or seeing stars, feeling in a fog
Headache, dizziness, nausea, personality changes, fatigue
Double vision, blurred vision
Red Flag Signs - Immidiate Emergency Referral
Repeated loss of conciousness
Repeated vomiting
Fluids draining from ears or nose
Suspected fracture of the cranial vault
Unreactive pupils (usually dilated with no response to bright light)
Radiating nerve pain down one of both arms/legs
Testing
Testing for a concussion will consist of a neck examination as often the neck is invovled in a concussion injury. A neurological examination inlcuding cranial nerve, reflexes, sensation, and motor testing will be done. Balance and/or coordination testing, eye movement examination, as well as concentration and memory should be part of any concussion examination.
Baseline testing can be done every 1-2 years to estabilish a "normal function" so that should a concussion happen there is a rehabilitation objective to return to.
Diagnosis
Diagnosis of a concussion is established due to a constelation of signs and symptoms during the history and physical examination. A medical doctor is needed to diagnose a concussion. Any other healthcare professional will come to a "clinical suspicion" and should work in collaboration with the primary physician.
Treatment
Treatment of concussion can involve a multitude of modalities depending on the severity and symptom load/systems affected.
Modalities to treat concussion range from education for the patient and family, soft tissue therapy, acupuncture, rehabilitation exercises for the visual and balance systems, return to low risk cardiovascular activity early on (proper application and protocols are person dependant), mobilizations or manipulations (when safe to do so).
Return to sport
Return to sport decisions are made with the health care team, with the head being the primary cary physician.
Certain things like the symptom load, standardized (pre-season testing) targets, age of the patient (second impact syndrome), and response to cardivascular exercise are all part of the decision makeing process.
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Second impact syndrome is a name for the injury/death that may occur should a second concussion happen while still symptomatic from the first concussion. Unfortunately, Rowan's law resulted from this condition happening in a young athlete whose frist concussion was missed.
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