Down
For The Count
By
Lee Philips , M.D.
PersonalMD.com Advisory Board
Fortunately
most concussions are minor, and rarely is there permanent damage.
Most result from the head striking against an object, a blow to
face or jaw, or a rapid turning and or twisting of the head and
neck. The person might be stunned from a couple of seconds to
a few minutes. The person may black out, but concussions do not
always result in a loss of consciousness.
Depending
on the extent of the injury, immediate signs of a concussion may
include confusion, irritability, blurred vision, dizziness, and
vomiting as well as memory loss for the event. In mild concussions,
within eight hours, the person is back to normal. The most alarming
features are usually bleeding from the skin and swelling (hematoma)
where the head was hit. The size of the bump does not reveal anything
about the severity of the injury. The cuts often bleed heavily
because the skin has many blood vessels near the surface.
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Seek
Emergency Care
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If the person is unconscious, drowsy, confused, doesn't
recognize surroundings, or doesn't answer questions correctly.
If
there is difficulty speaking, garbled or slurred speech
For
severe headache, vision problems, seizures
If
there is repeated vomiting
For
a child under the age of two
For
any person taking Coumadin, a blood thinner.
If the person has been using alcohol or other drugs.
If
you suspect child or domestic abuse.
If
there is bruising under the eyes or behind the ears or there
is blood or fluid draining from the ear or nose.
For
blurred or double vision, unequal pupils.
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A
concussion often is divided into three categories.
Grade
1. There is no loss of consciousness but the person may seem
dazed. Symptoms go away in less than 15 minutes.
Grade
2. There is on loss of consciousness but has a period of confusion,
more than 15 minutes, and does not recall the event.
Grade
3. Occurs when there is any loss of consciousness and the
person has no memory of the event
It
is often difficult to determine initially the difference between
a mild concussion and a more serious head injury. Bleeding into
the brain, is the main concern after a head injury.
This
can occur with any head injury even if the skin is not bleeding,
and whether or not the person was knocked-out. Blood may begin
to collect in or around the brain, causing an increase in pressure
on the brain.
Usually
with increased pressure on the brain, there is a worsening headache,
confusion and sleepiness. Generally the more force involved in
a head injury the more likely a serious head injury has taken
place. And usually a more serious head injury is characterized
by longer periods of unconsciousness.
Seeing
your doctor...
Your
doctor will perform a neurological exam, which include looking
for difficulties with walking, speech, memory, coordination, and
unequal pupils. Based on this exam your doctor will decide on
treatment. For most people, the diagnosis is based on what you
and your family relate to the doctor and the physical exam. If
there is a suspicion of bleeding in the brain, you doctor will
order a (CT) computed tomography of the head.
If
you are diagnosed with a concussion enter the diagnosis in your
PersonalMD medical record.
Home
Treatment
Even
if the doctor determines that the concussion is mild, the person
should rest and be observed by a responsible adult to make sure
symptoms are not worsening. If there are going to be complications,
normally they will show up in the first 24-48 hours.
Sleep
is fine during this period, a responsible person will need to
check you every 2 hours to be sure that the person awakens easily.
The patient should be able to answer simple questions like: address,
age, phone number, and the date. Ice applied to the bruised area
will help minimize swelling. Before giving any medications check
with your doctor. Do not allow the person to drink alcohol.
Prognosis...
The
prognosis for concussions varies from person to person, and full
recovery can be expected in mild concussions. Generally, the more
severe the concussion, the longer the recovery period. Also, if
there is a history of previous concussions, the effects are additive,
they may last longer or be more severe.
Post-concussive
Syndrome
Some
people after sustaining a concussion may suffer from post-concussive
syndrome. The syndrome can include persistent headaches, dizziness,
fatigue, irritability and difficulty concentrating. Symptoms can
begin 2 days after injury and last for weeks to months. At the
present time there is no treatment to shorten the course of post
concussive syndrome, but a doctor might be able to improve the
symptoms with medications.
Second
Impact Syndrome
If
you have had a previous concussion, your doctor may advise you
against participating in high impact sports like football or boxing.
Studies have shown that there is an increased rate of long term
brain damage and occasionally death from repeat concussions.
Sudden Impact Syndrome is fatal brain swelling that occurs when
athletes suffer repeated concussions within short intervals of
time before complete recovery from a previous concussion. Any
head injury of an athlete must be evaluated a trained person,
and depending on the level of concussion and the history of a
previous concussion, must then decide when a player can re-enter
the game.
Any
athlete who has a grade 1 concussion can return to competition
if all symptoms resolve in 15 minutes. If another grade 1 concussion
happens to that athlete in the same competition, the athlete should
be taken out of competition for 1 week.
An
athlete with a grade 2 concussion should not be allowed to compete
again on that day, and should be monitored to make sure there
are no complications. The athlete should not practice or play
until there are no symptoms for one week.
Any
athlete with a grade 3 concussion should be evaluated at an
emergency department. The athlete should not be allowed to compete
for a minimum of 2 weeks.
Prevention
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