Causes

The development of a concussion is always related to external forces acting on the head. In most cases, these are blunt force effects that are caused by a fall, a blow or an impact trauma. The brain floats inside the bony skull in the cerebrospinal fluid (technical term: liquor).

This cerebrospinal fluid can absorb many movements of the head in such a way that the brain mass does not come into direct contact with the bony skull. However, if a movement stops abruptly, the brain often beats against the skull bone. For this reason, a concussion occurs particularly in sports such as boxing. Furthermore, the concussion is one of the most common injuries caused in the household and in traffic.

Diagnosis

A patient who is suspected of having a concussion should be presented to a doctor immediately. The detailed doctor-patient consultation (anamnesis) plays a decisive role in the diagnosis of concussion. If the affected patient is not able to talk, witnesses or relatives can be questioned if necessary.

Important points in this questioning are the course of the accident and the complaints that have occurred since. In addition, the patient’s consciousness, motor skills and general condition must be examined in an orienting examination. By definition, a concussion is a light degree of craniocerebral trauma.For this reason, the so-called “Glasgow Coma Scale” (synonym: Glasgow Coma Scale; GCS) should be determined.

This scale can be used to determine the severity of the trauma. In the course of determining the Glasgow Coma Scale, the physician performs various reaction tests on the affected person. Important aspects such as the ability to open the eyes, movement and responsiveness of the affected person are checked.

Depending on the patient’s reaction, different scores can be determined. Glasgow Coma Scale 6 points: 5 points: 4 points: 3 points: 2 points: 1 point:

Open your eyes: –
Speak: –
Movement: follows prompts
Open your eyes: –
Speaking: conversational, oriented
Movement: targeted pain defense
Open your eyes: spontaneously
Speaking: conversational, disorientated
Movement: untargeted pain defense
Open eyes: on demand
Speaking: coherent words
Movement: on pain stimulus (abnormal flexion)
Open eyes: for pain stimulus
Speaking: incomprehensible sounds
Movement: on pain stimulus
Open eyes: no reaction
Speaking: no verbal reaction
Movement: no reaction to pain stimulus

In case of uncomplicated concussion, the patient should achieve a score of 13 to 15 points on the Glaskov Coma Scale (GSK). In addition, the patient’s head should be examined for visible or palpable bone injuries.

Further damage can be ruled out with the aid of imaging techniques (X-ray or computed tomography). In patients who have been unconscious for a long period of time and/or have persistent memory deficits, a higher degree of craniocerebral trauma (e.g. a cerebral contusion or cerebral hemorrhage) must be excluded. If the computer tomography does not provide a clear result despite persistent symptoms, an additional magnetic resonance tomography (short: MRI of the brain) can be performed.