Concussion: Causes, Symptoms & Treatment

A concussion, also known as commotio cerebri or traumatic brain injury, is reversible damage to the brain that is most often caused by a blow or accident to the head.

What is a concussion?

Schematic diagram showing the coup-contre mechanism in traumatic brain injury. Click to enlarge. A concussion is often an injury or damage to the brain or head. This may involve a brief loss of consciousness. Most often, a concussion is caused by a blow or accident to the head. This then results in a disturbance of the brain and its function. A concussion usually does not leave any permanent damage because there is no internal bleeding or blood clots in the brain. A concussion can be divided into mild, moderate and severe concussion. A Glasgow Coma Scale (GCS) scoring system is used for diagnosis. The lower the final score, the more severe the concussion.

Causes

The main causes of concussion are mostly external force to the head. This can cause the head to accelerate and decelerate abruptly. In the process, the nerve cells in the brain are temporarily but reversibly disturbed. So far, however, the exact processes involved in concussion are unknown. However, recent studies show that in some patients the cell tissue is slightly injured. In concussion, the structure of the brain itself is not damaged. However, the bones of the skull may be severely stressed. Typical symptoms or signs of a concussion are mostly impaired consciousness, confusion and memory lapses. Likewise, severe headaches, nausea and vomiting may also be indicative of a concussion.

Symptoms, complaints, and signs

In most cases, the complaints and symptoms of a concussion are relatively clear and can be easily recognized. Especially after an accident or after a severe blow to the head, the complaints usually always indicate a concussion. In most cases, the affected person suffers from unconsciousness and various disorders of consciousness. These can continue to occur for some time after the concussion and can limit the life of the affected person. Many patients also exhibit memory lapses and are unable to remember the events of the accident correctly. Severe headaches can also occur and spread to the back. Furthermore, many affected persons suffer from dizziness and vomiting. These complaints usually last for several hours after the accident. Also [disturbances of the equilibrium]] occur, so that it also comes to movement restrictions. The severity of these symptoms depends to a large extent on the severity of the accident, so that no general prediction can be made here. In some cases, epileptic seizures can also occur, which in the worst case can lead to death. A concussion itself usually does not lead to any particular complications if it is treated early.

Course

A concussion should be distinguished from a skull contusion, because in the latter the brain itself is not injured and disturbances of consciousness do not take place. If the symptoms worsen, a more profound brain injury or cerebral hemorrhage could also be possible. The following must still be ruled out: fainting, epileptic seizure or impairment due to medication or drugs.

Complications

Concussion usually has no long-term consequences. However, if there are persistent mood disturbances, decreased performance, and headaches or depressed mood, there may be postconcussion syndrome or chronic posttraumatic syndrome that needs to be evaluated by a physician. Increasing headaches, possibly associated with dizziness and visual disturbances, suggest a hemorrhage or hematoma under the meninges. If left untreated, such a hemorrhage can be fatal. In addition, a concussion also limits general well-being. If the trauma is not treated promptly, the symptoms may be carried over and, as a result, severe physical and mental disorders may develop.If concussions occur repeatedly, this can impair mental performance in the long term. In severe cases, permanent damage and diseases such as dementia develop from the recurring concussions of the brain. Concussions in babies and young children can cause speech disorders and memory lapses, as well as permanent developmental disorders. The not yet fully formed skull bone also favors life-threatening skull fractures. A fall or blow to the head should therefore be immediately medically clarified to avoid complications.

When should you go to the doctor?

Suspicion of a concussion is always a reason to see a doctor or nearby clinic. This is because the extent of possible brain involvement after an accident or fall usually cannot be properly assessed by the layperson. This applies, for example, to the reaction of the pupils to light or other neurological effects, which an affected person is often unable to assess properly. In addition, the symptoms of a concussion, such as headache and nausea, may be mild at first, but later develop serious complications. The clarification by a physician brings here reassuring security. Even after the doctor’s assessment, it may be necessary to seek medical advice again at a later date. This is the case if symptoms suddenly worsen significantly or if other symptoms are added. Characteristic symptoms that require another visit to the doctor or even the calling of an emergency physician are severe headaches, sudden vomiting, visual disturbances as well as neurological deficits of all kinds. Here it is important to react promptly and to rule out complications such as a possible cerebral hemorrhage or to have them treated quickly. The doctor may also recommend monitoring for 24 hours right up front if a concussion is suspected.

Treatment and therapy

First aid for traumatic brain injury and the typical symptoms. Click image to enlarge. Urgent medical attention is advised for concussion. A possible hospital stay of at least 24 hours after concussion cannot be ruled out. Important bodily functions such as pulse, blood pressure and breathing are monitored. Furthermore, the state of consciousness is checked in order to recognize deteriorations of the general condition in time. Appropriate medication is administered by the doctor for headaches, nausea and vomiting. If the symptoms persist or worsen, the doctor should exclude an injury to the brain or blood vessels. In addition, the physician should check the general orientation to verify the state of consciousness. Unrestricted bed rest should be provided. In addition, a follow-up examination is recommended in order to be able to treat potential brain hemorrhages or blood clots in a timely manner. As a rule, however, the symptoms of a concussion disappear on their own after a few days if the affected person takes it easy on himself, keeps to bed rest and refrains from watching television and doing sports. Better the condition can be performed light activities, however.

Outlook and prognosis

Concussion is usually not life-threatening. If the trauma is treated promptly, headache, dizziness and other typical symptoms resolve quickly. Permanent damage or dysfunction to the brain is unlikely. However, the symptoms can persist for weeks to months. Those affected then suffer from persistent concentration problems, mood swings or migraines – symptoms that put a strain on the psyche in the long term and greatly reduce the quality of life. The greater complaints occur immediately after the triggering trauma. Then there is dizziness, severe pain and bleeding, which often cause panic attacks or severe nervousness in the affected person. Severe traumatic brain injuries can cause neurological damage, persistent loss of consciousness and other late effects. If there is swelling of the brain or internal bleeding after a concussion, it can be fatal. Usually, however, a traumatic brain injury has a good prognosis. Most of those affected can resume sports after a short stay in hospital and are also completely mentally fit.Isolated failure symptoms can never be completely ruled out, even with a positive course. The exact diagnosis can only be made by a physician who can accurately evaluate the extent of the trauma and assess the likelihood of any secondary symptoms.

Prevention

Concussion cannot be prevented directly. However, protective measures, such as bicycle helmets, motorcycle helmets, etc., are quite useful. Likewise, one should refrain from too brute sports, such as boxing, possibly.

Aftercare

The aftercare of a concussion is to be kept absolutely. It consists of immobilization of it head and very much rest. Drinking and related hydration should also not be neglected. A patient who suffered from concussion has excessively stressed his head and brain. Therefore, it is necessary that it needs rest for a while to be able to function properly again. In order for the recovery to progress in the best possible way, it needs not only physical rest, but also mental rest. The affected person should completely switch off and not worry too much. The duration of rest depends entirely on the severity of the concussion. This can be different for each person. Some people need months of rest, while for others a few weeks is enough and you no longer feel any pain. If children are affected by a concussion, even more attention should be paid to rest. The brain usually needs a lot of time to recover properly. For this very reason, it is very important that certain guidelines are followed to promote a speedy recovery.

This is what you can do yourself

A concussion is an event that can often heal more quickly and without the addition of undesirable complications through the cooperation of the affected person. In principle, it is important in this context that the patient consistently follows the instructions of the attending physician and seeks medical treatment immediately if new symptoms occur, such as more severe pain, dizziness, or visual disturbances. With regard to the fastest possible recovery from a concussion, it is important to take the greatest possible care. In particular, this means avoiding all physical activities that could cause a renewed concussion of the already stressed regions. Mental rest is also important. In many cases, the patient can read a little or watch television, but heavy mental stress should be avoided. This applies in particular to mental stress or wearing headphones with loud music. The best way to recover is to rest in a darkened, quiet room at a pleasant temperature. It is often ideal if the head is slightly elevated in the process, but in any case comfortable for the patient. Rapid recovery can also be supported in the context of nutrition. Easily digestible foods and a sufficient amount of drinking, ideally water or herbal teas, often prove to be optimal. Alcohol and nicotine should be avoided during concussion.