A concussion (commotio cerebri) is the mildest form of traumatic brain injury. After a fall or blow to the head, a brief loss of consciousness and symptoms such as lightheadedness, memory lapses, headache, and nausea may occur. If a concussion is suspected, a doctor should be consulted – especially if babies and young children are affected. This can rule out a more serious head injury through appropriate examinations and adequately treat the symptoms of concussion.
Causes of concussion
Injuries to the skull in which brain tissue is injured or impaired in function by an external force are called traumatic brain injury. Mere skull fractures or lacerations to the head do not fall into this category because the brain is not affected. A concussion is the mildest form of traumatic brain injury. More severe forms are called brain contusions or brain bruises. Our brain floats in the skull in the so-called cerebrospinal fluid (CSF) and is protected from external influences by the skull bone. If the brain suddenly and jerkily hits the skull bone – as is the case, for example, with a fall or a blow to the head – a concussion can occur. Such an injury can occur quickly during sports or in road traffic – it is not for nothing that concussion is one of the most common head injuries. It is particularly common in boxing, but such an injury can also be caused by a fall while cycling or inline skating. Depending on the severity of the impact, a distinction is made between a mild and a more severe concussion.
Concussion: symptoms
Often with a concussion, there is a brief period of unconsciousness, loss of consciousness, or a lapse in memory. However, mild concussions do not necessarily cause these symptoms. Unconsciousness often lasts only a few seconds to a few minutes. In more extreme cases, however, it can last longer than 30 minutes. When the victim wakes up, he or she usually has no recollection of the accident. In some cases, memory of the time immediately after the accident is also missing (anterograde amnesia). Retrograde amnesia – the absence of memory of the time before the accident – is also possible and indicates a more severe head injury. While more severe head injuries usually involve damage to the brain structure, concussions only temporarily disrupt brain function.
Postconcussion syndrome as a complication
In addition to the symptoms already mentioned, concussion also causes symptoms such as nausea and vomiting, lightheadedness and dizziness, and visual disturbances and headaches. Some of these symptoms may be delayed – for up to twelve hours after the accident. Normally, the symptoms subside on their own after a few days, but in rare cases – about one percent of those affected – it can take several weeks for the last symptoms to disappear. This complication is called post-commotion syndrome. In this case, patients continue to suffer from:
- Headache,
- Nausea,
- Dizziness,
- Sleep disturbances as well as
- Sensitivity to light and sound.
If concussions occur more frequently in a person – as is the case with boxers, for example – it can lead to long-term impairment of mental performance. In the worst case, multiple concussions can lead to dementia.
Concussion in babies and (young) children.
Falls to the head are much more common in children than in adults. However, because the skull in babies is not yet firmly ossified all over, impacts can be absorbed better. Nevertheless, concussions also occur in babies and young children. The symptoms of such an injury are similar to those of adults: headaches, nausea, speech disorders, memory lapses, fatigue and confusion. In babies and young children, the typical symptoms often appear with a time delay. That is why you should observe your child closely after a fall on the head.If you notice typical symptoms of a concussion in your child after a fall, you should definitely have him or her examined by a doctor. A visit to the doctor is advisable in any case for small children under one year of age, because they often have only a few symptoms of a concussion. In addition, a skull fracture, which is a typical injury for this age group, must be ruled out by the doctor.
The Glasgow coma scale
To confirm the suspicion of a concussion, the physician first asks about the course of the accident and the symptoms that occur, and then checks the patient’s general condition. Using the Glasgow Coma Scale, the physician can determine exactly how severe the traumatic brain injury is. To do this, he performs various tests and assigns points for the patient’s reaction. He checks whether the patient opens his eyes, whether he moves and whether he is responsive. Depending on the reaction, the patient can score between 3 and 15 points in total:
- 3 to 8 points: severe traumatic brain injury (brain contusion).
- 9 to 12 points: moderate traumatic brain injury (brain contusion).
- 13 to 15 points: mild traumatic brain injury (concussion).
| Adult | Children | Points | |
|---|---|---|---|
| Open eyes | spontaneous | spontaneous | 4 |
| on speech | on call | 3 | |
| on pain stimulus | on pain stimulus | 2 | |
| no reaction | no reaction | 1 | |
| Language | oriented | babbles | 5 |
| disoriented | screams | 4 | |
| inadequate words | cannot be consoled | 3 | |
| unintelligible | moans | 2 | |
| no reaction | no reaction | 1 | |
| Motor skills | on demand | Spontaneous movement normal | 6 |
| Targeted pain defense | targeted pain defense | 5 | |
| untargeted pain defense | untargeted pain defense | 4 | |
| Diffraction response | Diffraction reaction | 3 | |
| Stretch response | Stretch response | 2 | |
| no reaction | no reaction | 1 |
Rule out a severe head injury
Palpation, a computed tomography (CT) scan, or an X-ray can help the doctor determine if there are any injuries to the skull or surrounding areas such as the cervical spine. In the case of prolonged unconsciousness or persistent memory lapses, a more serious injury to the brain must also be ruled out. If the CT has not yielded a clear result and symptoms persist, the doctor may also perform a magnetic resonance imaging (MRI) scan. Patients who suffer from severe discomfort or persistent memory lapses, who have been unconscious for a prolonged period of time, and in whom a more serious head injury cannot be ruled out with certainty should be observed by a physician for at least 24 hours after the accident. However, even in the case of a mild concussion, a period of observation under medical supervision is recommended.
Concussion – what to do?
If it is suspected that you have suffered a concussion due to a fall or external force, you should always see a doctor directly or call an emergency physician. The doctor must rule out the possibility of more serious injuries to the brain or skull, such as a skull contusion, brain hemorrhage, skull base fracture or whiplash. Ask your doctor if it is advisable that you spend the first few hours after the injury under medical supervision. In any case, rest for a few days and avoid physical work and sports. In the beginning, you should also refrain from watching television, working on the computer, and reading for long periods of time so that the brain can recover in peace. If necessary, the doctor treating you can prescribe an appropriate medication for complaints such as headaches or nausea.If the injury heals well, you will be able to return to work after about a week, depending on the severity of the concussion. If you suspect another person has a concussion, notify a doctor and do not leave the person alone until the doctor arrives. Check breathing, pulse and heartbeat, treat any wounds and ask how the accident happened if the person is conscious. If this is the case, elevate the upper body slightly. If the victim is unconscious, carefully place him or her in the recovery position.
Preventing a concussion
As with other injuries, a concussion cannot be prevented with 100 percent certainty. However, you can significantly reduce your risk for a concussion by following certain behaviors. For example, you should always wear a helmet when playing sports that involve a high risk of falling, such as bicycling, inline skating or skiing. Also, do not practice these sports if you feel physically tired. This is because the risk of falling is particularly high then.