Concussion

What is a concussion?

A concussion (kun-KUSH-un) is an injury to the tissue or blood vessels of the brain. It is also called a "closed head injury" or "mild traumatic brain injury" (MTBI). Concussions happen when the soft tissues of the brain are forced against the bone of the skull. The injury can cause the brain to have trouble working normally for a short time. A mild concussion is usually not a serious problem. Concussions can be further described by the following categories:

• Grade 1: A mild concussion. You did not lose consciousness (were not "knocked out"). You may have been dazed or confused for a short time after the injury. Normal thinking and behavior returns within 20 minutes of the injury.
  
  
• Grade 2: You did not lose consciousness, but you did not think clearly for more than 20 minutes after the injury. Also, you may not remember what happened.
  
  
• Grade 3: You lost consciousness for a short time. Also, you may not remember what happened.

What are possible causes of a concussion?

A concussion is usually caused by a blow to the head. A concussion may happen because of a fall, a motor vehicle crash, or a sports injury. Sometimes being forcefully shaken may cause a concussion.

What are the signs and symptoms of a concussion?

Every concussion is different. Right after the injury, you may seem dazed, lose consciousness, or have a seizure (convulsion). Other symptoms may show up right away. Some symptoms may not happen for days or weeks after the concussion. Symptoms of a concussion may last anywhere from a few hours to several weeks. After a concussion, most people get better within four weeks. After the injury, you may have one or more of these symptoms:

• Mild to moderate headache.
  
  
• Dizziness or loss of balance.
  
  
• Nausea (feeling sick) or vomiting (throwing up).
  
  
• Change in mood (such as restlessness or irritability).
  
  
• Trouble thinking, remembering things, or concentrating (giving full attention to one thing for a period of time).
  
  
• Ringing in the ears.
  
  
• Drowsiness or decreased amount of energy.
  
  
• Change in normal sleeping pattern (you may sleep more than usual or cannot sleep).

What signs and symptoms should concern me in the days following a concussion?

It is common to have a headache or feel dizzy after a concussion. Some people who are thought to have minor concussions may have a more serious injury. The symptoms of a serious head injury may not show up right away. It is very important to watch for more serious symptoms after a concussion. If possible, have someone stay with you after a concussion to help you watch for symptoms.

• You may be at higher risk of having a more serious head injury if you:
  
  
  • Had a previous head injury or concussion.
    
    
  • Are on medicine that thins your blood, or have a bleeding disorder.
    
    
  • Have other neurologic (brain) problems.
    
    
  • Have difficulty walking or if you fall often.
    
    
  • Are active in high impact contact sports, like soccer or football.
  
  
• Call your caregiver if you have any of the following symptoms:
  
  
  • You are harder to wake up than usual.
    
    
  • Your symptoms get worse during the first several days after the injury.
    
    
  • You have new headaches that are very bad, or that get worse in the days after the injury.
    
    
  • You have concussion symptoms that last longer than six weeks after the injury.
  
  
• You should be seen in an emergency room, doctor's office, or clinic immediately if:
  
  
  • You have repeated or forceful vomiting.
    
    
  • You have increasing confusion, or a change in personality or behavior.
    
    
  • You have blood or clear fluid coming out of the ears or nose.
    
    
  • You do not know where you are, or you do not recognize people that are familiar.
    
    
  • You have new problems with vision (blurry or double vision).
    
    
  • Your speech becomes slurred or confused.
    
    
  • You have arm or leg weakness, loss of feeling, or new problems with coordination (balance and movement).
  
  
• You or someone with you should dial 9-1-1 or 0 (Operator) for an ambulance if :
  
  
  • Your pupils (black part in the center of the eye) are unequal in size, and this is new for you.
    
    
  • You have a seizure (convulsion).
    
    
  • Someone tries to wake you and cannot do so.
    
    
  • You stop responding to others or you pass out (faint).

How is a concussion treated?

Although you need to be seen by a caregiver, usually no treatment for a concussion is needed. The most important thing you can do is to watch for signs of a more serious problem. You may need tests or to stay in the hospital for a short time. You may be sent home with special instructions.

• If you lost consciousness, a CT or MRI scan may be taken of your brain to check for serious injury. You may have a concussion even if it does not show up on a CT or MRI scan.
  
  
• You may need x-rays taken of your neck or face if there is a chance of other injuries.
  
  
• You should get plenty of rest in the days following your concussion.
  
  
• Only take medicine that your caregiver says is OK.
  
  
• Sometimes a blow to the head may cause bruising, swelling, or a cut on your skin. An ice pack may be used to decrease your pain and swelling. It is best to start using ice right after an injury and up to 24 to 48 hours afterwards. Do not use ice directly on the skin, or for longer than 20 minutes at a time. If ice is not covered or is put on one area of your body for too long, it may cause frostbite.
  
  
• You need to be protected from another head injury for a period of time. It is dangerous to receive another concussion before the brain has recovered (gotten better) from the first one. You may not be able to play sports or to do activities that may result in a blow to the head. Your caregiver will let you know when it is OK for you to return to normal activities.
  
  
• Let a friend or household member know about the injury and symptoms to watch for.

Will I have any lasting effects from a concussion?

Rarely, some people may develop post-concussion syndrome (PCS). Symptoms of PCS may not start for several weeks or months after an injury. Symptoms of PCS usually go away over time. Some people may need special treatment. Call your caregiver if you have concussion symptoms for more than six weeks after the injury. You may have PCS if one or more of the following symptoms start or continue six weeks or more after the injury:

• Headache that will not go away.
  
  
• Dizziness or vision changes.
  
  
• Problems with memory, planning, or thinking.
  
  
• You become irritable, depressed, get angry more easily, or you are not able to control your emotions.

Risks:

• You may also have had other injuries at the same time as the concussion, like a neck or face injury. The longer you were unconscious, the more serious the concussion may be. The risk of serious problems are decreased if you carefully follow your caregiver's advice.
  
  
• Each additional concussion you have may increase your risk of having long-lasting problems. These problems may include poor coordination, or trouble thinking or concentrating. Having repeated concussions can be life threatening.

Where can I go for more information?

You can contact one of the following national organizations for more information about concussions and head injuries:

• Brain Injury Association
  1608 Spring Hill Road
  Vienna , VA 22182
  Phone: 1- 703 - 761-0750
  Phone: 1- 800 - 444-6443
  Web Address: http://www.biausa.org
  

• Centers for Disease Control and Prevention
  1600 Clifton Road
  Atlanta , GA 30333
  Phone: 1- 404 - 6393311
  Phone: 1- 800 - 3113435
  Web Address: http://www.cdc.gov
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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