Concussion Management

What is a Concussion? 

A concussion can be simply defined as a disruption in neurological functioning following a significant impact to the head or elsewhere on the body.  This causes an imbalance in molecules within the brain cells as well as an energy deficit (the energy molecule required for cell function is known as ATP).  Large reductions in blood flow to the brain immediately after concussive impact have been shown.  

What Causes a Concussion?

A concussion is caused by acceleration or deceleration of the brain, following a significant impact to the head or elsewhere on the body. One common misconception is that someone must be hit in the head to cause a concussion; however, a significant enough hit to the body may cause a whiplash effect and result in enough force to the brain to cause a concussion.

What are Symptoms of a Concussion?

A concussion causes the brain cells to become excited initially, followed by an extreme drop in energy. This may result in any of the following symptoms:

• Loss of consciousness (more than 90% of concussions do not result in loss of consciousness)
• Headache or pressure in the head
• Neck pain or whiplash
• Dizziness or vertigo
• Nausea and/or vomiting
• Blurred or distorted vision
• Balance problems
• Feeling tired, fatigue, slowed down, drowsy or having no energy
• Feeling “foggy” or not thinking clearly
• Not feeling right or feeling off
• More emotional
• Feeling sad, upset or angry
• Nervousness or anxiety
• Sensitivity to light or noise
• Difficulty reading or working at a computer
• Difficulty remembering or concentrating
• Confusion
• Difficulty falling asleep
• Sleeping more or sleeping less
• Irritability

Visual signs of a concussion may include:

• Loss of consciousness
• Lying motionless on the field, ice, or court
• Disorientation or inability to respond to questions
• Blank or vacant stare
• Stumbling or incoordination
• Clutching head
• Slow to get up after a hit to the head or body

If you experience any one of these symptoms following a significant impact to the head or body, then you should have a high suspicion of concussion.

When in doubt, sit them out!

What Do I Do if I Have a Concussion?

Always tell a parent, teacher, coach and/or friend if you, a teammate or even an opposing player may have suffered a concussion. When in doubt, sit them out!

The first 24-48 hours following a concussion are critical due to the potential for a more serious injury that may require immediate medical attention such as a bleed or swelling in the brain. Following the injury, the patient should be monitored for at least 3 hours for any worsening of their condition as this may indicate bleeding or swelling in the brain.

Immediately go to the nearest emergency department if any of the following signs or symptoms are present. These are known as red flags.

• Very drowsy or cannot be woken up
• Vomiting
• Drug or alcohol intoxication at time of injury
• Short-term memory deficits
• Seizure
• Decreasing level of consciousness or awareness
• Fluid or blood coming from the ears, nose, mouth or eyes
• Bruising behind the ears, black eyes or very tender points on the face
• Inability to remember 30 minutes before or after injury
• Unsteadiness standing or walking
• Dangerous mechanism of injury (e.g., struck by a car or falling down stairs)
• Slurring speech
• Weakness or numbness in the arms or legs

It is important that patients receive a proper neurological evaluation and management advice as soon as possible following a concussion as this can significantly impact recovery.

What is Post-Concussion Syndrome?

Up to 90% of concussion injuries can resolve symptomatically within 7-10 days; however, in some cases, concussion injuries have longer lasting symptoms. If you experience symptoms beyond 4 weeks, this is known as post-concussion syndrome.

Very little is known about what causes post-concussion syndrome. It is currently believed to be due to continued blood flow abnormalities in the brain, continued energy deficits in the brain, psychosomatic disorders, vestibular/ocular issues (integration between visual and balance systems) and/or potential dysfunction in the muscles and joints of your neck that occurred because of the impact.