What is a concussion?
A concussion is a condition that results from a head injury. It is a clinical state where there is a temporary disruption in normal brain function. It is classified as ‘minor’ and can happen as a result of a fall, road traffic accident, assault or as part of playing sports
Most concussions get better on their own. However, many patients experience ongoing problems even two weeks after then event, and some symptoms may persist beyond this time.
What are the common symptoms of a concussion?
The symptoms in each patient are different. The most common symptom is dizziness and headache, but people report a wide range of symptoms which can include:
- Loss of consciousness
- Balance problems
- Double or fuzzy vision
- Sensitivity to light or noise
- Feeling sluggish
- Concentration or memory problems
- Slowed reaction time
- Feeling unusually irritable
What are the problems with a concussion?
Some people that are concussed have symptoms that persist for weeks or even months. When this happens this is known as post-concussive syndrome. Symptoms are similar to those experienced initially, and include memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, difficulty sleeping or excessive drowsiness. This can significantly affect quality of life.
This is a serious but rare condition that can lead to death. It results in fatal brain swelling resulting from a second head injury sustained before complete recovery from a previous concussion has occurred. It is not clear why this happens, but it is thought to be because of an alteration in how the brain manages its blood supply.
When do concussion symptoms appear?
Concussion symptoms normally appear within minutes of the blow to the head although symptoms may develop after a few hours. It is important to realise that symptoms may change and others develop. This can be a result of the brain being stressed even by such activities as reading or running.
How is a concussion diagnosed?
A concussion is diagnosed based on the symptoms you provide and how you came by your symptoms. Doctors check for physical signs as well as thinking, capability, and mood symptoms. Sometimes a CT scan or MR scan might be helpful and can show changes such as bruising to the brain. Often however, these tests are normal and the diagnosis is made by the doctors treating you based on your symptoms alone.
What normally happens to concussion symptoms?
Most concussion symptoms usually resolve on their own. How quickly they get better depends on how severe the injury was, how fit and healthy the individual was before the injury, and what was done after the injury. In most cases, rest is one of the most important treatments for a concussion because it helps the brain to heal.
If I have a concussion, how likely am I to have another one?
Once you have a concussion, you are at three to five times greater risk for later concussions.
Who needs treatment?
We would advise that patients seek immediate medical attention if any of the following warning signs are present immediately (<48 hours) after the injury. This initial assessment is best done though the Accident and Emergency service.
- Constant pain or recurring headache
- Inability to control or coordinate arms or legs
- Disturbance of balance
- Changes in ability to hear, taste or see
- Dizziness or hypersensitivity to light or sound
- Feeling of disorientation, confusion
- Difficulty finding the "right" word
- On warfarin or other blood thinning medication
- History of a loss of consciousness
- Failure to remember the events before or after the injury
- Any seizure since the injury
- Any previous brain surgery
- A high-energy head injury
- Any history of bleeding or clotting disorders
What does the clinic offer?
The clinic is set up to provide advice and ongoing treatment for all patients (>15 years) that have ongoing problems (> 1 week) after a head injury. The clinic provides for non-athletes as well as for amateur and professional athletes.
- Specialist clinical assessment
- Screening of cognitive and emotional symptoms
- Balance problem assessment
- Visual disturbance assessment
The clinic is also designed to offer assessments and judgments on a return to study or work, return to play assessment for professional/amateur sportsmen as well as assessment and discussion on the long term effect of concussions. These assessments may require multiple visits and more detailed clinical, imaging and cognitive screen tests than offered routinely.
What can I expect?
Each visit will be tailored to the needs of the individual.
Non-sports related injury
The initial assessment will be a detailed clinical review with review of relevant brain imaging. Education will be offered and an individualised recovery plan will be offered.
Symptoms and progress will be tracked and addressed. Follow-up appointments and more detailed testing may be required. This may need to continue until the symptoms resolve, which is usually within one to six weeks for acute injuries. In the presence of ongoing or more chronic symptoms a more detailed assessment with specialist imaging and screening tests for cognitive or emotional disturbance may be required. Further referral to a headache specialist, balance specialist, vision specialist or neuropsychology team may be required.
Sport related injury
The assessment for amateur or professionals sportsmen or women will also include a detailed clinical and radiological review. There may be a requirement for more detailed testing and early requirement for follow-up with repeat testing to allow for objective decisions about return to play.
The clinic is able to provide an in-depth discussion and education about the short- and long-term effects of concussion
Assessment of the long term risks of concussion will require multiple visits. This decision for long term impact may need to be made over a number of years and would require consideration of the additive effects of multiple concussions.