Concussions – #TBI Awareness Month

If you or someone you know have had a recent head injury, please keep reading. TBI’s can be serious and should be treated seriously.  Below is some relevant information regarding concussions.

Common signs and symptoms of concussion are:

• Loss of consciousness after any trauma to the head
• Confusion
• Headache
• Nausea or vomiting
• Blurred vision
• Loss of short-term memory (you may not remember the actual injury and the events some time before or after the impact)
• Perseverating (repeating the same thing over and over, despite being told the answer each time, for example, “Was I in an accident?”)

Concussions & Brain Damage Quiz

When to Seek Medical Care for Concussion

Call the doctor about any of the following situations. The doctor will recommend home care, set up an appointment to see the affected individual, or send the the person to a hospital’s emergency department.

• A person struck a hard object with the head (for example: tile floor, ice, bathtub) but did not lose consciousness
• Mild dizziness or nausea after a head injury
• Loss of memory of the event (amnesia) for just a few minutes
• Mild headache with no vision disturbances

Go to an emergency department by ambulance in the following situations. For people with less severe injuries not requiring ambulance transport, a car may be taken to the hospital.

• Severe head trauma, for example, a fall from more than the height of the person or a hard fall onto a hard surface or object with resulting bleeding or laceration.
• Any child that loses consciousness as the result of a head injury.
• Prolonged loss of consciousness (longer than two minutes)
• Any delayed loss of consciousness (for example, the injured person is knocked out only momentarily, then is awake and talking, then loses consciousness again)
• Vomiting more than once
• Confusion that does not go away quickly
• Restlessness or agitation
• Extreme drowsiness, weakness, or inability to walk
• Severe headache
• Loss of memory of the event (amnesia)

• Perseverating (saying the same thing over and over)
• Seizures or convulsions
• Slurred speech
• Someone who takes warfarin (Coumadin) or platelet inhibitors clopidogrel (Plavix) and aspirin (Aggrenox) for a medical problem and suffers a significant blow to the head.
• If the person fails to regain consciousness after two minutes, however, or the injury is very severe even if two minutes have not passed, DO NOT move the person. Prevent movement of the neck, which may exacerbate spinal injuries. If the person needs to vomit, carefully roll the person onto his or her side without turning the head. Call 911 immediately for help.

If you are unsure of the severity of the injury, take the person to the emergency department immediately.

Should an injured person be allowed to fall asleep? Many mistakenly believe it is important to keep people, especially children, awake after they have been struck on the head. Children are often more emotionally upset than they are physically injured after a minor fall. They will cry and appear distressed, but as the parent rushes them to the hospital, children may begin to calm down. Because they have expended a lot of physical and emotional energy crying, they will often want to go to asleep.

• You do not need to keep the patient awake. In many cases it may be helpful to the emergency doctor to be able to awaken the person who is now more calm and rested and will behave normally. This gives the doctor a better assessment of the severity of the head injury.
• If, however, a person who was initially normal after a head injury cannot be awakened, or is extremely difficult to awaken, then the person may have a more serious head injury and should be evaluated by a doctor.

How Is a Concussion Diagnosed?

The doctor will make sure that there are no severe or life-threatening injuries first and then will further evaluate the severity of the head injury.

History of the injury: If you can, give the doctor the following details about the injury:

• How long the person may have been unconscious.
• Details about how the injury happened, such as the speed of travel in a car accident, the height of a fall, or the size of the person or object that hit the victim.

Past medical history: Tell the doctor about the history of any of the following:

• Current medications, especially warfarin (Coumadin) or platelet inhibitors clopidogrel (Plavix) and aspirin and dipyridamole (Aggrenox)
• Allergies to medications
• Prior head injury or concussion, neurologic injury, or surgeries
• Bleeding disorder or history of easy bleeding or bruising

During the physical examination, the doctor will:

• Assess normal neurologic function such as reflexes and mental status.
• Examine the patient for other associated injuries, such as a neck injury or whiplash, that are common with head injury.
• Inspect for bleeding from the ears or nose as well as bruising around the eyes or behind the ears that is commonly seen with certain types of fractures to the base of the skull.

Many times people are concerned about a cut (laceration) on the scalp or face, and the doctor may not seem to take much notice. These cuts may bleed and appear serious, but severe or life-threatening bleeding from such a cut is rare and would be recognized right away. The doctor’s main concern will be to assure that there is not serious brain damage, or a neck or torso injury. The cut can be repaired later.

Looking inside: The best way to evaluate a person’s head injury is with a CT scan. This machine takes cross-sectional X-rays of the head (or other body parts), and a computer reassembles the information into images to let the doctor see details of the inside of the body. When a CT scan is used for a head injury, the doctor will look for evidence of bleeding under the skull or within the brain tissue itself.

• With less serious head trauma, the doctor may choose not to do a CT scan. A minor concussion can safely be observed either at home or in the hospital for 24-48 hours. If no other serious signs of injury develop, the person will usually be safe.
• Skull X-rays are no longer routinely used to evaluate a person with a concussion.
• A concussion may be accompanied by a skull fracture. The patient may still have a skull fracture even though the doctor does not perform a CT scan or take X-rays. This is acceptable. The presence of a fracture does not, alone, increase the likelihood of an injury to the brain unless there are also other signs of head injury.
  • Skull fractures almost always heal well. Casts are not used on the head.
  • In rare cases, a leptomeningeal cyst may form. These are bulges of the bone and tissue at the site of the fracture, which develop months later. There is no way to predict their occurrence or to  prevent them.
  • If the patient notices a bump forming months after a head injury, see a doctor. X-rays of the skull may be done at that time, and if there is a leptomeningeal cyst forming, the patient will be referred to a neurosurgeon for evaluation and treatment.

In the past, concussions were commonly graded on a scale according to severity. Most commonly, concussions are referred to as symptomatic or asymptomatic (meaning that symptoms are or are not present, respectively). Neurologists may do further testing to grade a concussion’s severity.