A bump on the head isn’t what it used to be. So, when does that ‘bump’ become a concussion?
Concussions are more common than you may think. State statistics from 2010 show that concussion resulted in 1,018 visits to the emergency room. Here at the UVM Medical Center, we had 661 patients visit our physicians in primary care, family medicine and pediatrics for a concussion evaluation.
It is real and it is dangerous, but because of the nature of concussion, it is not so visible with the naked eye.
What is a concussion?
The medical definition is that ‘A concussion is a type of traumatic brain injury, caused by a bump, blow, or jolt to the head that can change the way your brain normally works.’ Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth. Injuries like this can occur during athletics, recreational activities, and accidents, such as falls. Here’s the thing loss of consciousness is not required to have a concussion; in fact, less than 10 percent of people with concussion are “knocked out.”
Young athletes appear to be particularly vulnerable to the effects of concussion. They are more likely than older athletes to experience problems after concussion and often take longer to recover. Teenagers also appear to be more prone to a second injury to the brain that occurs while the brain is still healing from an initial concussion.
Does a concussion injury show up on x-ray, on CT scan or MRI?
No, it won’t show up on an x-ray, CT scan or MRI. It does, however, affect how the brain works. It’s a problem of function and not due to structural damage of the brain that can be seen. Even what appears to be a mild jolt or blow to the head or body may cause the brain to shift or rotate suddenly within the skull. This sudden movement of the brain causes stretching and tearing of brain cells, damaging the cells and creating chemical changes in the brain. These chemical changes result in physical, emotional/mood, thinking (cognition) and sleep changes.
What are common symptoms that a person with concussion may have?
Common symptoms are listed below. Your loved one may experience one symptom or several symptoms. In some people, symptoms don’t appear for several days. Once these changes occur, the brain is vulnerable to further injury and sensitive to any increased stress until it fully recovers. Studies suggest that it usually takes brain cells about three weeks to regain normal function, but it may take even longer.
Symptoms of concussion usually fall into four categories:
What should I do if I suspect I, or someone I know has a concussion?
- Stop the activity that you were doing that caused the concussion. Another blow to your head or injury could cause very serious injury.
- Seek medical attention for the concussion. If you are an athlete this may be started on the field or sidelines by an athletic trainer. This can also be done by trained medical professionals in the emergency room, by your primary care or family care physician, or your child’s pediatrician.
What are the treatment recommendations?
- Rest physically. This means don’t return to your athletic sport until cleared to do so or physical job.
- Rest cognitively. This means no video games, computer work, schoolwork, or job work. Avoid making big decisions.
- Rest until symptoms resolve and have your recovery monitored by trained professionals.
What signs or symptoms are red flags? When should I seek emergency care?
For adults: Go to the emergency department right away if you experience:
- Headache that gets worse and does not go away.
- Weakness, numbness or decreased coordination.
- Repeated vomiting or nausea.
- Slurred speech.
- Look very drowsy or cannot be awakened.
- Have one pupil (the black part in the middle of the eye) larger than the other.
- Have convulsions or seizures.
- Cannot recognize people or places.
- Are getting more and more confused, restless, or agitated.
- Have unusual behavior.
- Lose consciousness (a brief loss of consciousness should be taken seriously and the person should be carefully monitored).
For children: Take your child to the emergency department right away if he or she received a bump, blow, or jolt to the head or body, and:
- Has any of the danger signs for adults listed above.
- Will not stop crying nurse or eat, or cannot be consoled.
Seek immediate medical attention if any symptoms get worse; contact your doctor if new symptoms appear.
We all want to have fun and be active. We also want to be safe and avoid injury. We can have it both ways by being informed and educating ourselves.
For more information visit:
- UVM Medical Center Sports Safety
- Brain Injury Association of Vermont Concussion Management Toolkit
- CDC Injury Prevention and Control: Traumatic Brain Injury
This blog article was jointly written and reviewed by Raiel Barlow, MD, Physiatrist at the University of Vermont Medical Center and Assistant Professor at the Larner College of Medicine at UVM; Ray Keller, MD FACEP, Medical Director of the UVM Medical Center Emergency Department and Associate Professor of Surgery at the Larner College of Medicine at UVM; Suzanne Lawrence, PT, Rehabilitation Therapy Clinical Research Educator at Inpatient Rehabilitation Center; Trevor Squirrell, Executive Director of the Brain Injury Association of Vermont; and Barbara Winters, Program Manager/Education and Outreach Coordinator at the Brain Injury Association of Vermont; and Kim Doubleday, Administrative Assistant at the Inpatient Rehabilitation Center.
- http://www.cdc.gov/concussion/signs_symptoms.html, accessed 9/27/13
- http://www.cdc.gov/concussion/feel_better.html, accessed 9/27/13
- BIAofVT, concussion toolkit, accessed 9/27/13
- Agency for Healthcare Research and quality (AHRQ) Inpatient Database and state emergency department, Vermont association of hospitals and health systems accessed 9/27/13
- Zurich international consensus 2012: Concussion Consensus Agreement 2012: Zurich 4th international conference Zurich 2012 consensus agreement: concussion
- SCAT-3 Sport Concussion Assessment Tool 3 2013, SCAT-3