Concussion, also called mild traumatic brain injury (mTBI), is defined as a temporary disruption of brain function that results in an alteration or loss of consciousness, and one or more of the memory symptoms listed in the Concussion Symptoms table below. Concussions are the most common type of brain injury and occur from a variety of causes. They can cause many short-term and long-term problems, as well as a variety of physical, cognitive, and emotional symptoms.
Lots of people wonder, what are concussions or how do I know if I sustained a concussion? Sometimes it is difficult to tell if a concussion occurred. You don’t have to lose consciousness to have a concussion. There aren’t any outward visible signs, although there may be cuts, scraps, and bruises from the incident or accident that caused the concussion. Sometimes the signs and symptoms are so subtle, they are missed and it goes undiagnosed and left untreated. Concussion symptoms range from mild to severe, and they can last for hours, days, weeks, or longer. Even a minor dysregulation of the brain can have a serious and significant impact on one’s life. Therefore, it is important to seek medical advice no matter how mild a head injury or concussion seems. Proper diagnosis and treatment is crucial to recovery and prevention of more serious injury.
The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), minor head trauma, concussion, and post concussion syndrome (PCS) may be used interchangeably, although the last is often treated as a narrower category. Although the term “concussion” is still used in sports literature as interchangeable with “MHI” or “MTBI”, the general clinical medical literature uses “MTBI” instead.
Concussions are typically caused by a blow, bump or jolt to the head. They can occur when the head forcefully hits an object, or a moving object strikes the head. The brain is a soft complex organ made of soft tissue. It is surrounded by spinal fluid and protected by the skull. Under normal circumstances, the fluid cushions the brain preventing it from hitting the skull’s hard uneven surface. This protection is compromised as the speed of impact increases. Impacts to the head or upper body can cause the brain to bang against or rotate within the skull’s bony interior walls. If the force is strong enough, it strains, stretches, shears and even tears the nerve cells and nerve fibers, impairing brain function, and resulting in concussion (mTBI) or TBI.
Concussion can also result from sudden acceleration and deceleration of the head. Imagine an aggressive push to the chest, an accident causing whiplash, and the often overlooked amusement park rides. All of these produce a sudden action of snapping the head and neck, back and forth quickly, jostling the brain.
Automobile accidents are the leading cause of concussion, followed by falls; assault and other type of physical abuse, including shaken baby syndrome; blast injury; and collision and playground injuries. They also commonly occur while engaging in sports or recreational activities such as football, soccer, bike riding, boxing, hockey, skiing, and snowboarding.
It is a misconception that concussions can be mild or minor. A concussion is the actual event which caused injury to the brain. The symptoms can range from mild to severe. When concussion symptoms do not resolve within a week or two of disrupted function, the label Post Concussion Syndrome (PCS) is then applied. They used to be categorized as simple or complex. In 2009, the term simple concussion and complex concussion were changed to acute concussion and post concussion syndrome respectively.
Acute concussion, formerly referred to as simple concussion, is a temporary disruption of brain function that results in an alteration or loss of consciousness, and one or more of the memory symptoms listed in the Concussion Symptoms table below. Acute concussions are typically characterized by having mild symptoms that spontaneously resolve within two weeks with rest and proper diet, and generally do not result in complications or health risks. With this type of concussion, symptoms are generally treated by a primary care physician (PCP), certified athletic trainer or coach working together with a PCP.
Post Concussion Syndrome (PCS), formerly referred to as complex concussion, is characterized by persistent symptoms and can affect brain function. The symptoms are often debilitating and continue for weeks, months and years. Sometimes the effects are permanent. With PCS, there is an increased risk for complications, such as swelling or bleeding in the brain, seizures and convulsions.
When a person suffers from multiple concussions, it is unlikely that natural and spontaneous healing will take place. Repeated brain injuries, including multiple concussions, can cause cumulative effects on the brain and have severe outcomes. There is an increased risk of more serious brain injury if a second one is sustained before being completely recovered from the first. Multiple concussions are divided into two categories: second impact syndrome (SIS) and Chronic traumatic encephalopathy (CTE). Second impact syndrome occurs when a second concussion is sustained before symptoms of a first have resolved. The second impact, which could take place minutes, days or weeks after the first concussion, causes the brain to swells rapidly, and catastrophically, often resulting in death or severe disability. Chronic traumatic encephalopathy is a progressive neurodegenerative brain disease of the brain found in people with a history of repetitive brain trauma. CTE has been linked to boxers, football and hockey players, and military veterans. CTE evolves slowly over decades. Symptoms often begin years after the last brain trauma or end of active athletic or military participation. Common symptoms of CTE include aggression, memory loss, confusion, impaired judgment, depression, suicidality, and progressive dementia.
Signs and symptoms of concussion are not always obvious or realized immediately. Some people do not experience ill effects, while others experience long-term physical, cognitive, and emotional symptoms. Common symptoms of concussion include feeling disoriented and confusion, memory loss, blurred vision, appearing dazed, dizziness, temporary loss of consciousness, delayed response to questions, slurred speech and “seeing stars”. While these side effects often resolve shortly after the impact, it is common to experience nausea, vomiting, headache, dizziness and fatigue several hours after the impact or injury took place. When symptoms do not naturally or spontaneously resolve within two weeks following the injury, the term Post Concussion Syndrome (PCS) is applied.
Falls are the leading causes of traumatic brain injury (TBI) in children up to 14 years old. Shaken baby syndrome is the number-one cause of mild traumatic brain injury (mTBI) in infancy, while domestic abuse is the number-one cause in childhood. Other causes include automobile accidents, and collisions with moving or stationary objects. Head trauma is very common in young children, but because you can’t see a concussion it may be difficult to determine if an infant or toddler has sustained a concussion. As described in Dr. Diane’s latest book, Coping with Concussion and Mild Traumatic Brain Injury:
“It is likely that concussions related to riding toys are under-reported, because the parent or caregiver may focus on external injuries such as scrapes or bruises. It is easy to overlook a child’s appearing dazed and shaken if her knee is bleeding. Even when an injury is serious enough to warrant a trip to the emergency room, the focus tends to be on the visible. Medical personnel may overlook that a child seems to be dazed or not thinking clearly, which is why concussion is called ‘the Silent Epidemic.”
Therefore, it is very important to recognize concussion symptoms in babies, toddlers and young children who may not be able to articulate how they are feeling. Concussion symptoms in babies and toddlers will be the same as in older children and adults (see section above), but watch for signs such as excessive crying, lethargy and tiring easily, sadness, irritable, loss of balance, change in sleeping and eating habits, lack of interest in favorite activities. Toddler concussion symptoms will be similar, but may include loss of new skills and lack of interest in playing with favorite toys.
Sometimes after a fall or blow to the head, very few symptoms are exhibited or symptoms are so subtle they are often missed or ignored. In these cases, people may think they are experiencing symptoms of a “mild concussion” or symptoms of a “minor concussion”. These terms are incorrect, as there is no such condition as mild concussion or minor concussion. A concussion, also called a minor traumatic brain injury (mTBI), is the actual event or incident. It is the severity of the symptoms caused by this event that can range from mild to severe. No matter how mild or minor the injury is perceived, it is important to seek medical advice. The proper term for what is commonly mislabeled as minor concussion, is acute concussion. Symptoms of acute concussion generally resolve within a week or two with physical and cognitive rest and proper diet.
Unlike symptoms of acute concussion, which are temporary and resolve quickly, many people suffer from another group of symptoms which appear a week or two after injury. The name for the collective group of ongoing and long term concussion symptoms is called Post Concussion Syndrome (PCS). People with PCS may notice changes in balance, attention span, decision-making abilities and judgment, and suffer from chronic pain, persistent headaches, fatigue, difficulty concentrating, sleep disturbances, dizziness, loss of taste and smell, as well as emotional and behavioral problems. These symptoms can be debilitating, and to make matters worse they can be compounded by social and psychological factors. Post-concussion symptoms are not visible, and sometimes present months after the injury, along with depression, anxiety, irritability and sense of hopelessness. Family, friends, co-workers and others may not be able to relate to what the sufferer is feeling on the inside. In addition, their doctors may not know how to treat the wide range of mTBI and PCS issues and often say there is nothing left they can do. This is described in the book, Coping with Concussion and Mild Traumatic Brain Injury:
“Worse still is the fact that by time concussion consequences begin to disrupt an individual’s life, he or she may not even connect the symptoms to the accident that caused them. It is no wonder, then, that after weeks of seeing little or no improvement in their symptoms, many people with a concussion find themselves facing another roadblock; persistent depression and underlying grief from the loss of self.”
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