What are the core characteristics of concussion?
What are the core characteristics of concussion?
Typical signs of concussion (with or without loss of consciousness) are short-term memory lapse, confusion and balance disorders. However, this classic triad is often not observed, which makes diagnosis more difficult.
What are the other symptoms of concussion?
What are the other symptoms of concussion?
The symptoms are heterogeneous and not always typical to concussion. In addition to the core characteristics (short-term memory lapse, confusion and balance disorders), concussion can also manifest through non-specific symptoms such as headache, dizziness/vertigo, nausea, light-headedness, visual disorders, sensitivity to light or noise, or memory disorders. However, all of these symptoms can have other causes. Orientation disorders or seizures indicate damage to the nervous system.
When should I contact a physician?
When should I contact a physician?
A specialist medical assessment is required for all types of symptoms after a collision or impact involving the head, even if there are no objectifiable external injuries (such as swelling, bleeding from the mouth, nose or ear, lacerations or cuts).
When should I go to the closest hospital?
When should I go to the closest hospital?
A specialist medical assessment should be carried out on the same day if no physician with experience in the management of concussion is present at the site of the accident (stadium/sports field). Emergency transport to the closest hospital is essential in the presence of the following warning signs (red flags): loss of consciousness, Glasgow Coma Scale < 15, memory lapse, disorientation, abnormal behaviour, coordination disorders, weakness in the arms or legs, headache increasing in intensity or other neurological symptoms that are increasing in intensity/extent, multiple vomiting, seizure, or known risk factors such as e.g. increased susceptibility to bleeding or indications of a cranial fracture or possible injury to the cervical spine.
What is the best therapy?
What is the best therapy?
There is no single therapy (one therapy fits all) that is equally effective for all types of concussion. Treatment is based on the current clinical neurological findings and its course, which is documented by repeated (and, especially during the early phase, close) examination. The correct diagnosis is essential for the initiation of optimum therapeutic measures.
When can I take part in competition again?
When can I take part in competition again?
The decision on a return to routine training and competition must be taken by a physician with experience in the management of concussion. The return to competitive sports must take place step-wise/gradually, in accordance with the current international Guidelines. The gradual, step-wise Return-to-Sport programme produced by the Concussion in Sports Group is currently generally applicable and is composed of 6 steps (from initial rest, through light aerobic and anaerobic exercises, to training for a specific sport without and with the risk of contact or collision, to resuming routine training and competition). Once the athlete has completed the current level without suffering any symptoms, he/she can progress to the next level after 24 hours. Ideally, the athlete requires a minimum of 6 days to full rehabilitation as soon as he/she is no longer suffering from symptoms at rest. The athlete must rest for 24 hours if any symptoms typical for concussion occur during or after exercise and then continue training at the next asymptomatic level down. The general recommendation is: “When in doubt keep her/him out.”
What is the prognosis after concussion?
What is the prognosis after concussion?
The prognosis is good for concussion. In 85-90% of cases, the symptoms have fully abated after 7 to 10 days. Longer recovery times are described for specific risk constellations. Recovery may also take longer in children and adolescents. It is important to identify athletes at high risk of longer recovery times at an early stage so that optimum therapeutic measures can be initiated.
What happens in concussion?
What happens in concussion?
Concussion is characterized by diffuse, usually reversible damage to the brain caused by an external force exerted against the head that can lead to the rapid emergence of neurological and neurocognitive changes with and without loss of consciousness immediately after the event. The exact mechanism is as yet unknown. We assume that a temporary neural network disorder occurs. The improvement in the neurological and neurocognitive symptoms typically follows a sequential pattern. However, it is important to note that recovery may be prolonged in some cases.
How is concussion diagnosed?
How is concussion diagnosed?
The clinical diagnosis of concussion is reached based on the results of the anamnesis, the neurological and neuropsychological examination and examinations of the balance system and the cervical spine. There is currently no device or biomarker that can be used to diagnose concussion. A concussion can be distinguished from severe forms of traumatic brain injury through the lack of objectifiable abnormalities in conventional imaging (brain MRIO or CT).
Why is the correct diagnosis so crucial to the management of sports-related head injuries?
Why is the correct diagnosis so crucial to the management of sports-related head injuries?
The symptoms of concussion are heterogeneous, not always typical for concussion and can therefore also be caused by other injuries/functional disorders, e.g., by a functional disorder in the region of the cervical spine or in the balance organ in the inner ear. Different therapies and recovery times are recommended depending on the cause. For example, while an initial rest phase is recommended after concussion by the return to sports guidelines, in the event that the balance organ is involved, prompt resumption of training with specific exercises for the balance organ must be initiated to trigger central compensation mechanisms.
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Schulthess Klinik
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