Concussion

Diagnosis

Symptoms of a concussion might not become evident until hours or even days following the injury. The process of diagnosis entails inquiring about the details of head injury, evaluating the exhibited symptoms, reviewing the individual’s medical history, and conducting a neurological assessment. 

To validate the diagnosis, the assessments might encompass:

• Neurological examination: A neurological exam involves checking the neurological function and reflexes, vision, eye movement, hearing, strength, sensation, light sensitivity, balance and coordination, and neck muscles for their motion and for tenderness.
• Cognitive testing: Verbal, written or computerized tests may be used to check one’s thinking ability, problem–solving skills, and memory and concentration. These are often administered during neurological examination.
• Imaging tests: Brain imaging may be performed to evaluate whether the injury is severe and has resulted in bleeding or edema in the skull. This is usually not required in the early stages of a concussion since most of the symptoms of a concussion are not visible on imaging. These tests are often requested of those who have severe headaches, seizures, persistent vomiting, or symptoms that are worsening. 
  • CT scan: This is a type of X–ray that produces cross–sectional images of the skull and brain. In children, CT scans are only utilized if certain criteria are met, such as the type of damage or evidence of a skull fracture to minimize radiation exposure in young children. In adults, the standard procedure for evaluating the brain immediately after an injury is a cranial CT scan. 
  • Magnetic resonance imaging (MRI): An MRI creates comprehensive images of the brain by using powerful magnets and radio waves. It may be used to detect brain alterations or to assess issues that may occur after a concussion.
• Observation: If the healthcare provider approves home monitoring after a concussion, it is essential to have someone with them, checking the patient for at least 24 hours to ensure that symptoms are not getting worse. In some cases, one might require an overnight hospital stay for observation.

Treatment

There are actions you can take to aid in the healing of your brain and accelerate the recovery process.

• Physical and mental rest: To recover from a concussion, a healthcare provider would usually advise patients to rest both physically and mentally. For the first two days after a concussion, it is advisable to limit activities that demand thinking and mental attention. 

While it is crucial to prioritize extra rest and sleep during the recovery, it is not advisable to aim for complete inactivity. Research suggests that excessive mental rest can potentially extend the recovery timeline and heighten sensitivity to activities when one eventually resumes them. Instead of completely discontinuing activities, learn to identify the triggers that cause concussion symptoms. 

Begin gently and in modest increments. When symptoms appear, take a step back and rest. During the initial 48 hours, it is advisable to minimize engagement in mentally demanding activities like video games, TV watching, schoolwork, reading, texting, or computer usage if they exacerbate the symptoms. It is also advised to steer clear of physical activities that worsen any of the symptoms, including general physical exertion, sports, or strenuous movements. 

Research has shown that engaging in light exercise and physical activity, if well–tolerated, a few days post–injury can potentially accelerate one’s recovery. It is advisable to gradually ease back into the daily routine, including activities like screen time. However, it is vital to steer clear of activities that pose a high risk of another head impact until fully healed.

The healthcare provider may offer alternative therapy, such as vision rehabilitation, balance rehabilitation, or cognitive rehabilitation for thinking and memory issues. As part of the recovery process, one may be required to temporarily shorten their school hours or workdays, take breaks during the day, or modify or minimize their school responsibilities or job tasks.

• Returning to routine activity: The healthcare provider will determine when it is appropriate to reintroduce light physical activity. Usually, as the symptoms subside, patients can progressively reintroduce more of their usual activities into their daily life. Once all signs and symptoms of a concussion have subsided, returning to sports may be discussed. However, this is critical since returning to sports too soon raises the chance of another brain injury. (1)

Typically, within a few days following the injury even if the symptoms have not entirely subsided, engaging in light physical activities like using a stationary bike or light running may be advised. People with concussion can also gradually incorporate more thinking–intensive tasks, such as accomplishing more schooling or work projects, or increasing their time spent at school or work. 

• Pain relief: Aspirin and nonsteroidal anti–inflammatory medicines (NSAIDS) like naproxen and ibuprofen should be avoided immediately after a suspected concussion, as these medications mask symptoms and thins the blood, which may increase the risk of bleeding. If a concussion is detected, acetaminophen is a safer option for pain relief. Headaches are common in the days and weeks following a concussion.