How do You Treat a Mild Concussion?

Concussion, from the Latin concutere ("to shake violently")1 or concussus ("action of striking together"),2 is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), minor head trauma, and concussion may be used interchangeably,34 although the last is often treated as a narrower category. 5 Although the term "concussion" is still used in sports literature as interchangeable with "MHI" or "MTBI", the general clinical medical literature now uses "MTBI" instead.

6 In this article, "concussion" and "MTBI" are used interchangeably. Frequently defined as a head injury with a temporary loss of brain function, concussion causes a variety of physical, cognitive, and emotional symptoms, which may not be recognized if subtle. Treatment involves monitoring and rest including both physical and cognitive (reduction of such activities as school work, television watching and text messaging).

7 Symptoms usually resolve within three weeks, though they may persist, or complications may occur. Those who have had one concussion seem more susceptible to another, especially if the new injury occurs before symptoms from the previous concussion have completely resolved. 9 There is also a negative progressive process in which smaller impacts cause the same symptom severity.

7 Repeated concussions may increase the risk in later life for dementia, Parkinson's disease, and/or depression. A variety of signs accompany concussion including somatic (such as headache), cognitive (such as feeling in a fog), emotional (such as emotional changeability), physical signs (such as loss of consciousness or amnesia), behavioral changes (such as irritability), cognitive impairment (such as slowed reaction times), and/or sleep disturbances. 7 A 2010 Pediatrics review article focussing on children and adolescents noted that fewer than 10% of sports-related concussions had associated loss of consciousness.

Due to varying definitions and possible underreporting, the rate at which concussion occurs annually is not accurately known but is estimated to be more than 6 per 1,000 people. 11 Common causes include sports injuries, bicycle accidents, car accidents, and falls, the latter two being the most frequent among adults. 12 In addition to a blow to the head, concussion may be caused by acceleration forces without a direct impact, and on the battlefield, MTBI is a potential consequence of nearby explosions.

It is not known whether the brain in concussion is structurally damaged or whether there is mainly a loss of function with only physiological changes. 14 Cellular damage has reportedly been found in concussed brains, but it may have been due to artifacts from the studies. 15 It is now thought that structural and neuropsychiatric factors may both be responsible for the effects of concussion.

No single definition of concussion, minor head injury,17 or mild traumatic brain injury is universally accepted. 18 In 2001, the expert Concussion in Sport Group of the first International Symposium on Concussion in Sport19 defined concussion as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces."20 It was agreed that concussion typically involves temporary impairment of neurological function that heals by itself within time, and that neuroimaging normally shows no gross structural changes to the brain as the result of the condition. However, although no structural brain damage occurs according to the classic definition,21 some researchers have included injuries in which structural damage has occurred and the National Institute for Health and Clinical Excellence definition includes physiological or physical disruption in the brain's synapses.

22 Also, by definition, concussion has historically involved a loss of consciousness. However, the definition has evolved over time to include a change in consciousness, such as amnesia,23although controversy continues about whether the definition should include only those injuries in which loss of consciousness occurs. 1 This debate resurfaces in some of the best-known concussion grading scales in which those episodes involving loss of consciousness are graded as more severe than those without.

Definitions of mild traumatic brain injury (M.T.B.I) were inconsistent until the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) provided a consistent, authoritative definition across specialties in 1992. 4 Since then, various organizations such as the American Congress of Rehabilitation Medicine25 and the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders4 have defined MTBI using some combination of loss of consciousness (LOC), post-traumatic amnesia (PTA), and the Glasgow Coma Scale (GCS). Concussion falls under the classification of mild TBI,26 but it is not clear whether concussion is implied in mild brain injury or mild head injury.

27needs update "MTBI" and "concussion" are often treated as synonyms in medical literature25 but other injuries such as intracranial hemorrhages (e.g. Intra-axial hematoma, epidural hematoma, and subdural hematoma) are not necessarily precluded in MTBI8 or mild head injury,2829 as they are in concussion. 30 MTBI associated with abnormal neuroimaging may be considered "complicated MTBI". 31 "Concussion" can be considered to imply a state in which brain function is temporarily impaired and "MTBI" to imply a pathophysiological state, but in practice few researchers and clinicians distinguish between the terms.

8 Descriptions of the condition, including the severity and the area of the brain affected, are now used more often than "concussion" in clinical neurology. At least 41 systems measure the severity, or grade, of a mild head injury,8 and there is little agreement about which is best. 33 In an effort to simplify, the 2nd International Conference on Concussion in Sport, meeting in Prague in 2004, decided that these systems should be abandoned in favor of a 'simple' or 'complex' classification.

34 However, the 2008 meeting in Zurich abandoned the simple versus complex terminology although the participants did agree to keep the concept that most (80–90%) concussions resolve in a short period (7–10 days), although the recovery time frame may be longer in children and adolescents. In the past, the decision to allow athletes to return to participation was frequently based on the grade of concussion. However current research and recommendations by professional organizations including the National Athletic Trainers' Association recommend against such use of these grading systems.

Currently, injured athletes are prohibited from returning to play before they are symptom-free during both rest and exertion and until results of the neuropsychological tests have returned to pre-injury levels.

Make sure not to let the victim walk away if you suspect a concussion, as symptoms may not be apparent immediately and stay with the victim at all times. 4Know how to assess consciousness. It is important to know whether or not the victim is conscious, as the victim needs special positioning if unconscious, paying particular attention to breathing.