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Dr. James Tan Siah Heng , Consultant Neurosurgeon

Articles

Concussion - what you need to know

Introduction

Concussion is also known as minor head injury or mild traumatic brain injury (TBI). It occurs as a result of trauma to the head, with sufficient force to affect brain function. 

What happens when you bang your head?

The brain is a soft organ that floats in the skull, surrounded by water (cerebral spinal fluid). The interior of the skull consists of ridges and sharp corners. Any sudden, quick movement of the head can cause the brain to move and come in contact with the skull. If the impact is hard, it will cause bruising of the brain, leading to a concussion. Examples of these are when the head hits an object or when a moving object hits the head. It can happen with a fall, sports activities and car accidents.

Upon impact, the brain is temporarily stunned and its function is disrupted for several seconds - enough to result in a loss of consciousness. The forces involved affect cellular processes in the brain for days or weeks.


Signs and Symptoms

Depending on the severity of the impact and the resultant concussion, the signs and symptoms may vary.

In a concussion,

    1. There may or may not be a loss of consciousness (varying from several seconds to several minutes)
    2. There is temporary confusion (disorientated to time, location, person)
    3. Inability to recall details of the incident
    4. Inability to retain information (after being told where the patient is, he keeps asking the same question)
    5. Headache
    6. Nausea and/or vomiting
    7. Ringing sound in the ears
    8. Dizziness

Some of these symptoms above will last only a few hours and others may last up to a week or more. Patients with concussion may develop new symptoms after a few hours. Some have complained of increasing headaches, dizziness, difficult falling or staying asleep. Rarely, they report difficulties with concentration (for example, when reading).

About 2% of patients with concussion have a seizure immediately after the impact. These are known as immediate post-traumatic seizures and are the result of temporary loss of brain function. As there is no structural damage to the brain, it is very rare for this to proceed to repeated epileptic seizures and the outcome is good.

They may also develop post-traumatic amnesia where the person cannot remember events leading up the injury or after it, or both.

Some patients actually lose their sense of smell (anosmia) after a fall. The olfactory nerves (responsible for our sense of smell) are sensitive to horizontal translational forces that may tear and permanently damage these nerves fibres. Losing one's sense of smell will affect the sensation of taste as well. 


Management of Concussion

It is important that the concussed patient be examined by qualified personnel. This is especially true if there has been a period of unconsciousness. It is important not to move the unconscious patient as there may be an underlying spinal injury as well. The medical team will need to perform physical examination including examining the conscious levels, pupils and neurological examinations. It is of the upmost importance that more severe injuries (spine, chest and abdominal) be excluded.

A CT scan of the brain is very helpful in diagnosing the presence of life threatening bleeding in the brain. There are some clots (extradural hematomas) that take several hours to develop and if left undiagnosed and untreated, will result in permanent brain damage and death.


Treatment

The treatment of concussion is symptomatic. This means that the appropriate medications are given to treat the headache, nausea, vomiting or dizziness. Complete rest is recommended for a few days to a week depending on the severity of the concussion. Exertion during this time may result in increased headaches and vomiting as the brain is vulnerable to raised intracranial pressure.


Conclusions

Head injury, especially when it occurs in high impact accidents like road traffic accidents and sports injuries need to be assessed carefully to exclude any potentially dangerous extradural hematomas that can kill a patient within several hours. Fortunately, most concussions are benign and complete recovery occurs in a matter of weeks.


Date Posted : 2009-07-15 14:04:31