Concussion
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Concussion Microchapters |
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Diagnosis |
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Treatment |
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Concussion On the Web |
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American Roentgen Ray Society Images of Concussion |
Diagnosis
Diagnosis of MTBI is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia (PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15).[1] Neuropsychological tests exist to measure cognitive function.[2] The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient's condition.[3] Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury.[4]
Health care providers examine head trauma survivors to ensure that the injury is not a more severe medical emergency such as an intracranial hemorrhage. Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting,[5] increasing disorientation or a deteriorating level of consciousness,[6] seizures, and unequal pupil size.[7] Patients with such symptoms, or who are at higher risk for a more serious brain injury, are given MRIs or CT scans to detect brain lesions and are observed by medical staff.
Health care providers make the decision about whether to give a CT scan using the Glasgow Coma Scale.[8] In addition, they may be more likely to perform a CT scan on people who would be difficult to observe after discharge or those who are intoxicated, at risk for bleeding, older than 60,[8] or younger than 16. Most concussions cannot be detected with MRI or CT scans.[9] However, changes have been reported to show up on MRI and SPECT imaging in concussed people with normal CT scans, and post-concussion syndrome may be associated with abnormalities visible on SPECT and PET scans.[10] Mild head injury may or may not produce abnormal EEG readings.[11]
Concussion may be under-diagnosed. The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead clinicians to miss the injury, and athletes may cover up their injuries in order to be allowed to remain in the competition.[12] A retrospective survey in 2005 found that more than 88% of concussions go unrecognized.[13]
Dementia pugilistica
Chronic encephalopathy is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition called dementia pugilistica, or "punch drunk" syndrome, which is associated with boxers, can result in cognitive and physical deficits such as parkinsonism, speech and memory problems, slowed mental processing, tremor, and inappropriate behavior.[14] It shares features with Alzheimer's disease.[15]
Second-impact syndrome
Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases. The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away.[16] No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain's arterioles lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow.[3] As the brain swells, intracranial pressure rapidly rises.[5] The brain can herniate, and the brain stem can fail within five minutes.[16] Except in boxing, all cases have occurred in athletes under age 20.[17] Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.[18]
Related Chapters
References
- ↑ Invalid
<ref>tag; no text was provided for refs namedBorgHolm04 - ↑ Invalid
<ref>tag; no text was provided for refs namedRees03 - ↑ 3.0 3.1 Moser RS, Iverson GL, Echemendia RJ, Lovell MR, Schatz P, Webbe FM; et al. (2007). "Neuropsychological evaluation in the diagnosis and management of sports-related concussion". Archives of Clinical Neuropsychology. 22 (8): 909–916. PMID 17988831.
- ↑ Maroon JC, Lovell MR, Norwig J, Podell K, Powell JW, Hartl R (2000). "Cerebral concussion in athletes: Evaluation and neuropsychological testing". Neurosurgery. 47 (3): 659–669, discussion 669–672. PMID 10981754.
- ↑ 5.0 5.1 Cook RS, Schweer L, Shebesta KF, Hartjes K, Falcone RA (2006). "Mild traumatic brain injury in children: Just another bump on the head?". Journal of Trauma Nursing. 13 (2): 58–65. PMID 16884134.
- ↑ Kay A, Teasdale G (2001). "Head injury in the United Kingdom". World Journal of Surgery. 25 (9): 1210–1220. doi:10.1007/s00268-001-0084-6. PMID 11571960.
- ↑ "Facts About Concussion and Brain Injury". Centers for Disease Control and Prevention. 2006. Retrieved 2008-01-13.
- ↑ 8.0 8.1 Ropper AH, Gorson KC (2007). "Clinical practice. Concussion". New England Journal of Medicine. 356 (2): 166–172. doi:10.1056/NEJMcp064645. PMID 17215534.
- ↑
Poirier MP (2003). "Concussions: Assessment, management, and recommendations for return to activity (abstract)". Clinical Pediatric Emergency Medicine. 4 (3): 179–185. doi:10.1016/S1522-8401(03)00061-2. External link in
|title=(help) - ↑ Invalid
<ref>tag; no text was provided for refs namedIverson2005 - ↑ Binder LM (1986). "Persisting symptoms after mild head injury: A review of the postconcussive syndrome". Journal of Clinical and Experimental Neuropsychology. 8 (4): 323–346. doi:10.1080/01688638608401325. PMID 3091631.
- ↑ Invalid
<ref>tag; no text was provided for refs namedBarthVarney99 - ↑ Delaney JS, Abuzeyad F, Correa JA, Foxford R (2005). "Recognition and characteristics of concussions in the emergency department population". Journal of Emergency Medicine. 29 (2): 189–197. doi:10.1016/j.jemermed.2005.01.020. PMID 16029831.
- ↑ Mendez MF (1995). "The neuropsychiatric aspects of boxing". International Journal of Psychiatry in Medicine. 25 (3): 249–262. PMID 8567192.
- ↑ Jordan BD (2000). "Chronic traumatic brain injury associated with boxing". Seminars in Neurology. 20 (2): 179–85. doi:10.1055/s-2000-9826. PMID 10946737.
- ↑ 16.0 16.1 Invalid
<ref>tag; no text was provided for refs namedBowen03 - ↑ Invalid
<ref>tag; no text was provided for refs namedTeam - ↑ McCrory P (2001). "Does second impact syndrome exist?". Clinical Journal of Sport Medicine. 11 (3): 144–149. PMID 11495318.
Template:Injuries, other than fractures, dislocations, sprains and strains
da:Hjernerystelse
de:Gehirnerschütterung
el:Εγκεφαλική διάσειση
it:Commozione cerebrale
he:זעזוע מוח
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no:Hjernerystelse
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