ImPACT Immediate Post-Concussion Assessment
What is a Concussion?
A concussion is a disturbance in the brain function that occurs following either a blow to the head or as a result of the violent shaking of the head.
Cutting-edge research suggests that concussion produces a metobolic rather than anatomical injury to the brain. In other words, following concussion there is a temporary disturbance of energy utilization in the brain that does not appear to produce permanent injury in the vast majority of cases. However, research also suggests that repeated injury, particularly during the recovery period, may result in more severe and, in some rare cases, life-threatening injury.
Because concussion is metabolic rather than structural injury, traditional neurodiagonostic techniques (e,g., CT Scan, MIR) are foten normal following concussive insult. However, it should be emphasized that these techniques are invalualble in ruling out more serious difficulties (e.g., cerebral bleed, skull fracture) that may also occur with head trauma.
Signs and symptoms that often develop early after injury:
- Headache or a sensation of pressure in the head
- Nausea with or without vomiting
- Confusion or disorientation to time, place
- Retrograde amnesia (loss of memory for events preceding injury)
- Posttraumatic amnesia (difficulty with formation of new memory)
- Feeling mentally slowed down
- Feeling mentally "foggy" or "groggy"
- Disruption of balance
- Light sensitivity (photosensitivity)
- Sensitivity to noise (phonosenstivity)
- Visual blurriness, fuzziness or difficulty tracking
- Short-term memory difficulties
- Concentration problems
- Motor clumsiness (stumbling, slowed movement)
Headache as a Symptom of Concussion
Headache is the most commonly reported symptom of injury and may be seen in over 70% of athletes who sustain a concussion. Although pre-existing headache in a given athlete may complicate the assessment of post-concussion headache, any presentation of headache following a blow to the head or body should be managed conservatively. Most frequently, a post-concussion headache is described as a sensation of pressure in the skull that may be localized to one region of the head or more generalized in nature. In some athletes (particularly athletes with a history of migraine), the headache may take the form of a vascular headache and may be on one side of the head (unilateral). This type of headache is often described as throbbing or pulsating and may frequently be accompanied by photophobia, phonophobia, dizziness and nausea. The headache may not develop immediately after injury. This highlights the importance of questioning the concussed athlete regarding the development of symptoms beyond the first few minutes after injury. Typically, post-concussion headache is worsened with physical exertion. Thus, if the athlete complains of worsening headache during exertional testing or return to play, post-concussion headache should be suspected and conservative management is indicated.
While headache following a concussion does not necessarily constitute a medical emergency, a severe or progressively worsening headache, particularly when accompanied by vomiting or rapidly declining mental status may signal a life-threatening situation such as a subdural hematoma or intracranial bleed. This should prompt immediate transport to a hospital and a CT scan of the brain. The management of headache in children under the age of 18 should be managed very conservatively.
Although headache is the most common symptom of concussion, concussion may occur without headache, and other signs or symptoms of injury should be carefully detailed and assessed. For example, athletes will commonly experience blurred or fuzzy vision, changes in peripheral vision, or other visual disturbance. Not infrequently, athletes will complain of temporary loss of color vision, seeing wavy lines, or flashes of light. These visual changes, in addition to photosensitivity and/or balance problems, are commonly associated with a blow to the back of the head (e.g. head to turf). Moreover, an athlete may report increased fatigue, "feeling a step slow," or feeling sluggish. Fatigue is especially prominent in concussed athletes in the days following injury and this symptom may be as prominent as headache in this regard. In addition to these symptoms, cognitive or mental status changes are commonly seen immediately following injury. Athletes with any degree of mental status change should be managed conservatively, and a thorough discussion of these issues is warranted.