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    Concussion

    A concussion is a minor traumatic brain injury that may occur when the head hits an object, or a moving object strikes the head.

    It can affect howthe brain works for a while. A concussion can lead to a bad headache, changes in alertness, or loss of consciousness.

    A concussion can result from a fall, sports activities,or car accidents.A bigmovement of the brain (called jarring) in any direction can causea personto lose alertness (become unconscious). How longthe personstays unconscious may be a sign of the severity of the concussion.

    Concussions do notalwaysresult inloss of consciousness. Most people who have a concussion neverpass out. But they may describe seeing all white, black, or stars.A personcan alsohave a concussion and not realize it.

    Symptoms

    Symptoms of a concussion range from mild to severe. They can include:

    • Acting confused, feeling spacey, or not thinking straight
    • Being drowsy, hard to wake up, or similar changes
    • Headache
    • Loss of consciousness
    • Memory loss (amnesia) of events before the injury orright after
    • Nausea and vomiting
    • Seeing flashing lights
    • Feeling like you have "lost time"

    The following are emergency symptoms of a concussion. Seek medical care right away if there are:

    • Changes in alertness and consciousness
    • Confusion that does not go away
    • Convulsions (seizures)
    • Muscle weakness on one or both sides
    • Persistent confusion
    • Pupils of the eyes that are not equal in size
    • Remainingunconsciousness (coma)
    • Repeated vomiting
    • Unequal pupils
    • Unusual eye movements
    • Walking or balance problems
    • Unconsciousness (coma) that continues

    Head injuries thatcause a concussion oftenoccur with injury to the neck and spine. Takespecial care when moving people who have had a head injury.

    While recovering from a concussion,the personmay:

    • Be withdrawn, easily upset, or confused
    • Have a hard time with tasks that require remembering or concentrating
    • Have mild headaches
    • Be less tolerant of noise
    • Be very tired

    Exams and Tests

    The doctor will perform a physical exam. The person's nervous system will be checked. There may be changes in the person's pupil size, thinking ability, coordination, and reflexes.

    Tests that may beordered include:

    • EEG (brain wave test) may be needed if seizures continue
    • Head CT scan
    • MRI of the brain

    Treatment

    A more serioushead injury that involves bleeding or brain damage must be treated in a hospital.

    For a mild head injury no treatment may be needed. But be aware that the symptoms of a head injury can show up later.

    • Friends or family may need to keep an eye on adults for symptoms after they are released from the emergency room or doctor’s office.
    • Parents or caregivers of children need to keep an eye on a child for symptomsafter a head injury.
    • Both adults and children must follow the health care provider’s instructions about when the person can return to sports.

    After even a mild concussion:

    • Do not do activities that can cause further head injury.
    • Avoid tasks that require concentration or complicated thinking. These include reading, homework, and preparing reports.
    • Avoid bright lights and loud sounds. These can overstimulate the brain.

    Outlook (Prognosis)

    Recovering from a concussion takes time.

    • It may take days, weeks, or even months.
    • The person have trouble concentrating and maybe unable to remember things. The person may be irritable,have headaches, dizziness, blurry vision, and nausea that comes and goes.
    • Adults should get help from family or friends before making important decisions. This is because reasoning and thinking processes may be impaired.

    In a small group of patients, symptoms of the concussion do not go away. The risk of long-term changes in the brain is high if the person has more than one brain injury

    Seizures may occur after more severe head injuries.

    When to Contact a Medical Professional

    Callthe health care provider if a head injury causes changes in alertness or produces any other worrisome symptoms.

    If symptoms do not go away or are not improving after 2 or 3 weeks, talk tothe doctor.

    Call the doctor right awayif the following symptoms occur:

    • Changes in behavior or unusual behavior
    • Changes in speech (slurred, difficult to understand, does not make sense)
    • Confusion
    • Difficulty waking up or becoming more sleepy
    • Double vision or blurred vision
    • Fever
    • Fluid or blood leaking from the nose or ears
    • Headache that is getting worse, lasts a long time, or does not get better with over-the-counter pain relievers
    • Problems walking or talking
    • Seizures (jerkingof thearms or legs without control)
    • Vomiting more than three times

    Prevention

    Not all head injuries can be prevented. But the following simple steps can help keep you and your child safe:

    • Always use safety equipment during activities that could cause a head injury. These include seat belts, bicycle or motorcycle helmets, and hard hats.
    • Learn and follow bicycle safety recommendations.
    • Donot drink and drive. Donot allow yourself to be driven by someone who you know or suspect has been drinking alcohol or is otherwise impaired.

    References

    Biros MH, Heegard WG. Head injury. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA:Elsevier Mosby; 2009:chap 38.

    Hunt T, Asplund C. Concussion assessment and management. Clin Sports Med. 2009;5-17.

    Landry GL. Head and neck injuries. In: Kliegman RM, Stanton BF, St. Geme JW III, et al., eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 680.

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        Review Date: 1/1/2013

        Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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