Dr. M.J. Bazos, MD Patient Handout

CONCUSSION

About Your Diagnosis

A concussion is an injury to the brain caused by a blow to the head, or by striking the head on another object. It may result in loss of consciousness or confusion. It may also cause amnesia or loss of memory about the event that related to the concussion as well as a variable amount of time before or after. A history of loss of consciousness, amnesia, or confusion after a blow to the head is diagnostic of this injury. In addition, a neurologic examination, which may include a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan, reveals normal findings. The effects of a concussion usually resolve completely in a few hours or days.

Living With Your Diagnosis
The signs and symptoms of concussion include temporary unconsciousness, short-term amnesia (including events shortly before the blow to the head), dizziness, headache, confusion, mild lack of coordination, nausea and vomiting, and inability to concentrate. All of these symptoms are short-term (hours to at most a few days) and should show steady improvement after the initial symptoms.

Treatment
Treatment consists of rest and careful observation. The initial symptoms of a concussion are similar to that of a head injury with bleeding into the brain. The difference is that the symptoms related to a concussion show improvement over a short period. If symptoms are worsening or not showing improvement, there is cause to worry about swelling or bleeding inside the skull. You can safely observe most individuals with a concussion at home. Indeed, a family member or close friend may notice changes in normal behavior that a medical person who did not know the patient might miss.

The DOs
Medications such as acetaminophen may be helpful for any headache. A light diet is appropriate. Many individuals with a concussion have nausea. If you are nauseous, you should stick mostly to small amounts of food or fluids; let your appetite be your guide. Many individuals will have a headache. Vigorous activity may make it worse. You probably do not need to be at bed rest, but you should keep your activity light and get plenty of rest until you are feeling normal. Ask your doctor about when you may return to work or athletic competition. An ice pack to the area struck by the original blow may
help with pain. It is important to be watched for signs of increasing injury. Symptoms include increasing confusion, drowsiness, loss of coordination, loss of memory, or nausea and vomiting. You should not be alone. Someone should check on you every couple of hours for the first 24 hours or until you are feeling back to normal.

The DON’Ts
You should avoid any medicines or substances that cause drowsiness or changes in level of consciousness, including narcotic pain medicines, alcohol, sleeping pills, muscle relaxants, tranquilizers, or recreational drugs. The symptoms produced by all of these drugs are similar to those of increasing pressure within the brain, and may mask important symptoms of a worsening condition. You should avoid a heavy diet because this may lead to vomiting. You should avoid strenuous activity because this will usually result in a more severe headache. In addition, you should avoid operating dangerous machinery. Many individuals with a concussion will be dizzy, have a decrease in muscle coordination, have a decrease in ability to concentrate, or have a decrease in memory. These symptoms would make operation of machinery hazardous. You should be very careful to avoid another concussion in the near future. Although a concussion usually resolves completely with no long-term effects, there is evidence that repeated concussions over time (especially within 3 months) may result in permanent brain damage and even death. Therefore, it is prudent to refrain from football, boxing, or full contact martial arts for a period of 3 months after a concussion to avoid another concussion.

When to Call Your Doctor
You should call your doctor if you have any increase in symptoms or if you are not improved within about 24 hours. Symptoms to be especially aware of include an increasingly severe headache; repetitive vomiting; increasing confusion; increasing drowsiness, including an inability to be wakened from sleep; muscle weakness on one or both sides; difficulty walking; unequal pupils or abnormal eye movements (which may cause double vision); and convulsions.
All the above symptoms will be an obvious change from normal for anyone that was familiar with the injured individual. All of these symptoms may be symptoms of a closed head injury with increasing pressure from swelling and bleeding. If you experience any of them, you must contact your doctor or the Emergency Medical System promptly.

Websites:
Brain Injury Association (formerly the National Head Injury Foundation):
http://www.biausa.org