What is a concussion?

A concussion is a brain injury that occurs after head trauma or impact (e.g. blunt forces, direct contact, etc.). In sports alone, over 3000 Australians will be hospitalised due to concussions [1]. Concerningly, tens of thousands of Australians suffering from concussions will not report it, let alone seek medical treatment [1]. The unpredictable nature of brain injuries can lead to both significant short and long-term consequences. Circumstances can suddenly change within a matter of days or even hours. If a concussion is suspected, medical attention must be sought immediately to prevent deterioration and seek appropriate treatment.

Concussion Symptoms

No concussions are identical. Symptoms of concussion are typically related to the severity and location of the head injury (e.g. knock, collision, bump on the head, etc.). It can be challenging for the concussed person to recognise that they’ve suffered a concussion. Signs of concussion are often first picked up by those who know the impacted individual (e.g. family, friends, teammates, etc.). They play an integral role in first identifying a concussion. Additionally, symptoms may not even appear until hours or days after the incident (known as delayed concussion symptoms). Depending on how the brain injury occurs, symptoms may scale in severity.

Mild concussion symptoms and signs [3][4]

These symptoms highlight the possibility that an individual has sustained a concussion. When assessing a potential concussed individual, these symptoms need to be identified immediately and continuously monitored. Medical attention should be sought as soon as possible if any or several of these are present.

Headache or sore head
Dizziness
Loss of balance
Sensitivity to noise and light
Fatigue
Confusion
Drowsiness
Blank and emotionless facial expressions
Not acting or behaving usually
Difficulty remembering what happened
Being more irritable or aggressive than usual

Severe concussion symptoms and signs [4][5]

If concussion symptoms become severe, the injured person needs to be taken to the hospital immediately. This may indicate potentially life-threatening brain injury that requires an urgent assessment and potential treatment. Please attend an Emergency Department or call 000 for an ambulance right away if any of these symptoms are present.

Loss of consciousness (even briefly)
Unequal pupil size
Fluctuating and/or decreasing state of consciousness
Significant neck pain
Numbness and/or tingling down the arms and legs
Increasing irritability, aggressiveness and violent tendencies
Seizures
Increasing nausea and vomiting
Slurred speech
Progressively unusual behaviour (e.g. aggression, drowsiness, etc.)

Causes

The leading cause of concussion is any impact or trauma to the head. Physical disruption to the brain can cause injury to the cells and vital structures or tissue [5]. Additionally, chemical imbalances and inflammation in the brain can proceed afterwards. Examples of traumatic incidents that can result in concussion include:

Sports accidents (e.g. falling or getting knocked on the head, tackles, collision, etc.)
Motor vehicle accidents
Whiplash injuries
Repeated head trauma
Forces from explosives (e.g. bombs, grenades, etc.)

Concussions Tests and Diagnosis

There are no specific tests that can reliably test for concussion. Imaging investigations, such as MRI and CT scans, are usually not routinely used to assist with diagnosis. In many situations, they will not pick up any changes to the brain after a concussion. Instead, these conditions are clinically diagnosed after a medical and physical screening from an experienced GP. However, after assessment, if a skull fracture or bleeding in the brain is suspected as a result of the injury, imaging investigations will be important in picking up these issues. A trained medical professional will assess a concussed individual’s circumstances and symptoms using specific criteria called the SCAT-5. Those without a medical background can use the concussion recognition tool (CRT) to determine the possibility of a concussion.

Concussion Treatment - What to do for a Concussion?

There is no single best treatment for concussion. Under most circumstances, a concussion will require a period of recovery and gradual improvement of symptoms. The management of a concussed individual will require constant monitoring from a medically trained or inclined person.

Acute Management

Once a concussion is suspected, symptoms must be monitored to prevent any further decline. Those who have been concussed will often not recognise they have been affected. Support from those nearby is essential. Although symptoms may seem mild initially, they can escalate quickly. The first point of call is to remove the patient from further harm (e.g. workplace, sporting environment, etc.). Afterwards, the individual should be assessed and monitored accordingly. A concussion can be diagnosed using the SCAT-5 or CRT,, depending on whether the assessor has had any medical training. If the individual is experiencing severe symptoms, a trained medical professional or doctor must be called immediately to assess the situation. Additional support, such as calling 000 for ambulance services, is recommended (especially if no medically trained professionals are nearby). Those with mild symptoms should also be supervised constantly and be assessed by a GP as soon as possible.

Post-Concussion Management

After a concussion has been diagnosed, the affected individual must be monitored by a GP before returning to normality. They must not drive or take medications (e.g. anti-inflammatories, sleep medication, aspirin, etc.) unless cleared by a GP. During then, the GP may recommend therapies, medication, or assessments to manage the condition. However, the primary treatment is constant supportive care. GPs will liaise with any support (e.g. coaches, supervisors, family, etc.) to gradually help the concussed person resume their normal activities (e.g. sports, work, etc.). Symptoms will be monitored to ensure that the patient can safely return. Those who have not fully recovered are at further risk of being injured or concussed, leading to long-term disabilities. While rest is encouraged for 24-48 hours after the injury, gentle aerobic activities (i.e. walking, cycling) can be started afterwards to assist with recovery. The GP will recommend gradual progressions in activity depending on the symptoms and rate of recovery.

Concussion Recovery - How long does a concussion last for?

Most concussed individuals will recover from their symptoms within 1-2 weeks [6]. However, many will not make a complete clinical recovery until one month after their injury [6]. In some circumstances, long-term complications can also occur. A GP should be involved throughout recovery until discharge.

Complications

While most concussions will recover, some people may experience further complications. Currently, the long term effects of a concussion are still being studied.

Post-Concussion Syndrome

Post-concussion syndrome describes persisting symptoms that last for weeks to months after the initial incident. This is the most common long-term complication, which leads to problems with behaviour, physical performance, cognition and sleep [7].

Second-Impact Syndrome

Another rare but avoidable complication is Second-Impact Syndrome [6]. Repeated trauma to the head before fully recovering from the first concussion can be highly problematic. Brain damage, swelling and even death are possible outcomes. GP clearance before returning to regular duties or sports can assist in preventing this syndrome.

Chronic Traumatic Encephalopathy

Chronic Traumatic Encephalopathy is another potential long-term consequence of concussion [6]. It is characterised by slow and gradual degenerative changes to the brain. Eventually, this can lead to significant complications, such as memory loss, personality change and even speech deficits.

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