concussion

Synonyms

Commotio cerebri, traumatic brain dream (TBI)

definition

The term "concussion" means a easy traumatic brain injurywhich is caused by external forces acting on the head. The concussion causes in most of the cases no permanent damage to the brain and is considered completely reversible.

introduction

Concussion (technical term: Commotio cerebri) is one of the most common injuries in the head area. In most cases, a concussion occurs in connection with an accident. In most of the affected patients, a concussion manifests itself as a temporary loss of consciousness and memory loss (amnesia). In addition, a concussion can lead to severe headaches, drowsiness, nausea, and vomiting.
Although a concussion is a serious illness, the typical symptoms in most cases subside within a few days without complications. The cause of the traumatic brain injury is usually an external force that hits the head. The concussion can be caused, for example, by jerking movements (for example, when falling). The actual trauma in the area of ​​the brain arises from the fact that the brain floating in the cerebral fluid (liquor) is forcibly pressed against the cranial bone.
If a patient is suspected of having a concussion, a doctor should be consulted as soon as possible. In these cases, serious injuries to the bony skull and brain matter must be ruled out. However, in most cases, a simple concussion with no further injury will not cause permanent damage. Affected patients should definitely take it easy and stop any excessive physical activity within the first few days.

Symptoms

In most of the affected patients, the presence of a concussion shows up through typical symptoms. One of the classic signs of a concussion is a brief loss of consciousness that occurs after the causal trauma. In most cases this loss of consciousness lasts only a few seconds. However, in some of those affected, unconsciousness persists for a few minutes.
Immediately after the causal trauma, the patient suffering from a concussion can often no longer remember exactly what happened. These memory gaps (amnesia) can include a period before (retrograde amnesia) as well as a period after the accident (anterograde amnesia). In addition, some of the people who suffer from a concussion appear drowsy and absent immediately after the causal event.
The occurrence of balance disorders and the associated dizziness are typical symptoms of a concussion. Furthermore, a slowing of the pulse (bradycardia) and low blood pressure can be observed in the affected patients. Severe headaches with nausea and vomiting are also typical symptoms of a concussion.

Symptoms at a glance:

• a headache

• unconsciousness

• nausea

• Vomit

• Tiredness / exhaustion

• Bradycardia

• Hypotension

• Balance disorders / dizziness

• Gaps in memory (amnesia)

The symptoms of the concussion need not appear immediately after the accident. In many cases, the symptoms are delayed. Depending on the extent of the concussion, the classic symptoms can only appear up to twelve hours after the accident.

Please also read our article on this Memory loss.

Memory loss with a concussion

Memory disorders usually occur in the course of a concussion. These are known as amnesia. The person concerned cannot remember the moment of the head trauma and a certain time afterwards. This is called anterograde or post-traumatic amnesia. Often the injured person cannot remember events shortly before the accident. This is referred to in technical jargon as retrograde amnesia. The extent of this memory disorder over time does not correlate with the severity of the concussion or with the duration of the loss of consciousness. As a rule, the events prior to the accident are not completely erased. But they are often no longer available. This call disruption can also persist permanently.

Concussion and nausea

Nausea often occurs because the concussion releases various messenger substances. The nausea can occur immediately after the head trauma or 6-12 hours after the event. In severe cases, medication against nausea, so-called antiemetics, can be taken temporarily to relieve the nausea. For example, domperidone drops or dimenhydride can have a soothing effect.

Read about it:

• Treatment of nausea
• Home remedies for nausea

Concussion and vomiting

A concussion can lead to overexcitability of the equilibrium organ. The vomiting center can be activated by the excitability of the equilibrium system. This leads to vomiting through various mechanisms. In addition, vegetative complaints such as sweating, increased salivation, vasoconstriction and palpitations can occur. Drug treatment is usually the same as for the symptom of nausea. Vomiting can also be triggered immediately after the head trauma or many hours later.

Read about it: Home remedies for vomiting

Pupils in a concussion

If the pupils are dilated to varying degrees, this can be a sign that there is damage to the brain. If the carotid artery has been damaged, the so-called Horner syndrome can occur. Here one pupil is narrowed. A diagnosis can be made with a measurement of the pupil size, the cocaine and the pholedrine test.

Symptoms in the child / toddler

The symptoms of a concussion in toddlers and children can vary. Short-term loss of consciousness, drowsiness, severe headache, dizziness, neck pain, nausea and vomiting are often clear signs. The nausea and vomiting can also occur many hours after the event with a time delay.

Usually there are slight gaps in memory shortly after the head trauma. A concussion causes unconsciousness from a few minutes to an hour. If the child is not yet able to speak, they can hold their heads harder or fend off any contact with them. Small children can also express neck pain by changing or seemingly painful head movements. Furthermore, it can come to light sensitivity, which toddlers sometimes make clear by squinting or holding eyes. In addition, restlessness, aggression, irritability and being tearful can express pain in young children.

If a change in character occurs in the child and a concussion is suspected, this should definitely be clarified by a doctor. In addition, pupils with different diameters can be a sign of damage to the brain. Only a doctor can assess the severity. If a child or toddler has fallen on their head or injured their head, a medical evaluation is required.

Read about it: Vomiting in the child or vomiting in the toddler

Concussion and fracture of the base of the skull

A fall or head injury can result in a fracture of the base of the skull. It is important to differentiate a skull base fracture from a concussion. A fracture of the base of the skull can manifest itself as the fact that blood runs out of the nose or ear without injuring these parts of the body directly. The bump on the head is also usually soft and can be an indication of a fractured skull base. In addition, bruises in the area around the eyes can be an indication of a skull base fracture. A medical examination and treatment are urgently needed.

Read about it:

• Symptoms of a fractured skull base
• Therapy of a skull base fracture

causes

The development of a concussion is always related to external forces acting on the head. In most cases, these are blunt forces that arise, for example, from a fall, a blow or an impact trauma. The brain swims within the bony skull in the cerebral fluid (technical term: liquor). This cerebrospinal fluid can intercept many movements of the head so that the brain mass Not comes into direct contact with the bony skull.
However, if a movement stops abruptly, the brain often hits the skull bone. For this reason, a concussion occurs especially in sports like boxing. In addition, a concussion is one of the most common injuries caused in the household and in traffic.

diagnosis

A patient suspected of having a concussion should see a doctor immediately. In the diagnosis of a concussion, the detailed doctor-patient conversation (anamnese) play a crucial role. If the patient concerned is unable to talk, witnesses or relatives can be questioned if necessary. Important points in this survey are the the accident and the complaints that have arisen since then.
In addition, the consciousness, motor skills and general condition of the patient must be checked in an exploratory examination. By definition, a concussion is a mild traumatic brain injury. For this reason, the so-called "Glasgow Coma Scale“(Synonym: Glasgow Coma Scale; GCS). This scale can be used to determine the severity of the trauma. In the course of determining the Glasgow Coma Scale, the doctor carries out various reaction tests on the person concerned. Important aspects such as the ability to open the eyes, the movement and the responsiveness of the person concerned are checked. Different scores can be determined depending on the patient's reaction.

Glasgow Coma Scale

6 points:

• Open eyes: -
• Speak: -
• Movement: follows prompts

5 points:

• Open eyes: -
• Speaking: conversational, oriented
• Movement: targeted defense against pain

4 points:

• Open eyes: spontaneously
• Speaking: conversational, disoriented
• Movement: untargeted defense against pain

3 points:

• Open eyes: on request
• Speak: coherent words
• Movement: on pain stimulus (abnormal flexion)

2 points:

• Open eyes: on painful stimulus
• Speaking: unintelligible sounds
• Movement: on pain stimulus

1 point:

• Open eyes: no reaction
• Speaking: no verbal response
• Movement: no response to pain stimulus

In the case of uncomplicated concussion, the patient should achieve a score of 13 to 15 points on the Glaskow Coma Scale (GSK). In addition, the head of the affected person should be examined for visible or palpable bone injuries. With the help of imaging procedures (x-ray or computer tomography), further damage can be excluded.
For patients who have been unconscious for a long period of time and / or who have long-lasting gaps in memory, a traumatic brain injury of a higher degree (such as a contusion or hemorrhage in the brain). If the computed tomography does not provide a clear finding despite persistent symptoms, a magnetic resonance tomography (for short: MRI of the brain) be performed.

therapy

For a patient suffering from a concussion, treatment should ideally begin at the scene of the accident. First of all, any physical activity on the part of the person concerned should be stopped immediately. If a concussion is suspected, a doctor should be consulted immediately or (if necessary) an emergency call should be made (phone: 112).

First aid
Should a person have the typical symptoms of a concussion and / or the circumstances of the accident suggest that the brain may be impaired, there are a few important things to consider. Above all else, the first aider should always try Keep calm and to have a calming effect on the person concerned. If a concussion is suspected, the patient should not be left alone under any circumstances. If open wounds are visible, they can already be treated with a plaster or bandage. If the affected patient is conscious and reacts to being spoken to, he should also slightly raised upper body be stored and covered.
The first aider should keep an eye on the pulse and breathing even with a conscious patient. In addition, it must be ensured that the injured person, even if he or she seems to be feeling a little better in the meantime, must not be given any food or fluids. Is the data subject unconscious and does not respond to being spoken to, urgently need your pulse, heartbeat and breathing (Vital signs) must be checked. The patient can then be placed in the stable side position.

Medical therapy
A patient suspected of having a concussion should be monitored for at least 24 hours. During this period, the patient's vital signs and consciousness should be checked regularly. If the patient recovers within the monitoring period without any evidence of complications, he can be discharged home. Treatment of the concussion is then carried out through rigorous bed rest. In addition, medicines for pain (Analgesics) and, if necessary, anti-vomiting medication. In the case of a concussion, however, it must be noted that complications may still occur 48 to 72 hours can occur after the accident. For this reason, the affected patient should continue to be observed by relatives during this period.

Which doctor do I go to?

Depending on whether it is a mild or severe concussion, you can first go to a family doctor or pediatrician, go straight to the emergency room or contact an emergency doctor. Once a general practitioner has been contacted, they may write a referral to a radiologist and / or neurologist. A hospital referral may be necessary depending on your complaints and concerns.

Complications

A simple concussion is relatively uncommon for serious complications. Nevertheless, affected patients can be relatively normal in the first few hours after the accident and the actual finding is misinterpreted as a simple concussion. Depending on the severity of the forces acting on the skull, serious and potentially life-threatening clinical pictures can be generated. If a person is suspected of having a concussion, there are various warning signs to watch out for. If the affected person experiences persistent disturbances of consciousness, severe stabbing headaches and different pupillary reactions, a Brain swelling or Cerebral hemorrhage exist.

What can the consequential damage be?

Consequential damage after a concussion is a sensitive topic among experts. Some authors and experience reports state that permanent headaches can arise in particular. These are sometimes described as very extreme. In some cases, the consequential damage seems to severely restrict the flow and quality of everyday life. In addition, poor posture of the neck and head can lead to damage and pain in the neck and head muscles. In addition, dizziness, nausea, ringing in the ears, concentration and memory problems, sleep disorders, sensitivity to light and noise and moods are described as consequential damage.

Some authors suspect a connection between an unhealed concussion and long-term effects. For example, the development of dementia is discussed in this context. According to other authors, these consequential damages occur less often than is the general opinion with adequate treatment. The diagnosis of vasomotor headache after head trauma is controversial. These are headaches caused by a regulation disorder of the vessels in the head.

Some authors also speak of a post-commotional syndrome if the symptoms of a concussion last for weeks or months. They estimate that around 1% of patients are affected. Other authors deny that it is related to a concussion. However, many authors agree that, under certain circumstances, sequelae can occur after a concussion. With previous exposure, insufficient healing, small children and older people, the risk of consequential damage can increase. Other authors completely deny the long-term effects of uncomplicated concussion.

course

An uncomplicated concussion usually heals within less days without consequential damage. Nevertheless, the affected patients should take physical rest for at least a week. However, multiple concussions can lead to a long-term impairment of mental performance. Under certain circumstances, those affected can develop a dementia come.

Duration

Depending on the severity, a concussion can last different lengths of time. The average duration of a concussion is 10-25 days. The symptoms of a slight concussion are usually over after a few days. A mild concussion lasts an average of 3 days. Exceptions confirm the rule. A severe concussion requires inpatient monitoring. Severe concussion symptoms take longer to subside. They can last for a few weeks to months. But regardless of the symptoms, the structures of the brain need time to regenerate. This is important to note in order to enable a complete, uncomplicated healing process. Even if the symptoms have subsided, it is therefore necessary, even with a slight concussion, to refrain from exercising, watching TV, reading and romping for at least 1-2 weeks. If a concussion does not heal sufficiently, it can cause recurring or persistent symptoms.

How long will you be unable to work after that?

As a rule, you are written incapacitated for 2 weeks. During this time you should avoid physically and mentally strenuous activities. Depending on the job, work activities, stress and individual factors, the incapacity for work may be extended.

How long should I be in bed rest?

It used to be that bed rest was prescribed for weeks. This still happens in some hospitals. Usually bed rest is 1-3 days. The length of bed rest depends on the severity and individual factors.

Can I fly with a concussion?

If you have an acute concussion, you should avoid flying if possible. Even when there is no symptoms, the brain should have completely regenerated. This means that about 1-2 weeks after the concussion, a flight should be avoided as a precaution, if possible. At best, you should consult the attending physician before a flight. If the concussion is completely healed, flying is usually not a problem.

When can I drink alcohol again?

As long as medication is being taken, alcohol should be avoided completely. The interactions between the drugs and alcohol could lead to unpredictable complications. Alcohol can also worsen concussion symptoms.