Traumatic Brain Injury (TBI), commonly known as concussions are very common and although usually benign, they can cause serious long-term effects that should be taken seriously.
Usually, TBI occurs with injury due to direct contact to the head. It can occur with symptoms such as loss of consciousness, loss of memory before accidents, or retrograde amnesia. Other more general symptoms include headache, dizziness, lack of awareness of surroundings, nausea, vomiting, mood or cognitive disturbances, sensitivity to light or noise, and sleep disturbances. Symptoms can occur immediately after head injury or after several minutes.
Evaluation
Patients who are suspected of a concussion should be evaluated in a doctor’s office with a neurologic assessment and mental status testing. In a neurologic assessment, patients should describe the incident and events leading up to the injury to assess for amnesia, and a symptom checklist, such as the Standardized Assessment of Concussion, should be elicited. A neurologic examination should include assessing cranial nerves III through VII, limb strength, coordination, and gait. Imaging would include a CT without contrast and is recommended for patients with mild TBI in acute settings. Most patients with a diagnosed mild TBI will not require more imaging but if needed, MRI is preferred over CT in some patients due to higher sensitivity and lack of ionizing radiation.
Diagnosis
Diagnosis of concussion is made based on physical examination, results from symptom checklists, and imaging. Typically the patient has neurologic symptoms including confusion or memory. They typically do not have neurologic deficits associated with Glasgow Coma Scale score of less than 13 (which is measured about 30 mins after the injury).
Complications
In patients with acute mild TBI with seizures, they are typically self-limiting and do not recur but they are still treated with anti-seizure medications due to risk of aggravation. Due to blunt trauma, intracranial hemorrhage is a possible complication. Hypopituitarism can be a complication of a mild TBI after trauma and presents similar to postconcussion syndrome.
Prognosis
Observation is recommended for at least 24 hours after mild TBI because of risk of intracranial complications. Symptoms are usually greatest within the first 7-10 days for the majority of patients. Typical cases without exacerbations resolve within one month as symptoms are greatly improved if not completely resolved. Patients with complications such as loss of consciousness, persistent symptoms or regression should be referred to an emergency department for further evaluation. Athletes should not return to play the same day after concussion due to concern for subsequent injury and should not return to play until both asymptomatic and off of all medications.
Resources
Assessed and Endorsed by the MedReport Medical Review Board