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Concussion
(Closed Head Injury, Head Trauma)

Definition:
A concussion is a mild brain injury in which trauma to the head results in a temporary disruption of normal brain function. The injury may involve subtle pulling, tugging or shearing of brain cells without causing any obvious structural damage. After a concussion, the brain does not work right for a while. Loss of consciousness may or may not occur, but confusion or problems with awareness or memory are usually present.

Causes:
Anything that makes the brain bounce around and against the side of the skull can cause a concussion. For example:
  • A blow or jolt to the head
  • Severe jarring or shaking
  • Abruptly coming to a stop

Concussion often results from accidents that involve:

  • Motor vehicles
  • Bicycles
  • Skates, skateboards, and scooters
  • Sports and recreation
  • Falling down
  • Firearms
  • Physical violence
  • Assault and battery
  • Domestic violence
  • Child abuse

Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

  • A previous concussion or head injury
  • Sex: Male
  • Certain age groups:
    • Children age 5 years or younger
    • Teens and young adults age 15-24
    • Persons over 75 years old
  • Contact sports such as football or boxing
  • Work that involves farming, logging, or construction
  • Travelling by vehicle at a high rate of speed
  • Use of alcohol
  • Lack of sleep
  • Medications that cause drowsiness
Symptoms:
A concussion causes symptoms that may last for days, weeks, or even longer.

Symptoms include:

  • Confusion
  • Loss of memory about the accident
  • Low-grade headaches or neck pain
  • Nausea
  • Having trouble:
    • Remembering things
    • Paying attention or concentrating
    • Organizing daily tasks
    • Making decisions and solving problems
  • Slowness in thinking, acting, speaking, or reading
  • Feeling fatigued or tired
  • Change in sleeping pattern:
    • Sleeping much longer than usual
    • Trouble sleeping
  • Loss of balance
  • Feeling light-headed or dizzy
  • Increased sensitivity to:
    • Sounds
    • Lights
    • Distractions
  • Blurred vision or eyes that tire easily
  • Loss of sense of taste or smell
  • Ringing in the ears
  • Mood changes:
    • Feeling sad, anxious, or listless
    • Becoming easily irritated or angry for little or no reason
    • Lacking motivation

Symptoms that may appear in a child with a concussion include:

  • Listlessness or tiring easily
  • Irritability or crankiness
  • Changes in:
    • Eating or sleeping patterns
    • Play
    • Behavior
    • School performance
  • Lack of interest in favorite toys or activities
  • Loss of new skills such as toilet training
  • Loss of balance, unsteady walking
Diagnosis:
The doctor will ask you and others who were present at the time of injury about your symptoms and how the injury occurred. The physical exam usually includes checking for strength, sensation, balance, reflexes and memory.

Tests may include:

CT Scan – a type of x-ray that uses a computer to make pictures of structures inside the head

Magnetic Resonance Imaging (MRI) Scan – a test that uses magnetic waves to make pictures of structures inside the head

Treatment:
The goal of treatment is to allow the brain injury to heal.

Treatment may include:

Rest – providing adequate time for recovery. This means not rushing back into daily activities such work or school.

Observation by a responsible adult – someone to awaken you every few hours as advised by your doctor. The doctor will explain how to watch for complications such as bleeding in the brain.

Limiting exposure to drugs – not taking medicines without your doctor's permission. This is especially true for aspirin, blood thinners, and drugs that cause drowsiness. Avoid use of alcohol and illicit drugs.

Preventing re-injury – avoiding activities that might jolt or jar your head. Never return to a sports activity until your doctor has given you clearance. Ask when it's safe to drive a car, ride a bike, work or play at heights, or use heavy equipment.

Preventing "Second Impact Syndrome" – avoiding a second head injury in children and adolescents who have had a concussion. Even a mild second injury in children and adolescents can rapidly increase swelling, causing unconsciousness and even death. Children or adolescents who sustain a mild concussion without loss of consciousness but with confusion or other symptoms lasting more than 15 minutes should avoid activities that would lead to a second head injury for at least one week. Those who have loss of consciousness should avoid a second head injury for two to four weeks. Because these recommendations vary, parents should seek medical attention for any child with a concussion.

Prevention:
The following safety measures may help you avoid getting a concussion:
  • Don't drink and drive.
  • Avoid use of sedating drugs, especially when driving or using heavy equipment.
  • Obey speed limits and other driving laws.
  • Always use child safety seats, seatbelts, and shoulder harnesses in vehicles. Also learn how to safely use air bags.
  • Wear a helmet when:
    • Riding a bike or motorcycle
    • Playing a contact sport such as football or hockey
    • Using skates, scooters, and skateboards
    • Catching, batting, or running bases in baseball or softball
    • Riding a horse
    • Skiing or snowboarding
  • Make sure your child's playing surface is soft and free of rocks, holes, and debris.
  • Reduce falling hazards at home for children and adults.
  • Keep firearms and bullets locked safely away.
  • Wear mouth guards, face guards, pads, and other safety gear during sports.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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