Joshua Rotenberg, MD MMS
 DABPN, DABP, DABSM 
Board Certified in 
Neurology - Children/Adolescents 
Epilepsy
 Sleep Medicine for All Ages
Sleep Apnea Testing for Adults & Children
About Concussion

Brain Injury - Concussion - Diagnosis & Management

Expertise

Trained at Walter Reed and Children's National Medical Center, AMC Dr. Rotenberg manages head injury and concussion in children and young adults.

Some facts:

Concussion can have a delayed onset

Concussion's effects can last longer in children than in adults.


Concussion and Mild TBI

What is a Concussion?

A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth.

Health care professionals may describe a concussion as a “mild” brain injury because concussions are usually not life-threatening. Even so, their effects can be serious.


Concussion

What are the Signs and Symptoms of Concussion?

Most people with a concussion recover quickly and fully. But for some people, symptoms can last for days, weeks, or longer. In general, recovery may be slower among older adults, young children, and teens. Those who have had a concussion in the past are also at risk of having another one and may find that it takes longer to recover if they have another concussion.

Symptoms of concussion usually fall into four categories:

TBI symptoms thinking icon.gifThinking/
Remembering

TBI symptoms physical icon.gifPhysical

TBI symptoms emotional icon.gifEmotional/
Mood

TBI symptoms sleep icon.gifSleep

Difficulty thinking clearly

Headache

Fuzzy or blurry vision

Irritability

Sleeping more than usual

Feeling slowed down

Nausea or vomiting
(early on)

Dizziness

Sadness

Sleep less than usual

Difficulty concentrating

Sensitivity to noise or light

Balance problems

More emotional

Trouble falling asleep

Difficulty remembering new information

Feeling tired, having no energy

Nervousness or anxiety

 

Some of these symptoms may appear right away, while others may not be noticed for days or months after the injury, or until the person starts resuming their everyday life and more demands are placed upon them. Sometimes, people do not recognize or admit that they are having problems. Others may not understand why they are having problems and what their problems really are, which can make them nervous and upset.

The signs and symptoms of a concussion can be difficult to sort out. Early on, problems may be missed by the person with the concussion, family members, or doctors. People may look fine even though they are acting or feeling differently.

See Getting Better, for tips to help aid your recovery after a concussion.

Concussion in Sports

What Should I do If a Concussion Occurs?

If you suspect that an athlete has a concussion, implement your 4-step action plan:

  1. Remove the athlete from play. Look for signs and symptoms of a concussion if your athlete has experienced a bump or blow to the head or body. When in doubt, keep the athlete out of play.
  2. Ensure that the athlete is evaluated by a health care professional experienced in evaluating for concussion. Do not try to judge the severity of the injury yourself. Health care professionals have a number of methods that they can use to assess the severity of concussions. As a coach, recording the following information can help health care professionals in assessing the athlete after the injury:

    soccer player

    • Cause of the injury and force of the hit or blow to the head or body
    • Any loss of consciousness (passed out/knocked out) and if so, for how long
    • Any memory loss immediately following the injury
    • Any seizures immediately following the injury
    • Number of previous concussions (if any) 


  3. Inform the athlete’s parents or guardians about the possible concussion and give them the fact sheet on concussion. Make sure they know that the athlete should be seen by a health care professional experienced in evaluating for concussion.
  4. Keep the athlete out of play the day of the injury and until a health care professional, experienced in evaluating for concussion, says they are symptom-free and it’s OK to return to play. A repeat concussion that occurs before the brain recovers from the first—usually within a short period of time (hours, days, or weeks)—can slow recovery or increase the likelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.
When to Seek Immediate Medical Attention:


Trust your instincts. If the child or adult is not behaving normally, act sooner than later. Err on the side of caution.

Danger Signs in Adults
In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. Contact your health care professional or emergency department right away if you have any of the following danger signs after a bump, blow, or jolt to the head or body:

  • Headache that gets worse and does not go away.
  • Weakness, numbness or decreased coordination.
  • Repeated vomiting or nausea.
  • Slurred speech.

The people checking on you should take you to an emergency department right away if you:

  • Look very drowsy or cannot be awakened.
  • Have one pupil (the black part in the middle of the eye) larger than the other.
  • Have convulsions or seizures.
  • Cannot recognize people or places.
  • Are getting more and more confused, restless, or agitated.
  • Have unusual behavior.
  • Lose consciousness (a brief loss of consciousness should be taken seriously and the person should be carefully monitored).

Danger Signs in Children
Take your child to the emergency department right away if they received a bump, blow, or jolt to the head or body, and:

  • Have any of the danger signs for adults listed above.
  • Will not stop crying and cannot be consoled.
  • Will not nurse or eat.


Concussion Recommendations

According to the Vienna Concussion Conference Recommendations, athletes should complete the following step-wise process prior to return to play following concussion:

  • Removal from contest following signs and symptoms of concussion
  • No return to play in current game
  • Medical evaluation following injury
    • Rule out more serious intracranial pathology
  • Step-wise return to play
    1. No activity - rest until asymptomatic
    2. Light aerobic exercise
    3. Sport-specific training
    4. Non-contact drills
    5. Full-contact drills
    6. Game play

Concussion Treatment

The goal of concussion treatment is to allow the brain injury to heal. Treatment of concussions differs depending on the level of severity. Concussion treatment may include:

  • Rest. Provide adequate time for recovery from a concussion. Do not rush back into daily activities for work or school.
  • Preventing re-injury. Avoid 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.
  • Observation by a responsible adult. Ask 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. Do not take medicines without your doctor's permission. This is especially true with aspirin, blood thinners, and drugs that cause drowsiness. Avoid the use of alcohol or illicit drugs.
  • Consult with a physician skilled in brain disorders and concussion management

Adapted From:

  • http://www.cdc.gov/traumaticbraininjury/


      



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