Concussion

Reviewed by Dr Dan Rutherford, GP

What is concussion?

Concussion is a disturbance of function of the nerve cells in the brain as a result of a blow to the skull. This means that parts of the brain's functions are temporarily 'on hold'.

The symptoms include temporary unconsciousness, headache and, often, a loss of memory concerning the critical incident. Vomiting and nausea are also common.

All blows to the head may be dangerous

An uncomplicated concussion is not dangerous and cannot be treated. The brain will simply need time to heal. But complications can arise in severe cases:

A blow to the head can cause a tear of a blood vessel under the skull and thereby cause a growing accumulation of blood that will gradually cause the brain to become displaced. This condition is life threatening if the blood accumulation is not drained by drilling a hole in the skull.

A very serious concussion with several days of unconsciousness is also dangerous owing to the risk of the brain swelling.

The doctor should be contacted if:

the patient has been unconscious for more than a couple of minutes.

the patient, after having regained consciousness, becomes sleepy and hard to converse with.

the patient's condition worsens after improvement.

the patient vomits.

the patient has a fit.

When will a doctor send a concussed person to hospital?

The doctor will admit the patient to hospital for observation for 24 hours if there has been unconsciousness. If the concussion is less severe and the home circumstances are adequate then observation at home may be satisfactory.

What to look for in a concussed person

In general, the patient should be watched by an adult for 12-24 hours after the incident. Once every hour the patient should be asked to repeat something simple like their name and address, even during the night.

If the patient is unable to remember simple personal details, the doctor should be contacted immediately.

What to do after a concussion

Usually the symptoms disappear gradually after a few days or a few weeks. Some points to remember:

the brain needs to rest until the injures have healed and it should be strained as little as possible. Avoid too much reading or watching TV.

hard physical activity should be avoided in the first week.

get plenty of physical rest.

Is there a risk of permanent injury?

If the concussion has been particularly severe or the patient does not rest, there is a risk that the symptoms may stay for months and, in a few instances, the injuries become permanent. There is also a small risk of developing epilepsy after a concussion. The risks are particularly high when the concussions occur repeatedly, ie in boxers. This condition can be very uncomfortable, and is also called post-traumatic cerebral disorder. Many suffer from heavy headaches, dizziness, tiredness, irritability, sensitivity to sound and a lack of ability to concentrate. They may also feel uncomfortable when consuming alcohol.

If you recognise these symptoms you must consult a doctor.

Generally, the younger the patient, the better the chances of a complete recovery.

'Post concussion' syndrome more commonly follows a mild head injury and includes: headaches, dizziness, difficulty in breathing, depression and anxiety.

This syndrome can develop even if brain damage is minimal or absent on investigation.

All head injury patients require adequate medical assessment and for any other than minor injuries, this should be by a consultant in trauma medicine or a neurologist.

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