May 8th, 2013
Concussions can occur at any time and any place. A concussion is a traumatic brain injury that is caused by a blow to the head or body, fall, or another injury that jars or shakes the brain inside the skull. In some cases, a concussion can even occur without any impact to the head itself (whiplash from a car crash, or crashing on roller skis). If an injury occurs the results in cuts or bruises on the head or face, there may be no visible signs of a brain injury. Concussions are often overseen, since many people believe there must be loss of consciousness to have a concussion.
With rest, most people recover fully from a concussion. Recover can take a few hours, days, or weeks. In some rare cases, repeated concussions or a severe concussion may require surgery of lead to long-lasting problems related to movement, learning, or speech. Due to the possibility of long term problems, it is important to be able to diagnose a concussion immediately and seek medical assistance.
Symptoms of a concussion can be mild to severe and for hours, days, or weeks depending on the severity of the injury. The categories symptoms fall into are thinking and remembering, physical, emotional and mood, and sleep. The thinking and remembering symptoms include: not thinking clearly, feeling slowed down, not being able to concentrate, and not being able to remember new information. The physical symptoms include: headache, blurred vision, nausea and vomiting, dizziness, sensitivity to light or noise, balance problems, and feeling tired or having decreased energy. Emotional and mood symptoms include: being easily upset or angered, sadness, nervousness or anxiousness, and being more emotional. The sleep symptoms include: sleeping more than usual, sleeping less than usual, and having a hard time falling asleep.
There is neurological testing and a cognitive assessment that can be performed if a concussion is suspected. The neurological portion consists of testing cranial nerves. I have mentioned these nerves and how to test them in a previous post, but here they are again. Cranial nerves are labeled 1-12: olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, and hypoglossal. Each nerve tests a different sensory, motor, or mixed function. Depending on the nerve or function that is damages, the area of injury to the brain can be more focally localized.
1 – Olfactory: tests smell – test smell with smelling salts, smelly socks, or a strong food
2 – Optic: tests vision – can you see the tree down the mountain or the tree right in front of you
3 – Oculomotor: tests reaction to light and eye movement – look at pupils while passing a light in front of the eyes and following a finger down and in (from lower corner to center of sight) with just the eyes, test both eyes
4 – Trochlear: eye movement – follow a finger up and out (from center of sight to upper corner) with just the eyes: test both eyes
5 – Trigeminal: tests jaw clench and facial sensation: clench jaw tightly and try to separate, feel for sensation on the face
6 –Abducens: tests lateral eye movement: watch pupil movement as eyes move from side to side (fast and slow)
7 – Facial: tests taste and facial movements: raise eyebrows, smile/frown, taste (eat a mint or taste the sap from a tree)
8 – Vestibulocochlear: tests hearing: can check hearing by tapping a ski against the other; snap fingers near the eyes to check for peripheral hearing
9 – Glossopharyngeal: tests swallowing and taste: make swallowing motion; eat a mint or taste the sap from a tree
10 – Vagus: testing swallowing, and uvula: making swallowing motion; say ‘ahhh’ and watch the uvula (the conic projection at the back of the throat)
11 – Accessory: tests neck range of motion and strength: shrug shoulders and apply downward pressure to shoulder shrug
12 – Hypoglossal: tests tongue movement, stick out tongue
The cognitive assessment includes red flags such as unusual communication, inappropriate behavior, irrational thinking, mental disability, or personality changes. Recall and memory can be tested for retrograde (prior to event) or anterograde (since event occurred) amnesia. Amnesia is a deficiet in memory caused by brain damage or trauma. Retrograde testing can include asking the time (what time of the day is it?), place (where are you?), person (who are you? what is your full name?), and purpose (what are you doing here?). Anterograde is usually only affected by more severe head injuries. Anterograde is checked by telling the person 3 words in the beginning of the assessment (such as apple, snow, bubble). Have the person repeat the words back after the neurological and retrograde testing. The affected person can also test analytical skills by counting down by 7’s from 100; spelling the word ‘world’ forward and backward; and saying the months of the year backwards.
Treatment of concussions is very conservative. While symptoms persist, the indivdual should avoid all brain stimulation. Stimulation includes homework, reading, watching tv, and looking at a computer. There must be no symptoms before light aerobic activity can take place. Progression daily from light to moderate to heavy activity must take place. Each day the activity level increases as long as symptoms do not return. It is better to be cautious when it comes to the brain. When in doubt, seek medical assistance