What is a concussion?
A concussion is a change in mental status or a loss of consciousness after a head injury.
Quickcare or ER?
Red Flags that will send your to the ER include:
- loss of consciousness
- repeating questions
These will send you to the ER. If in doubt, stay out of activities such as contact sports until seen by a doctor.
What will your doctor ask?
Your doctor will want to know your concussion SYMPTOMS. A symptom is your description of your condition to your doctor. It is your story.
Answering the following questions will help your doctor understand.
Did you get knocked out? I mean out out. Not “just dizzy” or ” I saw stars.”
Did you vomit afterwards?
Did you have a seizure?
Is there any numbness or weakness?
What will your doctor look for?
Your doctor will look for SIGNS of concussion. A sign is an objective finding that a doctor discovers upon examination.
Many times after a concussion, a patient will repeat the same question.
Patient: “What happened?”
Doctor:” You got hit in the head”
Doctor:”You got hit in the head.”
A CT scan of the head may be needed. The question is,”does this fancy scan tell the whole picture?”
The brain is packed with cells (neurons) Many papers show that these begin to leak fluid that is not seen on a scan.
But a scan will tell if there is a bleed.
What is your doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
Concussions are a hot topic. It used to be, when players got their “bell rung,” then they would enter after a short rest on the bench. Not anymore. We are discovering that a young developing brain is more vulnerable after a second injury closely following the first. This is called second impact syndrome.
We need to make sure players do not have something serious developing like a bleed.
Sometimes knowing for sure if there was a loss of consciousness is hard to figure out. If a patient is repeating questions, then that is enough to say that this is a concussion.
Keep in mind that women, with the lower neck musculature, are at an increased risk for concussions.
What is the treatment of a concussion?
If there are no big bleeds going on in the head, then how to treat a concussion is simple.
Time and rest. Sounds easy. But if a young athlete is ready to go out and kick butt, having him sit down to simply watch a game is torture.
I routinely will do a referral to a neurologist as well. Clearance to play again is for the specialist to determine. Not the doctor in the ER or clinic.
How long will you be sick?
Head injuries such as this (see story below) were ok to play in 1-2 weeks. More recent studies state that up to 45 days is recommended without play. A repeat injury immediately after the initial injury can be devastating.
Even if the scan is negative and the exam is negative, many patients will have lingering pain such as migraines. Also they can have amnesia (forgetfulness).
Let me tell you a story
If you saw little Mikey walking from class to class at his high school, you would never guess at his hidden talent. His pants are baggy, braces on his teeth and way too much acne. He never really spoke up in class. Quietly, he blended into the overcrowdedcorridors like everyone else.
Once the school day was done, books put away, it was time for the demon to come out. The transformation is the material for werewolf tales. Except Mikey changed not with a full moon but with a football uniform.
As soon as he put on those pads and cleats, he became an animal. His dream was to knock a quaterback’s head off- literally.
If he was not savagely attacking the ball carrier, then he was on the sideline screaming at the top of his lungs.
Poor Mikey. He should have known that the punishment that he gave was going to come back to him. During the final game, when he thought he controlled each play, he let his guard down. From out of nowhere came an opposing player, best known as “Sasquash.” Mikey got crunched. WHAM!! That is all Mikey knew. He was out. The game stopped. The doctor in the stands came by. The ambulance took him to the ER.
For the next few hours, he kept asking what had happened. After a negative CT scan, the neurosurgeon still kept him over night in the hospital for observation.His wicked headache finally resolved the next day.
He quit football. He changed sports and went to ping-pong instead. He figured he will be able to hit but not be hit.
I hope this helps