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Concussion

For concussion (mild traumatic brain injury) in children and adolescents, see Pediatric concussion.
For other uses, see Concussion (disambiguation).

Concussion
Other namesMild brain injury, mild traumatic brain injury (mTBI), mild head injury (MHI), minor head trauma
Acceleration (g-forces) can exert rotational forces in the brain, especially the midbrain and diencephalon.
SpecialtyEmergency medicine, neurology
SymptomsHeadache; trouble with thinking, memory, or concentration; nausea; blurry vision; sleep disturbances; mood changes[1]
ComplicationsChronic traumatic encephalopathy, Parkinson's disease, depression, post-concussion syndrome
DurationUp to 4 weeks[2]
CausesMotor vehicle collisions, falls, sports injuries, bicycle accidents[3][4]
Risk factorsPhysical violences, drinking alcohol, playing contact sports such as American football, playing martial arts such as muay thai, previous history of concussion[5]
Diagnostic methodBased on symptoms[6]
PreventionHead protection equipment, like hard hats, gridiron football, martial arts, motorcycle, or bicycle helmets [7]
TreatmentPhysical and cognitive rest for a day or two with a gradual return to activities[8][2]
MedicationParacetamol (acetaminophen), NSAIDs[2]
Frequency6 per 1,000 people a year[3]

A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning.[9] Symptoms may include loss of consciousness; memory loss; headaches; difficulty with thinking, concentration, or balance; nausea; blurred vision; dizziness; sleep disturbances, and mood changes.[1] Any of these symptoms may begin immediately, or appear days after the injury.[1] Concussion should be suspected if a person indirectly or directly hits their head and experiences any of the symptoms of concussion.[10] Symptoms of a concussion may be delayed by 1–2 days after the accident. It is not unusual for symptoms to last 2 weeks in adults and 4 weeks in children.[11][2] Fewer than 10% of sports-related concussions among children are associated with loss of consciousness.[12]

Common causes include motor vehicle collisions, falls, sports injuries, and bicycle accidents.[3][4] Risk factors include physical violence, drinking alcohol and a prior history of concussion.[13][5] The mechanism of injury involves either a direct blow to the head or forces elsewhere on the body that are transmitted to the head.[13] This is believed to result in neuron dysfunction, as there are increased glucose requirements, but not enough blood supply.[2] A thorough evaluation by a qualified medical provider working in their scope of practice (such as a physician or nurse practitioner) is required to rule out life-threatening head injuries, injuries to the cervical spine, and neurological conditions and to use information obtained from the medical evaluation to diagnose a concussion.[6][14][15] Glasgow coma scale score 13 to 15, loss of consciousness for less than 30 minutes, and memory loss for less than 24 hours may be used to rule out moderate or severe traumatic brain injuries.[6] Diagnostic imaging such as a CT scan or an MRI may be required to rule out severe head injuries.[14] Routine imaging is not required to diagnose concussion.[16]

Prevention of concussions includes the use of a helmet when bicycling or motorbiking.[3] Treatment includes physical and mental rest for 1–2 days, with a gradual step-wise return to activities, school, and work.[8][2][17] Prolonged periods of rest may slow recovery and result in greater depression and anxiety.[2] Paracetamol (acetaminophen) or NSAIDs may be recommended to help with a headache.[2] Prescribed aerobic exercise may improve recovery.[18] Physiotherapy may be useful for persisting balance problems, headache, or whiplash; cognitive behavioral therapy may be useful for mood changes.[2] Evidence to support the use of hyperbaric oxygen therapy and chiropractic therapy is lacking.[2]

Worldwide, concussions are estimated to affect more than 3.5 per 1,000 people a year.[19] Concussions are classified as mild traumatic brain injuries and are the most common type of TBIs.[3][19] Males and young adults are most commonly affected.[3][19] Outcomes are generally good.[20] Another concussion before the symptoms of a prior concussion have resolved is associated with worse outcomes.[21][22] Repeated concussions may also increase the risk in later life of chronic traumatic encephalopathy, Parkinson's disease and depression.[23]

Video explanation of concussions in children[24]
  1. ^ a b c "What are common TBI symptoms?". NICHD. Archived from the original on 18 March 2021. Retrieved 18 December 2017.
  2. ^ a b c d e f g h i j Mahooti N (January 2018). "Sports-Related Concussion: Acute Management and Chronic Postconcussive Issues". Child and Adolescent Psychiatric Clinics of North America. 27 (1): 93–108. doi:10.1016/j.chc.2017.08.005. PMID 29157505.
  3. ^ a b c d e f Cassidy JD, Carroll LJ, Peloso PM, Borg J, von Holst H, Holm L, et al. (February 2004). "Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury". Journal of Rehabilitation Medicine. 36 (43 Suppl): 28–60. doi:10.1080/16501960410023732. PMID 15083870.
  4. ^ a b Ropper AH, Gorson KC (January 2007). "Clinical practice. Concussion". The New England Journal of Medicine. 356 (2): 166–172. doi:10.1056/NEJMcp064645. PMID 17215534.
  5. ^ a b "What causes TBI?". www.nichd.nih.gov. Archived from the original on 9 March 2021. Retrieved 18 December 2017.
  6. ^ a b c "How do health care providers diagnose traumatic brain injury (TBI)?". www.nichd.nih.gov. Archived from the original on 8 March 2021. Retrieved 18 December 2017.
  7. ^ "Brain Injury Safety Tips and Prevention | Heads Up | CDC Injury Center". 6 July 2021. Archived from the original on 2021-11-01. Retrieved 2021-11-01.
  8. ^ a b "What are the treatments for TBI?". www.nichd.nih.gov. Archived from the original on 22 March 2021. Retrieved 18 December 2017.
  9. ^ "Traumatic Brain Injury (TBI): Condition Information". NICHD. Archived from the original on 18 April 2021. Retrieved 18 December 2017.
  10. ^ "Concussion recognition tool 5©". British Journal of Sports Medicine. 51 (11): 872. June 2017. doi:10.1136/bjsports-2017-097508CRT5. PMID 28446447.
  11. ^ Patricios JS, Schneider KJ, Dvorak J, Ahmed OH, Blauwet C, Cantu RC, Davis GA, Echemendia RJ, Makdissi M, McNamee M, Broglio S, Emery CA, Feddermann-Demont N, Fuller GW, Giza CC (2023). "Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport–Amsterdam, October 2022". British Journal of Sports Medicine. 57 (11): 695–711. doi:10.1136/bjsports-2023-106898. ISSN 0306-3674. PMID 37316210.
  12. ^ Halstead ME, Walter KD (September 2010). "American Academy of Pediatrics. Clinical report--sport-related concussion in children and adolescents". Pediatrics. 126 (3): 597–615. doi:10.1542/peds.2010-2005. PMID 20805152. Archived from the original on 2016-11-18. Retrieved 2012-07-18.
  13. ^ a b McCrory P, Meeuwisse W, Dvořák J, Aubry M, Bailes J, Broglio S, et al. (June 2017). "Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016". British Journal of Sports Medicine. 51 (11): 838–847. doi:10.1136/bjsports-2017-097699. hdl:2263/61384. PMID 28446457.
  14. ^ a b Marshall S, Lithopoulos A, Curran D, Fischer L, Velikonja D, Bayley M (2023). "Living Concussion Guidelines: Guideline for Concussion & Prolonged Symptoms for Adults 18 years of Age or Older". Retrieved February 2, 2024.
  15. ^ Silverberg ND, Iverson GL, Cogan A, Dams-O'Connor K, Delmonico R, Graf MJ, et al. (May 2023). "The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury" (PDF). Archives of Physical Medicine and Rehabilitation. 104 (8): 1343–1355. doi:10.1016/j.apmr.2023.03.036. PMID 37211140. S2CID 258821806.
  16. ^ "CDC Pediatric mTBI Guideline | Concussion | Traumatic Brain Injury | CDC Injury Center". www.cdc.gov. 2020-07-28. Archived from the original on 2021-04-17. Retrieved 2020-08-05.
  17. ^ Halstead ME, Walter KD, Moffatt K (December 2018). "Sport-Related Concussion in Children and Adolescents". Pediatrics. 142 (6): e20183074. doi:10.1542/peds.2018-3074. PMID 30420472.
  18. ^ Vuu S, Barr CJ, Killington M, Jill G, van den Berg ME (2022). "Physical exercise for people with mild traumatic brain injury: A systematic review of randomized controlled trials". NeuroRehabilitation. 51 (2): 185–200. doi:10.3233/NRE-220044. PMID 35527580. S2CID 248569748.
  19. ^ a b c Nguyen R, Fiest KM, McChesney J, Kwon CS, Jette N, Frolkis AD, et al. (November 2016). "The International Incidence of Traumatic Brain Injury: A Systematic Review and Meta-Analysis". The Canadian Journal of Neurological Sciences. Le Journal Canadien des Sciences Neurologiques. 43 (6): 774–785. doi:10.1017/cjn.2016.290. PMID 27670907.
  20. ^ "Traumatic Brain Injury". Merck Manuals Professional Edition. October 2013. Archived from the original on 23 March 2021. Retrieved 18 December 2017.
  21. ^ "Sports-Related Concussion". Merck Manuals Consumer Version. Archived from the original on 7 May 2021. Retrieved 18 December 2017.
  22. ^ Graham R, Rivara FP, Ford MA, Spicer CM, eds. (2014). "Consequences of Repetitive Head Impacts and Multiple Concussions". Sports-related concussions in youth : improving the science, changing the culture. National Academies Press. p. Chapter 5. ISBN 978-0-309-28800-2. Archived from the original on 15 May 2021. Retrieved 18 December 2017.
  23. ^ Kenneth Maiese (January 2008). "Concussion". The Merck Manual Home Health Handbook. Archived from the original on 2014-12-02. Retrieved 2012-07-03.
  24. ^ "Traumatic Brain Injury (TBI): Condition Information". National Institute of Child Health and Human Development. Archived from the original on 18 April 2021. Retrieved 1 June 2018.
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