Concussion (Closed Head Injury, Head Trauma)

A previous concussion or head injurySex: male Certain age groups: Children aged five years or youngerTeens and young adults aged 15-24Persons over 75 years oldContact sports, such as football or boxingWork that involves farming, logging, or constructionTraveling by vehicle at a high rate of speedUse of alcoholLack of sleepMedications that cause drowsiness SymptomsA concussion causes symptoms that may last for days, weeks, or even longer. Symptoms include: ConfusionLoss of memory about the accidentLow-grade headaches or neck painNausea Having trouble: Remembering thingsPaying attention or concentratingOrganizing daily tasksMaking decisions and solving problemsSlowness in thinking, acting, speaking, or readingFeeling fatigued or tired Change in sleeping pattern: Sleeping much longer than usualTrouble sleepingLoss of balanceFeeling light-headed or dizzy Increased sensitivity to: SoundsLightsDistractionsBlurred vision or eyes that tire easilyLoss of sense of taste or smellRinging in the ears Mood changes: Feeling sad, anxious, or listlessBecoming easily irritated or angry for little or no reasonLacking motivation Symptoms that may appear in a child with a concussion include:

Listlessness or tiring easilyIrritability or crankiness Changes in: Eating or sleeping patternsPlayBehaviorSchool performanceLack of interest in favorite toys or activitiesLoss of new skills, such as toilet trainingLoss of balance, unsteady walking DiagnosisThe doctor will ask you and others who were present at the time of injury about your symptoms and how the injury occurred. The physical exam usually includes checking for strength, sensation, balance, reflexes, and memory.Tests may include:CT scana type of x-ray that uses a computer to make pictures of structures inside the head Magnetic resonance imaging (MRI) scana test that uses magnetic waves to make pictures of structures inside the head TreatmentThe goal of treatment is to allow the brain injury to heal.Treatment may include:Restproviding adequate time for recoveryThis means not rushing back into daily activities such work or school.Observation by a responsible adultsomeone to awaken you every few hours as advised by your doctorThe doctor will explain how to watch for complications such as bleeding in the brain.Limiting exposure to drugsnot taking medicines without your doctor's permissionThis is especially true for aspirin, blood thinners, and drugs that cause drowsiness. Avoid use of alcohol and illicit drugs.Preventing re-injuryavoiding activities that might jolt or jar your headNever return to a sports activity until your doctor has given you clearance. This is generally when signs and symptoms are gone (during rest and activity) and neurologic exam is normal. Ask when it's safe to drive a car, ride a bike, work or play at heights, or use heavy equipment since re-injury can lead to more severe or long-term symptoms. It is recommended that athletes return to play using a gradual, stepwise approach.Preventing "second impact syndrome"avoiding a second head injury in children and adolescents who have had a concussionEven a mild second injury in children and adolescents can rapidly increase swelling, causing unconsciousness and even death. Opinions vary regarding when it is safe to return to contact sports or other activities that may lead to another concussion. Parents should seek medical attention for any child with a concussion and address the issue of returning to activities.Neuropsychological testingtesting performed by a doctor to determine the stage of recovery and readiness for activities, such as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) Prevention The following safety measures may help you avoid getting a concussion:

Don't drink and drive.Avoid use of sedating drugs, especially when driving or using heavy equipment.Obey speed limits and other driving laws.Always use child safety seats, seatbelts, and shoulder harnesses in vehicles. Also learn how to safely use air bags. Wear a helmet when: Riding a bike or motorcyclePlaying a contact sport such as football, soccer, or hockeyUsing skates, scooters, and skateboardsCatching, batting, or running bases in baseball or softballRiding a horseSkiing or snowboardingMake sure your child's playing surface is soft and free of rocks, holes, and debris.Reduce falling hazards at home for children and adults.Wear mouth guards, face guards, pads, and other safety gear during sports. RESOURCES: American Academy of Physical Medicine and Rehabilitationhttp://www.aapmr.org/ American Association of Neurological Surgeonshttp://www.aans.org/ Brain Injury Association of Americahttp://www.biausa.org/ Brain Injury Societyhttp://www.bisociety.org/ National Resource Center for Traumatic Brain Injuryhttp://www.neuro.pmr.vcu.edu/ CANADIAN RESOURCES: Brain Injury Association of Alberta (BIAA)http://www.biaa.ab.ca/ Ontario Brain Injury Associationhttp://www.obia.on.ca/ References: American Association of Neurological Surgeons website. Available at: http://www.aans.org.

Can you recognize a concussion? American Academy of Physical Medicine and Rehabilitation website. Available at: http://www.aapmr.org/condtreat/injuries/concuss.htm. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/. Closed head injury. EBSCO Dynamed website. Available at: http://dynaweb.ebscohost.com/Detail.aspx?docid=/dynamed/dfb0e2a4bf9426a1852565db007e3a76&sid=991b341a-33b7-4504-9358-99705ac9b055@SRCSM1. Harmon KG. Assessment and management of concussion in sports. Am Fam Physician. 1999 Sep 1. Kirkwood M., Yeats, K., Wilson, P. Pediatric sport-related concussion: a review of the clinical management of an oft-neglected population. Pediatrics. 2006. 117(4);1359-1371. Available at: http://pediatrics.aappublications.org/cgi/content/full/117/4/1359. National Center for Injury Prevention and Control website. Available at: http://www.cdc.gov/ncipc/. Sports-related concussion information for athletes. Wesleyan University Athletic Injury Care website. Available at: http://www.wesleyan.edu/athletics/injurycare/concussion.html. Last reviewed May 2008 by John C. Keel, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.