A concussion is a type of TBI (traumatic brain injury). They can be referred to as a “mild TBI” because they are not usually life-threatening. Concussions occur when a hard hit to the head or body causes the brain to move in the skull. The movement of the brain in the skull can cause injury to nerve cells within the brain. This injury is an injury to the brain cells, and thus it is a microscopic injury. This is why x-rays, CT scans, and MRI’s, are usually normal even when the child or teen has suffered a concussion. X-rays are designed to look at bone and could help show a skull fracture, which is rarely present in a typical concussion. CT’s and MRI’s are helpful to look for brain swelling and bleeding, and these are also rarely ever present in a typical concussion. Occasionally a CT or MRI would be indicated after a head injury, but thankfully, are not needed often. When the brain cells are injured, it causes a cellular change. This cellular change causes chemicals that are typically inside cells to leak out and those that are outside cells to come in. There are also changes in the energy requirements and nerve transmission in these cells. Basically, it causes the injured cells not to work as well, which in turn leads to the symptoms of a concussion worsening with activities that cause you to “use your brain” (i.e. thinking , communicating, physical activity, etc).
Below is what we tell our patients so that they can recognize a possible concussion after a head injury and remove themselves from the activity or play. As we all know, after a head injury it is normal to have a headache or soreness to the site of a head injury. Though pain at the site of the hit/injury is normal, it is NOT normal to have any of these symptoms: feeling “dazed,” “seeing stars,” feeling like his/her “bell was rung,” dizziness, nausea or vomiting, feeling slowed down and foggy, feeling disoriented, having balance difficulty or trouble walking, having light or noise sensitivity, a headache that persists or worsens with cognitive effort, or difficulty with concentration or memory. If any of these symptoms are present (even only momentarily) after a head injury (or injury to the body where the head moves back and forth rapidly), they should stop the activity or play and discuss symptoms with a parent, school nurse, coach, or athletic trainer. These symptoms (one or more) are indicative of a concussion and evaluation is needed.
Red flags should prompt a visit to the emergency room and include the following:
After a potential concussion, it is very helpful to talk to a medical professional trained in concussions. At school, this may be a school athletic trainer or nurse. It is also important to consult your pediatrician’s office. After Hours Kids (open every evening, including weekends, from 6:30-10:30 PM) is a great evening option for evaluation of a potential concussion. After the concussion diagnosis is made, we often recommend follow-up with our concussion clinic, SportsSafe. More concussion specific information can be found on their website at www.sportssafect.com
It is best to stay home from school until symptoms are improved in the morning and your child can awaken without a headache. Also, we recommend no contact activities; it is very important to avoid any activity that may cause a re-injury. A provider that specializes in pediatric concussions can offer guidance as to when it is safe to return to contact activities and can offer patient specific academic accommodations. Until evaluated, it is important to get plenty of sleep at night, but it is not necessary to stay in a dark room and avoid all contact with people and activities. Once symptoms are improved, keeping a usual routine as much as possible, is helpful to facilitate concussion recovery. Quiet, non-contact activities, that do not worsen symptoms, are recommended (art, playing with legos, doing a puzzle, reading, etc).
More concussion specific information can be found on the SportsSafe blog at: www.sportssafect.com/blog
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