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Concussion

A concussion, also known as minor or mild traumatic brain injury (mTBI), results from head trauma causing blunt injury to the brain.

Clinical Presentation

• Headache or pressure in the head (worsening over time)
• Temporary loss of consciousness
• Confusion or feeling “in a fog”
• Amnesia surrounding the traumatic event
• Dizziness or recurring sensations of “seeing stars”
• Ringing in the ears (tinnitus)
• Repeated nausea and vomiting
• Slurred speech
• Delayed response to questions
• Fatigue
• Difficulty with concentration and memory
• Irritability and crankiness
• Loss of balance and unsteady gait
• Excessive crying
• Changes in eating or sleeping patterns
• Seizure
• Vision or eye issues (blurred or double vision, light sensitivity)
• Large head bumps or bruises on areas other than the forehead

Labs, Studies, and Physical Exam Findings

• Rule out intracranial hemorrhage (more severe brain bleeding).
• Neurologic Examination
• Pupils (unequal pupils can be concerning)
• Hearing
• Strength and sensation
• Balance
• Coordination
• Reflexes
• Glasgow Coma Scale
• Eye Opening (1-4, higher is better)
• Verbal Response (1-5, higher is bette)
• Motor Response (1-6, higher is better).
• Normal = 13-15 & severe impairment is 8 or below.
• Imaging Tests (if hemorrhage is suspected):
• CT Scan or MRI Scan

Treatment

• Prevention
• Ibuprofen or acetaminophen can help manage pain.
• Sleep and Rest
• Continuous monitoring for 24 to 72 hours is essential.

Post-concussion Syndrome (PCS)

Post-concussion syndrome (PCS) is th set o symptoms that can persist for an extended period after a concussion.

Clinical Presentation

• Headache: This is the most common symptom.
• Dizziness and Vertigo
• Nausea
• Vision Problems: Double or blurred vision.
• Auditory Symptoms: Hearing loss and tinnitus.
• Olfactory and Gustatory Changes: Reduced sense of smell and taste.
• Light and Noise Sensitivity
• Emotional Changes:
• Easily irritable.
• Increased anxiety.
• Depression.
• Sleep Disturbance
• Changes in Behavior and Interests:
• Reduced sex drive.
• Personality changes, including socially or sexually inappropriate behavior.
• Lack of energy and interest in usual activities.
• Sudden emotional outbursts.
• Cognitive Symptoms:
• Difficulty remembering things.
• Problems with concentration and attention.
• Slowed reaction times.
• Challenges processing information and problem-solving.
• Difficulty learning new things.

Labs, Studies, and Physical Exam Findings

• Physical Examination:
• Assessment of muscle strength.
• Evaluation of coordination and sensation.
• Mental processes assessments:
  • Stroop Color Test
    • Assesses the ability to name the color of words while ignoring their meaning. For example the word “red” is up on the screen in green font. The correct response is green.
  • 2 & 7 Processing Speed Test
    • The patient is given a random list of numbers and asked to mark the number 2s and ignore the 7s and other numbers.
  • Rivermead Post Concussion Symptoms Questionnaire
  • Hopkins Verbal Learning A Test
    • Asks the patient to learn and remember a list of words over multiple trials, measuring verbal memory and cognitive function.
• Imaging Tests:
• CT Scan.
• MRI Scan.

Treatment

Effective management of PCS may involve:

• Medication:
• Pain Relief
  • NSAIDS
  • Tylenol
• Anti Nausea
  • Reglan (metoclopramide)
  • Zofran (ondansetron)
• Antidepressents
  • SSRI: sertraline (Zoloft)
  • Tricyclic antidepressants: amitriptyline which may also help with headaches and chronic pain
• Psychotherapy:
• Cognitive-behavioral therapy (CBT) can help address emotional and cognitive symptoms.
• Educating the patient on coping strategies for impairments is crucial.
• Neurotherapy:
• Neurotherapy, an operant conditioning technique, involves providing conditional audio/visual rewards based on specific brainwave activities.

Traumatic Brain Injury (TBI)

A physical injury to the head, which disrupts normal brain function.

Clinical Presentation

• Headache
• Loss of Consciousness
• Memory Problems
• Confusion
• Dizziness
• Nausea and Vomiting

Labs, Studies, and Physical Exam Findings

• CT Scan or MRI: Imaging studies used to assess the severity of brain injury and identify any structural abnormalities.
• Glasgow Coma Scale (GCS)
• see Concusion
• Neurological Examination

Treatment

• Prevention
• The management of TBI depends on the severity of the injury.
• Mild TBI (Concussion): Rest and symptom management are typically recommended.
• Moderate to Severe TBI: Hospitalization, monitoring, and sometimes surgical intervention may be necessary.
• Rehabilitation: Physical therapy, speech therapy, and cognitive therapy may be required to aid recovery.
• Medications: Pain management and anti-seizure medications might be prescribed based on the individual’s needs. See Concussion

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