Concussion Health Article

Treatment

The symptoms of concussion usually clear quickly and without lasting effect, if no further injury is sustained during the healing process. Guidelines for returning to sports activities are based on the severity of the concussion.

A grade 1 concussion can usually be treated with rest and continued observation alone. The person may return to sports activities that same day, but only after examination by a trained professional, and after all symptoms have completely resolved. If the person sustains a second concussion of any severity that same day, he or she should not be allowed to continue contact sports until he or she has been symptom-free, during both rest and activity, for one week.

A person with a grade 2 concussion must discontinue sports activity for the day, should be evaluated by a trained professional, and should be observed closely throughout the day to make sure that all symptoms have completely cleared. Worsening of symptoms, or continuation of any symptoms beyond one week, indicates the need for a CT or MRI scan. Return to contact sports should only occur after one week with no symptoms, both at rest and during activity, and following examination by a physician. Following a second grade 2 concussion, the person should remain symptom-free for two weeks before resuming contact sports.

A person with a grade 3 concussion (involving any loss of consciousness, no matter how brief) should be examined by a medical professional either on the scene or in an emergency room. More severe symptoms may warrant a CT or MRI scan, along with a thorough neurological and physical exam. The person should be hospitalized if any abnormalities are found or if confusion persists. Prolonged unconsciousness and worsening symptoms require urgent neurosurgical evaluation or transfer to a trauma center. Following discharge from professional care, the patient is closely monitored for neurological symptoms which may arise or worsen. If headaches or other symptoms worsen or last longer than one week, a CT or MRI scan should be performed. Contact sports are avoided for one week following unconsciousness of only seconds, and for two weeks for unconsciousness of a minute or more. A person receiving a second grade 3 concussion should avoid contact sports for at least a month after all symptoms have cleared, and then only with the approval of a physician. If signs of brain swelling or bleeding are seen on a CT or MRI scan, the athlete should not return to the sport for the rest of the season, or even indefinitely.

For someone who has sustained a concussion of any severity, it is critically important that he or she avoid the possibility of another blow to the head until well after all symptoms have cleared to prevent second-impact syndrome. The guidelines above are designed to minimize the risk of this syndrome.

Prognosis

Concussion usually leaves no lasting neurological problems. Nonetheless, symptoms of post-concussion syndrome may last for weeks or even months.

Studies of concussion in contact sports have shown that the risk of sustaining a second concussion is even greater than it was for the first if the person continues to engage in the sport.

Prevention

Many cases of concussion can be prevented by using appropriate protective equipment. This includes seat belts and air bags in automobiles, and helmets in all contact sports. Helmets should also be worn when bicycling, skiing, or horseback riding. Soccer players should avoid heading the ball when it is kicked at high velocity from close range. Playground equipment should be underlaid with soft material, either sand or special matting.

The value of high-contact sports such as boxing, football, or hockey should be weighed against the high risk of brain injury during a young person's participation in the sport. Steering a child's general enthusiasm for sports into activities less apt to produce head impacts may reduce the likelihood of brain injury.

BOOKS

Evans, R. Neurology and Trauma. W. B. Saunders Co., 1996.

PERIODICALS

Quality Standards Subcommittee, American Academy of Neurology. "Practice Parameter: The Management of Concussion in Sports." Neurology 48 (Mar. 1997): 581-585.

"Sports-Related Recurrent Brain Injuries—United States." Morbidity and Mortality Weekly Report, 14 Mar. 1997, 224-227.

ORGANIZATIONS

American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (612) 695-1940. <http://www.aan.com>.

Richard Robinson

KEY TERMS

Amnesia—A loss of memory that may be caused by brain injury, such as concussion.

Parkinsonism—A neurological disorder that includes a fine tremor, muscular weakness and rigidity, and an altered way of walking.