Concussion is a form of mild traumatic brain injury in which there is a temporary change in mental status with or without loss of consciousness. Long term negative consequences in NFL players and military veterans has been in the news and has heightened awareness of this common condition.
Risk factors for concussions include having had a prior concussion, female gender, older age, and collision sports. IEDs have been a common cause of traumatic brain injury including concussions in Iraq and Afghanistan.
Diagnosis is mainly made on the basis of the history and the absence of worrisome findings on physical exam. Most patients do not need an imaging study such as a CT scan or an MRI. These tests are normal in patients with only a concussion.
However, some semi-experimental tests show some promise in providing concrete evidence of a concussion. General Electric and the NFL have joined together to provide research grants to study novel brain imaging studies for use in patients with a concussion. For example, the University of Pittsburg will use its grant to improve the use of High Definition Fiber-Tracking that produces a 3-D image of disrupted nerve fibers.
One common approach to assessing a concussion is to use a computerized or pencil-and-paper test of cognition. Ideally, people at risk of concussion, such as football players, are tested at the beginning of the season for a baseline and then retested after a head injury.
Fortunately, most people recover from a concussion within days or up to 3 months. This improvement has been shown to be enhanced by mental rest until symptoms have subsided. So, for example, a student may need to avoid school for a couple of days and limit how much time they devote to difficult homework assignments until they are back to baseline.
A subset of people with a concussion develop a post-concussion syndrome. Symptoms include: headache (usually of the migraine or tension-type), dizziness, noise intolerance, decreased memory and concentration, increased sensitivity to alcohol, and/or visual complaints. Also, about half of such patients develop psychiatric complaints such as anxiety, irritability, personality changes, and/or depression. A small minority develop an acute stress disorder, PTSD, panic disorder, full-blown major depression or an anxiety disorder. These latter conditions have made some investigators to consider how much of a post concussion syndrome is physical and how much is psychological.
For those patients with persisting cognitive difficulties, neuropsychological testing may show abnormalities such as difficulty with maintaining attention, working memory, and/or the speed of thought processes. Patients with ongoing dizziness that feels like the room is spinning (vertigo) or visual problems should probably be evaluated by a specialist.
Treatment of concussion is rather non-specific and includes brain rest as noted before and symptomatic treatment. This means that you provide typical treatments for whatever symptoms the patient has. For example, migraine headaches following a concussion are treated with migraine medications and depression is treated with antidepressants. Patients can usually be reassured that they will most likely recover over the next few days or weeks.
So, as you can see concussion can cause both physical and psychiatric symptoms. Both sets of symptoms deserve evaluation and management. It should not be thought that psychiatric symptoms are purely psychological in nature; such conditions can be the result of subtle biochemical changes and/or mild structural injury to brain structures such as stretching of groups of nerve cell axons.
