concussion

If your child suffers a head injury from a fall, a bicycle mishap, or in sports, your doctor may diagnose a concussion. Parents are often confused about what that term means.

A concussion is officially defined as "a trauma-induced alteration in mental status that may not involve loss of consciousness. Confusion and amnesia are the hallmarks of concussion." (American Academy of Neurology) Concussion means injury to the brain. The brain has been subjected to unnatural amounts of force, and some temporary disruption of normal brain tissue architechture and function has occurred. That means, simply put, that the brain tissue has been sufficiently injured to show outward neurological signs. These can include confusion, disorientation, headache, dizziness, nausea and vomiting.

Any time a person suffers a concussion, since significant enough injury to the brain occurred for it to malfunction to at least some degree, there is worry that the injury may have been more significant than was originally apparent. The so-called occult injury may suddenly declare itself with serious or fatal complications related to brain swelling or bleeding within or about the brain.

When children are evaluated for head injury in a hospital Emergency Department, their parents will be routinely given a "head injury sheet," a checklist of signs and symptoms of late complications to watch for. The parents should review this sheet carefully before leaving the Emergency Department, and be sure they understand it. This sheet should be posted on the refrigerator or some prominent place at home and not thrown away. Signs of late complications such as headache, nausea, vomiting, impaired balance, or confusion may appear up to several weeks after a head injury.

Concussions and sports participation

Repeated concussion or brain injury is especially dangerous. Second-impact syndrome refers to sudden, usually fatal brain swelling caused by a second concussion before the brain has totally recovered from prior concussion injury. For this reason, great care must be taken to ensure that young athletes especially are kept out of participation until the injury from a concussion has fully resolved. Your child's physician or consulting neurologist should make this decision, not your child's coach.

Concussions are divided by the Academy standards into three grades:

Grade 1 Transient confusion, no loss of consciousness, and mental status abnormalities lasting less than 15 minutes

Grade 2 Transient confusion, no loss of consciousness, and mental status abnormalities lasting more than 15 minutes

Grade 3 loss of consciousness of any duration

There are various guidelines about return to athletic competition following concussion; neurologists have several sets of guidelines. The most conservative is probably those proposed by Dr. Cantu in "Diagnosis and Management of Concussions," in Essentials of Sports Medicine, American College of Sports Medicine, Mosby, 1997 pp 345-47.

For the first injury:

Grade 1 With minor injury, the athlete may return to play if there is a normal sideline assessment during rest and exertion after 30 minutes; it is often best to hold the athlete out until there are no symptoms for one week.

Grade 2 The athlete should be held out of play for one full week after all symptoms completely resolve.

Grade 3 The athlete should be out of play for onje month with at least a one week period that the he or she is symptom-free

For the second injury:

Grade 1 Out of play for at least two weeks; the athlete must be symptom free at rest and during exertion for a complete week before returning to play.

Grade 2 Out of play for one full month after symptoms resolve and even consider ending the season.

Grade 3 Terminate the season.

For the third injury, terminate the season. The athlete may return the following year if completely symptom free.

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