By far the most common head injury, concussion results from a blow to the head — a blow hard enough to jostle the brain and make it hit against the skull, causing temporary neural dysfunction, but not hard enough to cause a cerebral contusion. Most concussion victims recover completely within 24 to 48 hours. Repeated concussions, however, exact a cumulative toll on the brain.
The blow that causes a concussion is usually sudden and forceful — a fall to the ground, a punch to the head, a motor vehicle accident. Also, such a blow sometimes results from child abuse. Whatever the cause, the resulting injury is mild compared with the damage done by cerebral contusions or lacerations.
Concussion may produce a short-term loss of consciousness, vomiting, and both anterograde and retrograde amnesia, in which the patient not only can’t recall what happened immediately after the injury but also has difficulty recalling events that led up to the traumatic incident. The presence of anterograde amnesia and the duration of retrograde amnesia reliably correlate with the severity of the injury.
Such an injury can cause an adult to be irritable or lethargic, to behave out of character, and to complain of dizziness, nausea, or severe headache. Some children have no apparent ill effects, but many grow lethargic and somnolent in a few hours.
Clinical tip Although all of the above signs and symptoms occur normally with a concussion, they may also result from more serious head injuries. Medical evaluation is necessary to rule out serious injury to the brain.
Postconcussion syndrome — characterized by headache, dizziness, vertigo, anxiety, and fatigue — may persist for several weeks after the injury.
Differentiating between concussion and more serious head injuries requires a thorough history of the trauma and a neurologic examination. Such an examination must evaluate the patient’s level of consciousness (LOC), mental status, cranial nerve and motor function, deep tendon reflexes, and orientation to time, place, and person.
If no abnormalities are found and if severe head injury appears unlikely, the patient should be observed for signs of more severe cerebral trauma. Observation provides a baseline for gauging any deterioration in the patient’s condition.
Computed tomography (CT) scans can help rule out fractures and more serious injuries; obtain them whenever you suspect severe head injuries. Skull X-rays remain controversial and are, in any case, being supplanted by CT scans.
❑ Obtain a thorough history of the trauma from the patient (if he isn’t suffering from amnesia), his family, eyewitnesses, or prehospital personnel. Ask whether the patient lost consciousness.
❑ Monitor vital signs, and check for additional injuries. Palpate the skull for tenderness or hematomas.
❑ If the patient has an altered LOC or if a neurologic examination reveals abnormalities, the injury may be more severe than a concussion; in such a case, the patient should undergo a CT scan and a neurosurgeon should be consulted immediately.
❑ If a neurologic examination reveals no abnormalities, observe the patient in the emergency department. Check his vital signs, LOC, and pupil size every 15 minutes. The patient whose condition is stable after 4 or more hours of observation can be discharged (with a head injury instruction sheet) under the care of a responsible adult.
Review other book chapters online related to Concussion:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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