By far the most common head injury, a concussion results from a blow to the head — a blow hard enough to jostle the brain and make it strike the skull, causing temporary neural dysfunction, but not hard enough to cause a cerebral contusion. Most concussion patients 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. It occurs when the head strikes a stationary object (as in a fall to the ground), or when a moving object strikes the head (as in a punch to the head). Such blows may also result from automobile accidents or child abuse. Significant jarring can lead to unconsciousness. Microscopic shearing of nerve fibers is thought to occur in the brain from sudden acceleration or deceleration from the head injury.
In 2001, death resulted in 5 of every 100,000 patients with trauma related to falls.
A concussion may produce vomiting and a short-term loss of consciousness. The patient may also suffer from 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 injury’s severity. The length of the unconsciousness may also relate to the concussion’s severity.
This type of injury commonly causes adults 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. Postconcussion syndrome — characterized by headache, dizziness, vertigo, anxiety, and fatigue — may persist for several weeks after the injury.
Differentiating between a concussion and more serious head injuries requires a thorough history of the injury 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 a 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. Whenever you suspect a severe head injury, obtain a computed tomography scan or magnetic resonance imaging to rule out fractures and more serious injuries. A neurosurgeon should be consulted immediately.
Treatment for concussion varies according to the type of injury. Supportive care may include application of an ice pack to the site of injury, analgesics for mild headache, and sutures or steri-strips for lacerations.
If the neurologic examination revealed no abnormalities, observe the patient in the emergency department. Check vital signs, LOC, and pupil size every 15 minutes. The patient who remains stable after 4 or more hours of observation can be discharged in the care of a responsible adult.
❑ Instruct the family or caregiver to wake the patient every few hours at night for observation of his mental state and for medication administration. Tell them they should follow these precautions for at least 3 days. Review the head injury instruction sheet and ensure that the family or caregiver is aware of signs necessitating a return to the emergency department.
Review other book chapters online related to Concussion:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
What do you think about the features of this website?
Take our user survey and have your say:
Next articles: Tools & Services:
Medical Articles:
Pictures
Book Source Details
More About Concussion
More Medical Textbooks Online about Concussion
Medical Books Excerpts
More About This Book:
Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
» Next page: Concussion (Handbook of Diseases)
Rate This Website
Medical Tools & Articles:
Forums & Message Boards
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
