What are the danger signs of a concussion?

How to Tell If Your Brain is Injured

Unequal Pupils
Unequal pupils can be a sign of traumatic brain injury or an injury to one eye. It can be from a harmless condition called aniscoria, or it can be from an eye doctor appointment, like this is. (c) Deborah Austin

Question

What are the danger signs of a concussion?

Getting hit in the head is a lot more dangerous than you may think. Early in my paramedic days, we were taught if somebody got knocked out and recovered, then he just had a concussion. And concussions, we were told, were no big deal. Concussions were the head injury equivalent of a near-miss. Today we know that belief is wrong.

Answer

To help you decide when and if to call 911 after a blow to the head, the CDC says to look for these signs and symptoms:

  • Worsening headache that won't go away
  • Weakness
  • Numbness
  • Fumbling or stumbling (decreased coordination)
  • Nausea and vomiting
  • Slurred speech
  • Drowsiness
  • Unequal pupils (see image)
  • Seizures
  • Confusion
  • Agitation or restlessness
  • Unusual behavior
  • Knocked unconscious (always suspect at least a concussion if someone gets knocked out)

Plus for very young kids, besides all the above signs, you should also look for:

  • Won't stop crying
  • Won't eat or nurse

More severe traumatic brain injuries may look exactly like concussions at first, followed by a period of time that the patient appears to be getting better -- sometimes referred to as talk and die syndrome. It sounds ominous, but it's rare. It doesn't matter if the patient has all these signs and symptoms or just one or two. When in doubt, call 'em out.

Treatment

Right now, there is no first aid treatment for concussions. Treatment is all about recognizing the signs and symptoms of concussion in order to prevent more severe injuries.

 Football players are to stay out of the game and soldiers off the front lines as long as necessary following a concussion.

Concussions are a big deal. Indeed, having multiple concussions is linked to neurological conditions similar to Parkinson's and Lou Gerig's disease. Despite the danger, concussions are still considered the mildest form of traumatic brain injury.

The biggest problem is telling the difference between a concussion and a more severe traumatic brain injury. Figuring it out requires a CT scan and thorough medical evaluation.

After getting a concussion (typically referred to as post concussion treatment), patients should be evaluated by a physician specially trained to care for concussion injuries, usually a neurologist. The physician will guide the patient on how to treat concussion symptoms, whether with over-the-counter medications for nausea and headache or by follow-up testing, such as CT or MRI scans.

Sources:

CDC. "Concussion: What are the Signs and Symptoms of Concussion?" CDC. 8 Mar 2010.

Guskiewicz, K.M., et al. "Research based recommendations on management of sport related concussion: summary of the National Athletic Trainers' Association position statement.Br J Sports Med. 2006 Jan; 40(1): 6–10.

Theye, Fred and Karla A. Mueller. "'Heads Up': Concussions in High School Sports.Clin Med Res. 2004 Aug; 2(3): 165–171.

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