Concussion and Related Syndromes

Concussion is a direct impact by a blow or whiplash to the head, face and the neck. It can be a blow to the body that transmits to head too. In mild cases, symptoms resolve within 10 days. CT or MRI of brain are usually normal. If an injury is serious, the patients improve slowly over time. Torsional forces can delay the recovery.

Post concussion syndrome symptoms are headaches, dizziness, imbalance, memory problems and mood swings. The pathophysiology involves many disrupted pathways in the brain either causing nerves to be functionally compromised or die at severe cases.

Second impact syndrome means a second head injury between 24 hours and 10 days after the first one. It can cause massive brain swelling leading to death or severe disability. It is common in young patients and boxers.

​Traumatic brain injury (TBI) is a consequence of concussion and can occur after bicycle accidents, skateboard accidents, MVAs, falls and sport injuries. Patients with repeated TBIs are at risk of chronic traumatic encephalopathy ( CTE). There are 4 stages of CTE. First stage includes headaches, inattention and concentration problems. Second stage includes impulsive behavior, depression and short term memory loss. Third stage includes executive dysfunction with severe cognitive decline. Fourth stage includes dementia. MRI of brain shows atrophy by then.

Treatment of concussion is to stop any activity for 10 days and see a neurologist. Patients need a full exam, rest and sleep. Imaging may or may not be necessary. The patients should then start some limited exercise like walking, cycling or swimming. If they have recurrence of their symptoms they should stop immediately. There is no diagnostic blood test available yet to diagnose these patients. The patients, coaches and families should have a understanding of these syndromes before pushing athletes back to the fields.