Types of Concussions

Concussion also Called Traumatic Brain Injury which is caused by a light blow or jolt collision to the head or a hit to the body that can cause the head and brain to move rapidly back and forth.

What is a concussion?

Also known as mild traumatic brain injury, it refers to a neurological disease that results in a temporary loss of consciousness after a mild violent blow or impact on the head, and then wakes up, with recent amnesia and no organic damage. .

How many Types of Concussions are there?

In General there are 5 Types of Concussions. Patients with a first-degree concussion have only mild confusion and appear to be confused. The patient is fully awake within 5 to 15 minutes, and there is no coma, sequelae, or sequelae;

Mild confusion and obvious post-traumatic amnesia in patients with second-degree concussion, and will be affected by mild tinnitus, vertigo and mild headache;

The clinical symptoms of patients with grade 3 concussion and patients with grade 2 concussion are basically the same, but patients with grade 3 concussion have different degrees of permanent retrograde amnesia;

Patients with grade 4 concussion have a loss of consciousness of less than or equal to 5 minutes. Patients may have coma, drowsiness, drowsiness, confusion, and unresponsiveness. Their anterograde or retrograde amnesia are obvious;

Patients with grade 5 concussions lost consciousness equal to or greater than 5 minutes, their anterograde or retrograde amnesia was significantly prolonged, and they had obvious tinnitus, vertigo, and headache.

What are the symptoms of a concussion?

Impairment of consciousness: mild and short-lived, can be as short as a few seconds or minutes, but not more than half an hour;

Amnesia of recent events: After waking up, the situation and the injury process cannot be recalled, but the things before the injury can be clearly recalled;

Other symptoms: often headache, dizziness, nausea, anorexia, vomiting, tinnitus, insomnia, photophobia, inattention and unresponsiveness and other symptoms.

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What other medical conditions can a concussion cause?

Skull fractures, open brain injuries, cerebral edema, cerebral hemorrhage, anxiety and physical disorders, mild cognitive decline, etc.

What are the characteristics of a concussion-induced headache?

The cause of headache caused by concussion is still unclear, but most people think that it is caused by the violent movement of the brain in the cranial cavity when the injury occurs, and the stretching of the meninges and blood vessels.

After concussion patients wake up, more than half of the patients may have headache symptoms. The location and nature of the headache are various. Clinically, dull pain on the forehead and squeezing pain are the most common symptoms. It improves after rest and worsens after fatigue. Symptoms include dizziness, dizziness, tinnitus, nausea, vomiting, fatigue, blurred vision, palpitations, insomnia, irritability, fear of noise, inattention, and poor thinking.

The headache generally lasts for several days to several weeks, and then gradually disappears. In some patients, the headache symptoms disappear slowly and last for several months to several years.

What are the sequelae of a concussion?

The emergence of sequelae of concussion may be the result of the interaction between the pathological factors of brain injury and the psychological factors of patients. There is evidence that psychological factors can be an important factor in the persistence of illness in concussion patients.

Therefore, during the recovery period of concussion, patients should participate in recreational activities or physical exercise appropriately, which can not only enhance their physical fitness, but also distract attention from concussion and promote the recovery of the disease.

What are the types and characteristics of cognitive impairment after concussion?

Short-term cognitive impairment: Impairment of consciousness and retrograde amnesia are one of the neurobehavioral hallmarks of acute concussion. Patients with retrograde amnesia have sleep-wake cycle disturbances, decreased daily arousal, anxiety and emotional instability, and perception of surroundings power drop.

Recovery from short-term cognitive impairment: In young exercise-related adults without comorbidities, cognitive function recovers gradually over a few days, but in motor vehicle concussion patients the recovery period is longer The recovery of cognitive function was significantly prolonged after the injury or age >50 years.

In general, 80% to 85% of cognitive decline in concussion patients recovers completely within 3 to 6 months. Long-term cognitive impairment: Cognitive impairment persists for more than 6 months in approximately 15% to 20% of concussion patients.

After investigation, it was found that the cognitive function of these patients did not deteriorate, mainly due to sleep disorders, anxiety, and irritability, which caused memory loss and inattention. They could recover completely after symptomatic treatment. In addition, boxers believed that The gradual decline of cognitive dysfunction is considered to be caused by chronic brain injury.

What are the characteristics of concussion in children?

Immediately after a child is injured in a collision, there will be a temporary disturbance of consciousness, such as inability to cry, confusion, etc., which lasts for about half an hour.

Those with mild injuries may only be in a trance (confused), and those with severe injuries may suffer from loss of consciousness (unconscious), irritability, mild shock, pale complexion, or nausea and vomiting.

Some are drowsy and wake up after several hours or overnight. After regaining consciousness, they may still be accompanied by headache (children knock their heads with their hands), irritability, vomiting or dizziness, and some may even lose consciousness for a long time.

If this kind of phenomenon occurs, it may be that the initial symptoms such as skull fracture, head hematoma, and cerebral hemorrhage are similar to concussion, or delayed bleeding occurs, so we should be especially vigilant.

How do concussions happen?

The etiology of concussion is related to occupation. The general population is mainly caused by falls (more common in children and the elderly), violent beating injuries, and head bumps in traffic accidents. Athletes such as football players are prone to headed balls, and boxers or combat athletes are prone to concussions during training. Blows to the head appear during competitions, and soldiers are mostly wounded by artillery shells in battles.

No abnormal lesions were found in imaging after traumatic brain injury, and the main mechanism of concussion is as follows:

It may be related to factors such as brain cell molecular disorder caused by violence, nerve conduction block, cerebral blood circulation regulation disorder, interneuron damage, and cerebrospinal fluid shock wave in the midline ventricle;

It may be due to damage to the reticular structure of the brainstem, affecting the function of the ascending activation system is an important factor causing disturbance of consciousness; however, these etiologies cannot satisfactorily explain all the phenomena of concussion, for example, there are cases of death due to concussion , Professional boxers have chronic brain atrophy damage or even dementia, and amateur boxers have also reported mild brain dysfunction.

Does "heading" football increase the risk of concussion?

Using a "heading ball" while playing football will definitely increase the risk of concussion, mainly because "heading the ball" will increase the risk of collision with other players.

What are the causes of chronic headaches from concussions?

It may be related to the patient's fear. Some patients do not have a clear understanding of concussion, thinking that concussion is a very serious disease, which is difficult to treat and has many sequelae. Excessive thinking may cause chronic headaches.

Why do some minor concussions still have sequelae?

Mild concussion symptoms usually disappear after about 2 weeks of rest, but some patients have symptoms that last for 3-6 months, and the main reason for patients with persistent symptoms is that they did not get enough rest after concussion. Go in and the doctor advises to rest.

Another part of patients have fear after hearing concussion, and they are afraid that oral sedative drugs may be addictive, so they are unwilling to take oral drugs to cooperate with treatment, resulting in mental dizziness and headache symptoms.

Why are concussions more likely to occur in children?

Children's heads are easily damaged by external forces, which can cause concussions. Parents should pay special attention. The causes of head injuries vary for children of different ages.

Babies of 3 to 4 months will just turn over, and the family members will fall off the bed if they don't pay attention. A 6-7 month old baby in the arms may fall backward from an adult's hand due to restlessness and carelessness. When learning to walk or just walking, when approaching the steps at the top of the stairs, they often lack self-control and roll down.

Diagnosis
How is a concussion diagnosed?

The diagnosis of concussion is mainly based on the history of injury or long-term chronic head impact history and occupational nature, short-term coma after injury, amnesia of recent events, and no positive signs of the nervous system, and various auxiliary examination methods are used to confirm the diagnosis: such as skull No fractures were found on plain radiographs, lumbar puncture manometry was within the normal range, and there were no red blood cells in the cerebrospinal fluid; both plain and enhanced CT scans should be negative.

The latest research found that special magnetic resonance examination (diffusion weighted imaging, diffusion tensor imaging or functional magnetic resonance examination) within 2 weeks or even 3 months after concussion can find abnormal changes in brain cell metabolism, which can provide more information about concussion. objective diagnosis.

Other laboratory tests, such as the detection of glial fibrillary acid protein (GFAP) and ubiquitin acid C-terminal hydrolase L1 (UCH-L1) in the patient’s urine and serum, are currently the laboratory basis for judging concussion in clinical practice. one. Concussions can be better differentiated from subjective intent with these updated examinations.

What are the tests for concussion diagnosis?

In the past, concussion examinations were mainly used to rule out moderate to severe traumatic brain injuries, and it was difficult to obtain objective examination evidence for concussions. Recent studies have discovered some new imaging and laboratory examination methods that can diagnose concussions.

Lumbar puncture has normal intracranial pressure, some patients may have decreased intracranial pressure, cerebrospinal fluid is colorless and transparent, does not contain blood, the number of white blood cells is normal, and most of the biochemical tests are within the normal range;

Skull X-ray examination: no fracture was found;

Brain CT scan: no obvious abnormal changes in the skull and intracranial;

EEG examination: EEG is mostly normal several months after the injury;

Magnetic resonance diffusion-weighted imaging (DWI), magnetic resonance diffusion tensor imaging (DTI) or functional magnetic resonance (fMRI) examination: Abnormal changes in brain cell metabolism can be found.

For example, glial fibrillary acid protein (GFAP) and ubiquitinic acid C-terminal hydrolase L1 (UCH-L1) detected in urine and serum of patients: significantly higher than those of normal people or non-concussion patients, although moderate to severe traumatic brain injury also increased High, but imaging studies can help rule out concussion.

What is a silent concussion? How to recognize a silent concussion?

Some concussions are difficult to detect because there are no obvious symptoms at the beginning, which can be called "hidden" concussions. A "hidden" concussion is usually first discovered by someone close to the child, such as a parent, sibling, or teacher.

This is because they do not have physical symptoms, nor do they make children feel painful, but are changes caused by the combined action of "thinking" and the environment. In other words, there are potential changes in the child's sleep patterns, thinking patterns, and behavior patterns.

Although these changes are subtle, someone who knows the child will know which behaviors are normal and which have changed. Seek immediate medical attention if your child has the following symptoms after a head bump.

Sleep: Your child has trouble falling asleep; wakes up easily during sleep; sleeps less than usual; sleeps more than usual; is more tired than usual.

Mood: Your child's personality has changed; is more irritable than usual; sad or depressed more easily than usual; becomes more anxious or tense; more impatient than usual; easily agitated.

Learning and thinking: Changes in your child's ability to learn new information; memory becomes better or worse; becomes better or harder to concentrate; responds slower when answering questions.

treat
How are concussions treated?

Condition observation

Concussion patients should stay in the hospital for short-term observation for 2 to 3 days after injury, and regularly observe changes in consciousness, pupils, and vital signs, so as to detect possible concurrent intracranial hematoma in time.

Proper bed rest to reduce mental and physical work.

Symptomatic and supportive treatment.

Mental encouragement, eliminate concerns.

Symptomatic treatment

When the headache is severe, advise it to rest in bed, reduce external stimuli, and give rotundine or other painkillers. For irritability, anxiety, and insomnia, give diazepam, etc.; in addition, drugs to improve autonomic nervous function, neurotrophic drugs and calcium ion antagonist nimodipine can be given.

After the injury, the condition should be explained to the patient, explaining that the disease will not affect daily work and life, and relieve the patient's concerns.

What are the first aid measures for concussion?

Sufficient attention should be paid when the head is injured on the ground. In mild cases, you can rest in bed for 1-2 days, and you can get out of bed if there are no special symptoms, and you should continue to observe for a week.

If the head is found to be accompanied by hematoma, you should go to the hospital to take a film examination to find out whether there is a skull fracture. Anyone with obvious disturbance of consciousness accompanied by shock should immediately lie supine, fix the head, and rush to a tertiary hospital for emergency treatment.

What are the discomforts of concussion recovery patients?

Often have dizziness, headache, nausea, vomiting, tinnitus, insomnia and other symptoms, which usually disappear gradually in a few weeks to several months, but some patients also have long-term dizziness, headache, insomnia, irritability, inability to concentrate and memory loss and other symptoms.

What other effects can a concussion have on the body?

The prognosis of concussion is good, and most patients return to normal within 2 weeks, but a small number of patients may also have secondary intracranial lesions or other complications. Therefore, during symptomatic treatment, the patient's mental state, consciousness, and clinical symptoms must be closely observed. and vital signs, and necessary inspections should be carried out in a timely manner according to the situation.

Some patients left dizziness, headache, insomnia and other symptoms for a long time;

short-term impairment of cognitive functions such as memory loss and inattention;

A very small number of patients still have memory loss, dizziness, headache, insomnia, and inability to concentrate half a year after traumatic brain injury. This is mainly because the patient has mild cognitive decline secondary to anxiety. Can be controlled and returned to normal.

What should patients recovering from concussion pay attention to?

When the patient's symptoms such as headache and tinnitus have not improved significantly for more than 3 to 6 months, in addition to considering whether there are mental factors, they should also be checked and analyzed in detail to see if there is delayed damage. In a word, it increases the patient's mental burden.

What should be paid attention to when a concussion is combined with an open brain injury?

To thoroughly debride the wound, bandage the wound, and use antibiotics if necessary to prevent infection.

After falling on the back of the head, I lost consciousness for a few seconds and then woke up afterwards. What should I do in this situation?

In this case, it is considered a concussion. After the injury, you should stay in the hospital for short-term observation for 2 to 3 days, and regularly observe changes in consciousness, pupils, and vital signs, so as to detect possible concurrent intracranial hematoma in time. Proper bed rest to reduce mental and physical work.

How is chronic headache from concussion treated?

The symptom of headache is only a clinical manifestation of concussion patients, so the treatment principle of headache caused by concussion is also the treatment principle of concussion, mainly including the following aspects:

The dynamic changes of the patient's condition should be closely observed within a certain period of time after the injury. Patients diagnosed with concussion are required to be hospitalized and observed for 1 to 2 weeks, so as to avoid delaying the treatment and delaying the timing of treatment when delayed intracranial hematoma occurs. The observation content includes the state of consciousness of the patient, whether there are symptoms such as nausea and vomiting, changes in the pupils, changes in the motor functions of the limbs, and so on.

In the acute phase, rest quietly. Patients need to rest in bed for 7 to 14 days and avoid loud noises. The patient should be provided with a quiet and tidy resting place with soft light and suitable temperature and humidity, so as to reduce the adverse stimulation to the patient and prevent the harm caused by the large fluctuation of intracranial pressure to the patient.

pain relief treatment. General headache can choose aspirin, craniodynia and other analgesics. For headache mixed with vasoconstriction and diastolic dysfunction, drugs that regulate vasomotor function can be used, such as nimodipine, ergotamine, caffeine, dimethazole and other drugs. For those with autonomic dysfunction, oryzanol, citicoline, etc. can be used to assist in the treatment.

psychotherapy. Make the patient eliminate the psychology of fear, anxiety, contribute to the cure of headache. After a detailed examination of the concussion patient, if necessary, CT scan, magnetic resonance imaging and other examinations, after excluding organic brain lesions, it is necessary to patiently explain to the patient, explaining the recovery of the headache caused by the concussion The time may vary, but it can be cured in the end, and it will not affect daily study and life. Patients need to reduce their psychological burden and actively cooperate with doctors' treatment.

What are the factors influencing the recovery of cognitive impairment after concussion?

Cognitive dysfunction after concussion is determined by many factors, including the grade of concussion, comorbidities, accompanying other organ damage, and the speed of recovery after injury. The recovery of cognitive function is also related to the rehabilitation environment after acute trauma.

Life
What should I pay attention to in terms of diet for concussion?

When craniocerebral injury is accompanied by hypertension, hyperlipidemia, coronary heart disease, cerebral hemorrhage, and cerebral thrombosis, a low-salt, low-fat diet is recommended; when accompanied by cerebral edema, more foods containing phosphorus and lecithin, such as fish and eggs Waiting for food.

How is a concussion patient cared for?

Excited and restless patients should not live in families with irregular family life or discord.

The color of the room should be cool tones, such as green and blue, and the room layout should be simple and elegant. During the period of the patient's illness, try to keep quiet at home, and try to receive guests as little as possible, such as dinners and parties.

When listening to music, you should also try to play some serenade or light music with a soothing rhythm. It is not advisable to play music with too intense and fast rhythm, so as not to arouse the excitement of the patient.

Monitor the patient not to use the brain excessively within 3 months after the injury, so as to eliminate the accompanying symptoms such as headache and dizziness as soon as possible. Take medicines in moderation as directed by your doctor.

What should be paid attention to when handling patients with severe concussion?

Keep the patient in a side lying position with the head high as far as possible to avoid the back of the tongue from obstructing ventilation;

Clean up the vomit in the patient's mouth in time to avoid aspiration into the airway;

Try to avoid long-distance transfer, and choose the nearest qualified medical unit for treatment;

Dehydration, antihypertensive and other treatments should be given before transfer;

Try to avoid vibration during transportation;

When transferring patients, they should be escorted by medical staff and observe the changes of their condition at any time;

There are basic facilities for rescue at any time.

Prevention
How to prevent concussion?

The prevention of concussion is mainly based on risk factors such as age and occupation:

Concussions in children and the elderly are mainly caused by falls. For children with concussions, see 16. Concussions in the elderly mainly prevent falls. At the same time, diseases that prevent falls should be treated and the monitoring of the elderly should be strengthened. If necessary, family members should accompany and assist;

Young and middle-aged concussions are mainly caused by being attacked by others. Fights should be avoided, and the head should be protected as much as possible. In the event of a car accident, the head should be avoided as much as possible;

Athletes and boxers mainly learn to protect their heads.

How to avoid concussion in children?

Children's skulls are relatively fragile. In addition to avoiding children's head collisions as much as possible, many of them are caused by people's habitual actions unintentionally.

For example, some parents shake the cradle vigorously and push and pull the stroller in order to make the child fall asleep quickly; in order to make the child happy, throw the child high; or take the baby out and let the child lie in a car that is too bumpy, etc. Parents should avoid these actions.

Can a concussion affect a child's intelligence?

Concussion is a type of closed craniocerebral injury, and it is the mildest one. Clinically, it only manifests as transient brain dysfunction.

Concussion patients usually regain consciousness within half an hour, and then have some headaches, nausea, and vomiting, and then return to normal after a few days, without permanent brain damage. Therefore, concussions generally do not affect children's intelligence.