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Concussion

The brain floats within the skull, surrounded by cerebrospinal fluid, which cushions it from the light bounces of everyday movement. But the fluid may not be able to absorb the force of a sudden hard blow or a quick stop. A violent jar or shock to the head can cause a concussion, a type of traumatic brain injury (TBI) resulting in bleeding in or around the brain and the tearing of nerve fibers.

A concussion causes at least a temporary loss in brain function. Although losing consciousness is a common sign of a concussion, it's possible to suffer a concussion without being completely knocked out.

Although not usually life-threatening, a concussion can have serious effects. Most people with mild injuries recover fully, but it's important to seek medical attention and to allow enough time for the healing process.

Each year, minor incidents of TBI happen to over one million people in the United States. These minor injuries result in the treatment and release from hospital emergency departments. Another 230,000 people are hospitalized each year with TBI. Of these people, 99,000 will show a lasting disability.

Causes

A concussion may result from a sudden physical assault on the head, which can cause the brain to slide forcefully against the inner wall of your skull and bruise your brain. This can result in bleeding in or around the brain and the tearing of nerve fibers.

The most common cause of TBI is motor vehicle accidents, accounting for almost half of all TBIs that require hospitalization. Sports or physical activity is the second most common cause, and assaults are third. For those who are over age 65, falls are the number one cause.

Symptoms

Any type of TBI, no matter how minor it may appear should be taken seriously. If you experience any loss of consciousness, no matter how brief, a doctor should be seen as soon as possible. Even if unconsciousness does not occur, the several hours that follow are still very important and you should watch for the following symptoms:

  • Headache
  • Nausea, vomiting
  • Slurred speech
  • Restlessness
  • Loss of consciousness after injury
  • Ringing in the ears (tinnitus)
  • Increased drowsiness
  • Change in pupils
  • Confusion about the time or date
  • Memory loss
  • Change in personality
  • Depression
  • Irritability
  • Other emotional and behavioral problems
  • Some people may have convulsions or seizures

Diagnosis

The full extent of the problem may not be completely understood immediately after the injury, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a head injury is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the patient and family and asks how the injury occurred. Trauma to the head can cause neurological problems and may require further medical follow up.

In addition to a physical examination, the physician may order an MRI or CT-scan of the head to detect any bleeding, brain damage or skull fractures in patients with head injuries. Imaging studies are the key component in the diagnosis of cerebral contusion and intracerebral hematoma.

Prognosis

The outcome of TBI depends on the cause of the injury and on the location, severity, and extent of neurological damage: outcomes range from good recovery to death. Doctors often use the Glasgow Coma Scale to rate the extent of injury and chances of recovery. The scale (3-15) involves testing for three patient responses: eye opening, best verbal response, and best motor response. A high score indicates a good prognosis and a low score indicates a poor prognosis.

Treatment

Rest is the best recovery technique. Healing takes time. Some over-the-counter and prescription drugs may relieve headache pain, but talk to your doctor before taking any medications, especially aspirin. Aspirin may contribute to bleeding. Never give aspirin to children because it may lead to serious problems, such as Reye's syndrome.

The process of healing from a concussion may take time, sometimes several months. These tips may help make for a smoother recovery:

  • Get plenty of sleep at night, and rest during the day.
  • Return to normal activities gradually. Don't take on too much too soon.
  • Avoid activities that could result in a second head injury, such as contact or recreational sports, until your doctor says you're well enough to participate.
  • Be sure to ask your doctor about when you can safely return to sports, drive a car, bike, or operate other equipment or machinery. Your ability to react to stimuli may be impaired.
  • Take only drugs that your doctor has prescribed or approved.
  • Don't drink alcohol until you have recovered fully. Alcohol may hinder recovery and can put you at risk of further injury.
  • Write down things that you find hard to remember.
  • Consult with your family or close friends before making important decisions.

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