The Hidden Dangers of Concussions

If you’re like nearly 25% of your fellow Americans, you’ve had a concussion at least once in your life.

Often lightheartedly referred to as “getting your bell rung,” concussions—like any brain injury— are no laughing matter. Caused by a bump, blow or jolt to the head or by a hit to the body that causes the head and brain to move quickly back and forth within the skull, concussions can lead to short- and long-term consequences. While symptoms can appear immediately, sometimes they may not be noticed until days or even weeks after the injury.

One of the biggest challenges with concussions is that they’re not always obvious. Less than 10% of people who suffer a concussion lose consciousness. For the remaining 90%, the symptoms can be very subtle and may not even show up for as many as two days after the event.

Symptoms

Some common immediate symptoms of concussion are:

• Amnesia. Some people are unable to recall events just before or after the injury.

• Feeling disoriented or confused. Concussions can cause an immediate change in mental status, including confusion.

• Losing consciousness. 

• Delayed response to questions.

• Vomiting. Throwing up right after a hit to the head is a red flag for concussion.

Other symptoms that may happen quickly or appear later:

• Changes in mood, such as feeling irritable, anxious, restless, or overly emotional.

• Cognitive trouble, such as feeling foggy or experiencing issues with memory and/or focus.

• Dizziness, especially that which feels like motion sickness and leads to balance issues.

• Fatigue, and a general feeling of sluggishness, especially after a long day.

• Headache or a feeling of pressure in the head.

• Severe headache, accompanied by nausea and light sensitivity.

• Light sensitivity without a headache.

• Sensitivity to noise.

• Nausea, may last for a few days or even weeks.

• Sleeping issues, including having trouble falling and staying asleep or sleeping more than usual.

• Blurry vision

In addition, many abnormal symptoms should prompt a visit to the emergency department regardless of when they occur. These include:

• Decreasing or fluctuating level of consciousness

• Increasing confusion

• Increasing irritability

• Numbness in the arms or legs

• Pupils becoming unequal in size

• Repeated vomiting

• Seizures

• Slurred speech or inability to speak

• Inability to recognize people or places

• Worsening headache

• Extreme difficulty with balance

• Post-concussion syndrome: Symptoms that persist for weeks or months after the injury.

• Psychological issues, including increased stress, anxiety, depression, and PTSD.

The Risks of Returning to Full Activity Too Soon

Typically, a single concussion doesn’t result in permanent brain damage. However, studies have found that once a person has had a concussion, their risk of experiencing another one is 3-5 times higher. With each additional concussion, the symptoms become more severe, and the length of time needed for recovery increases. Potential outcomes for returning to activity too soon include:

• Second-impact syndrome: A rare but potentially fatal condition that occurs when a second head injury happens before the brain has fully recovered from the first concussion.

• Chronic traumatic encephalopathy (CTE): A form of brain degeneration that may appear years after repeated concussions, leading to dementia, personality changes, and movement disorders.

Recovery

It’s extremely important to give the brain the time and conditions necessary to fully heal. It’s far better to take things easy or, if you’re an athlete, to sit out a few games than it is to live with permanent brain damage and disabilities that can result from repeated concussions.

Steps you can take to help with recovery include:

Your doctor may also recommend concussion testing, a vital tool for evaluating brain function after a head injury.

Common concussion tests include:

Sport Concussion Assessment Tool 5 (SCAT5) to assess symptoms, cognition, and balance 

Standardized Assessment of Concussion (SAC) to evaluate orientation, memory, and concentration

Computerized tests, like ImPACT, to assess cognitive functions such as memory and reaction time

Balance Error Scoring System (BESS) to measure balance and coordination

In addition to providing medical professionals with insight into the severity of a concussion, these tests also create a baseline and point of comparison for evaluating future head injuries.

Prevention

From young children falling off their bikes to senior citizens slipping on ice, people of all ages are susceptible to concussions. Even though the risk of concussion is never zero, there are things you can do to prevent them. Here’s where to start:

Wear a Helmet

• Wear properly fitting helmets and protective gear for activities including:

  • Riding a bike, motorcycle, ATV, snowmobile, skateboard, horse, or scooter

  • Contact and high-impact sports, such as football, ice hockey, or boxing, skiing, snowboarding, baseball, softball, or roller- or inline skating

NOTE: Helmets can reduce the risk of skull fractures and cuts, but they don't prevent all concussions. If you experience signs of a concussion—even when wearing a helmet—seek immediate medical attention.

Buckle Up and Drive Safely

• Always wear a seatbelt

• Properly install appropriate child safety seats in vehicles

• Never drive under the influence of alcohol or drugs.

• Obey speed limits and law

Senior Fall Prevention

• For older adults, talk to a doctor about fall risk and take measures to improve balance and strength.

• Make living spaces safer by removing tripping hazards and improving lighting.

• Ask your doctor or pharmacist to review your medications—including prescription and over the counter drugs, vitamins, and supplements—to see if any might make you dizzy or sleepy.

• Get your eyes checked at least once a year and update your prescription if needed.

Child-proof Your Home

• Install window guards to keep young children from falling out of open windows.

• Use safety gates at the top and bottom of stairs when young children are around.

Protect Athletes

• Make sure athletes and coaches are familiar with concussion signs, symptoms, and proper management.

• Make sure rules that reduce impact to the head are enforced and that techniques to reduce injury are covered in practice.

• If your child experiences a concussion, contact the athletic trainer or director at their school as they often specialize in recovery and “return to learn” to help manage symptoms during school.

No matter the cause or circumstance, seek a medical evaluation after a head injury to ensure proper diagnosis and management. Be sure to follow your provider’s advice regarding recovery to minimize complications and prevent further damage to your brain.

 Jackie Penson, PA-C, is a member of the care teams in the emergency department and ExpressCare at Southwestern Vermont Medical Center.