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Concussion (cont.)

Concussion Diagnosis

The doctor will make sure that there are no severe or life-threatening injuries first and then will further evaluate the severity of the head injury.

History of the injury: If you can, give the doctor the following details about the injury:

  • How long the person may have been unconscious.
  • Details about how the injury happened, such as the speed of travel in a car accident, the height of a fall, or the size of the person or object that hit the victim.

Past medical history: Tell the doctor about the history of any of the following:

  • Current medications, especially warfarin (Coumadin) or platelet inhibitors clopidogrel (Plavix) and aspirin and dipyridamole (Aggrenox)
  • Allergies to medications
  • Prior head injury or concussion, neurologic injury, or surgeries
  • Bleeding disorder or history of easy bleeding or bruising

During the physical examination, the doctor will:

  • Assess normal neurologic function such as reflexes and mental status.
  • Examine the patient for other associated injuries, such as a neck injury or whiplash, that are common with head injury.
  • Inspect for bleeding from the ears or nose as well as bruising around the eyes or behind the ears that is commonly seen with certain types of fractures to the base of the skull.

Many times people are concerned about a cut (laceration) on the scalp or face, and the doctor may not seem to take much notice. These cuts may bleed and appear serious, but severe or life-threatening bleeding from such a cut is rare and would be recognized right away. The doctor's main concern will be to assure that there is not serious brain damage, or a neck or torso injury. The cut can be repaired later.

Looking inside: The best way to evaluate a person's head injury is with a CT scan. This machine takes cross-sectional X-rays of the head (or other body parts), and a computer reassembles the information into images to let the doctor see details of the inside of the body. When a CT scan is used for a head injury, the doctor will look for evidence of bleeding under the skull or within the brain tissue itself.

  • With less serious head trauma, the doctor may choose not to do a CT scan. A minor concussion can safely be observed either at home or in the hospital for 24-48 hours. If no other serious signs of injury develop, the person will usually be safe.
  • Skull X-rays are no longer routinely used to evaluate a person with a concussion.
  • A concussion may be accompanied by a skull fracture. The patient may still have a skull fracture even though the doctor does not perform a CT scan or take X-rays. This is acceptable. The presence of a fracture does not, alone, increase the likelihood of an injury to the brain unless there are also other signs of head injury.
    • Skull fractures almost always heal well. Casts are not used on the head.
    • In rare cases, a leptomeningeal cyst may form. These are bulges of the bone and tissue at the site of the fracture, which develop months later. There is no way to predict their occurrence or to  prevent them.
    • If the patient notices a bump forming months after a head injury, see a doctor. X-rays of the skull may be done at that time, and if there is a leptomeningeal cyst forming, the patient will be referred to a neurosurgeon for evaluation and treatment.

In the past, concussions were commonly graded on a scale according to severity. Most commonly, concussions are referred to as symptomatic or asymptomatic (meaning that symptoms are or are not present, respectively). Neurologists may do further testing to grade a concussion's severity.

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