A concussion (Commotio cerebri) is the easiest form of craniocerebral trauma. After a fall or a blow to the head, a brief unconsciousness and symptoms such as drowsiness, memory gaps, headache and nausea may occur. If it is suspected that a concussion is present, a doctor should be consulted, especially if infants and toddlers are affected. This can exclude a more severe head injury by appropriate investigations and treat the symptoms of concussion adequately.

Causes of a concussion

Injuries to the skull in which the brain tissue is injured or impaired by an external force are known as craniocerebral trauma. Pure skull fractures or lacerations on the head do not fall into this category because the brain is not affected. A concussion is the mildest form of craniocerebral trauma. Heavier forms are referred to as brain bruising or brain squeezing.

Our brain floats in the skull in the so-called brain fluid (cerebrospinal fluid) and is protected by the cranial bone from external influences. If the brain hits the skull bone abruptly and suddenly - as is the case with a fall or a blow to the head - it can lead to a concussion.

Such an injury can occur quickly in sports or on the road - it is not for nothing that concussion is one of the most common head injuries. Especially in boxing, but also by a fall while cycling or inline skating such an injury can be caused. Depending on the severity of the impact, a distinction is made between a slight and a heavier concussion.

Concussion: symptoms

Frequently, a concussion results in a brief phase of unconsciousness, dysregulation, or memory lapse. In mild concussions, however, these symptoms do not necessarily occur. Unconsciousness often lasts only a few seconds to a few minutes. In more extreme cases, it can last longer than 30 minutes.

If the person wakes up again, he usually can not remember the accident. Sometimes the memory of the time immediately after the accident (anterograde amnesia) is missing. Retrograde amnesia - the absence of memory of the time before the accident - is also possible, suggesting a more severe head injury. While heavier head injuries usually cause damage to the brain structure, in a concussion only the brain function is temporarily disturbed.

Post-commotional syndrome as a complication

In addition to the symptoms already mentioned, concussion also causes symptoms such as nausea and vomiting, drowsiness and dizziness, as well as blurred vision and headache. Some of these symptoms may be delayed - up to twelve hours after the accident - occur.

Normally, the symptoms resolve themselves after a few days, in rare cases - about one percent of those affected - but it may take several weeks until the last symptoms have disappeared. This complication is referred to as a post-commotion syndrome. Patients continue to suffer from:

  • A headache,
  • Nausea,
  • Dizziness,
  • Sleep disorders as well
  • Light and sound sensitivity.

If a person experiences frequent concussions - as is the case with boxers, for example - impaired mental performance may occur in the long term. In the worst case, multiple concussions can lead to dementia.

A concussion in babies and (small) children

Falls on the head are much more common in children than in adults. Since the skull is not firmly ossified in babies everywhere, but shocks can be better intercepted. Nevertheless, concussions also occur in babies and toddlers. In them, such an injury is manifested by symptoms similar to those of adults: headache, nausea, speech problems, memory gaps, and tiredness and confusion. In babies and toddlers, the typical symptoms are often delayed. That's why you should watch your child closely after a fall on the head.

If you notice typical symptoms of concussion in your child after a fall, it is important that you seek the help of a doctor. In infants under one year a visit to a doctor is advisable in any case, because with them in a concussion often only a few symptoms. In addition, the physician must exclude a skull fracture, which is a typical for this age group injury.

The Glasgow Coma Scale

To confirm the suspicion of a concussion, the doctor first asks about the accident and the symptoms that occur and then checks the general condition of the patient.

With the help of the Glasgow coma scale, the doctor can determine exactly how severe the craniocerebral trauma is. To do this, he performs different tests and assigns points for the patient's response. He checks if the patient opens his eyes, if he is moving and if he is responsive. Depending on the reaction, the patient can reach a total of between 3 and 15 points:

  • 3 to 8 points: severe craniocerebral trauma (brain crushing)
  • 9 to 12 points: moderate craniocerebral trauma (brain contusion)
  • 13 to 15 points: slight traumatic brain injury (concussion)
open eyesspontaneousspontaneous4
on addresson calls3
on pain stimuluson pain stimulus2
no reactionno reaction1
inadequate wordscan not be comforted3
no reactionno reaction1
motor activityon demandSpontaneous movement normal6
targeted pain controltargeted pain control5
untargeted pain controluntargeted pain control4
flexor reactionflexor reaction3
yield reactionyield reaction2
no reactionno reaction1

Exclude a serious head injury

A palpation, computed tomography (CT), or x-ray exam can help the doctor determine if there are any injuries to the skull or surrounding areas such as the cervical spine. In case of a long unconsciousness or lasting memory gaps, a heavier injury to the brain has to be excluded. If the CT has not provided a clear result and complaints persist, the doctor may additionally perform magnetic resonance imaging (MRI).

Patients who have experienced severe discomfort or persistent memory deficits, were unconscious for an extended period of time and can not safely be excluded from a more severe head injury should be followed up for at least 24 hours after the accident. But even with a slight concussion, an observation phase under medical supervision is recommended.

Concussion - What to do?

If it is suspected that you have been concussed by a fall or external trauma, you should always consult a doctor or call an ambulance. This must rule out that heavier injuries to the brain or the skull such as a skull bruise, a cerebral hemorrhage, a skull base fracture or a whiplash.

Ask your doctor if it is advisable that you spend the first hours after the injury under medical supervision. Rest in any case for a few days and avoid physical work and sport. At the beginning, you should also refrain from watching television, working on the computer, and reading for a long time, so that the brain can rest in peace. For complaints such as headaches or nausea, the attending physician can prescribe you a suitable drug if necessary. If the injury heals well, one can - depending on the severity of the concussion - be able to work again after about one week.

If you suspect a concussion in another person, call a doctor and do not leave the person alone until the doctor arrives. Check respiration, heart rate and heart rate, treat existing wounds and ask about the accident if the person is conscious. If this is the case, store the upper body slightly higher. If the affected person is unconscious, carefully place them in the stable side position.

Prevent a concussion

As with other injuries, a concussion can not be avoided with 100% certainty. However, certain behaviors can significantly reduce the risk of concussion. So you should always wear a helmet for sports where there is a high risk of falling, such as cycling, inline skating or skiing. Also, do not exercise these sports when you feel physically tired. Then the risk for a fall is particularly high.

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