Concussion

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FACTS

Concussion can be determined immediately after trauma, traumatic brain injury evaluated around 6 hours after injury.

HPI

  • post-concussive symptoms
    • HA
    • dizziness
    • insomnia
    • exercise intolerance / fatigue
    • depression
    • irritability
    • anxiety
    • memory loss
    • difficulty concentration
    • light / noise hypersensitivity

PHYSICAL EXAM

IMAGING

CTH will most likely be negative, but if an MRI is obtained you will likely see evdence of DAI
Figure 1: (LEFT) negative CT scan (RIGHT) Grade 1 R frontal DAI
Figure 1: (LEFT) negative CT scan (RIGHT) Grade 1 R frontal DAI
A/P
  • Generally do not obtain further imaging beyond CTH unless a strong indication (patient is really far off from baseline, confused, not following commands) → if indicated, start with an MRI Brain w/o contrast with SWAN sequences to evaluate for diffuse axonal injury
  • return to play gradually after 24-48h rest
  • Concussion clinic referral