Do I Have a Concussion?

Concussions are becoming more mainstream, and the importance of their management has become the center of attention in many circles. But how do you tell if someone has a concussion? This article will explore all the symptoms of concussions and appropriate testing to ensure an accurate diagnosis and treatment options. Getting screened and treated early is the best way to provide a safe and speedy recovery without the lingering symptoms months later.

Concussion Physiology

A concussion occurs when the brain rushes within the skull, leading to chemical changes and temporary dysfunction. This jolt can damage essential processes in the sodium-potassium pumps, which maintain opposing charges on opposite sides of the cell membrane. When these gates break, the nerve cell loses its charge, thus losing its function temporarily. The brain perceives this as a crisis, so the immediate recovery period is called the “energy crisis.” After this phase, any additional damage to the nerve tissue will manifest as symptoms that can vary in intensity and quality. For a complete overview of the stages of concussion and what to do during each phase, click here.

Common Concussion Symptoms

Concussion symptoms can affect various systems and vary in the time it takes to manifest. The list below outlines many of the common post-concussion symptoms.

1. Physical Symptoms

    – Headache: Persistent or worsening headache is a standard concussion indicator.

    – Nausea or vomiting: Feeling queasy or experiencing vomiting may occur following a head injury.

    – Dizziness: Feeling lightheaded or unsteady can indicate balance issues.

    – Balance problems: Difficulties with coordination and maintaining balance may suggest a concussion.

    -Delayed reaction time: Delayed reactions or processing information at a slower pace.

2. Cognitive Symptoms

    – Confusion: Disorientation and mental fog are telling signs of a concussion.

    – Memory problems: Difficulty recalling events or experiencing short-term memory issues.

    – Difficulty concentrating: Problems focusing, paying attention, or following conversations point to cognitive impairment.

3. Sensory Symptoms

    – Sensitivity to light or noise: Increased sensitivity to light, noise, or both may be present.

    – Blurred vision: Vision problems such as blurriness or difficulty focusing indicate potential visual disturbances.

    – Ringing in the ears: Hearing ringing, buzzing, or other sounds in the ears could be a sensory symptom.

4. Emotional and Behavioral Symptoms

    – Irritability: Mood swings, heightened emotions, or irritability can be seen after a concussion.

    – Emotional changes: Anxiety, depression, or sudden shifts in mood may suggest brain injury.

    – Sleep disturbances: Changes in sleep patterns, such as difficulty falling asleep or excessive sleeping, may indicate a concussion.

• While the symptoms mentioned are a good indicator of concussion, how do you know for sure? The following section will outline available tools to tell if a person has a concussion objectively. Keep in mind many of these tests require a specialized medical professional. If you suspect you have a concussion, a best practice is taking as many self-assessments as possible and consulting with a medical professional.

Tools to Identify a Concussion

1. Symptom Assessment:

The healthcare provider will inquire about the individual’s symptoms, including headache, dizziness, nausea, confusion, memory problems, sensitivity to light or noise, and other common concussion symptoms. Many will have a numeric scale that allows you to see the severity of your symptoms.

2. Cognitive Testing:

Cognitive assessments may evaluate memory, attention, processing speed, and executive functions. Tests such as the SCAT5 (Sport Concussion Assessment Tool) and ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) commonly evaluate cognitive function. A thorough neuro-psych evaluation can also be helpful to tell whether the injury impacted specific cognitive functions.

3. Balance and Coordination Testing:

Assessing balance and coordination can help detect deficits that may indicate a concussion. Tests such as the Balance Error Scoring System (BESS) and timed tandem gait tests are utilized. A Balance tracking system (BTrackS) and CAPS system (computerized dynamic posturography) are other more objective ways to quantify concussive damage.

4. Vision Testing:

Visual assessments evaluate visual acuity, eye movements, pupil responses, and visual processing speed. The King-Devick test and visual tracking exercises are commonly used in concussion evaluations. A comprehensive neuro-optometry exam is a more extensive way to screen for visual dysfunction post-concussion. A VNG (video-nystagmography) test can also quantify visual tracking dysfunction. Its important to note that this type of testing is not simply assessing visual acuity. It is more useful for identifying functional deficiencies in how the eyes move and track things.  

5. Vestibular Function Testing:

Vestibular assessments focus on evaluating the inner ear balance system, which may be affected by a concussion. Tests like vestibular-ocular reflex (VOR) assessments and Dix-Hallpike maneuvers can help assess vestibular function if the issue is peripheral. Central vestibular problems are more easily detected using a VNG (video-nystagmography). It’s important to distinguish between central and peripheral vestibular problems, as their treatment differs. Peripheral lesions, typically handled by physical therapists, involve damage to the physical structure of the inner ear. Central lesions involve processing errors between the vestibular signals and other signals from the eyes and neck.

6. Neurological Examination:

A healthcare professional may conduct a comprehensive neurological exam to assess motor function, reflexes, sensation, and cranial nerve function. This evaluation helps determine the extent of neurological impairment resulting from a concussion. It is typically performed at the beginning of a more thorough examination to rule out any major damage before ordering more advanced testing.

7. Baseline Testing:

Pre-season or pre-injury baseline testing is a valuable tool in sports medicine to establish an individual’s cognitive and physical performance metrics before a concussion occurs. This baseline data serves as a reference point for post-injury comparisons. It can be used as a quick and easy way to screen for a possible concussion but should not be relied on for a complete diagnosis of concussion.

8. Imaging Studies:

In some cases, imaging studies such as a CT scan, X-ray, or MRI may be recommended to rule out more severe brain injuries. These tests are usually performed when there are red flags or worsening symptoms, which are identified in a standard neurologic exam or in a symptom checklist.

-X-ray testing is used to rule out spinal or cranial fractures.

-CT scans are helpful to identify fractures and cerebral bleeding.

-MRI scans are used to assess severe tissue damage in the brain tissue.

As a rule of thumb, if you suspect someone has had a concussion, start with at-home screening tools. This will help identify whether or not a more extensive evaluation is required. After this, the priority should always be safety. Make sure to rule out any more ominous symptoms of concussion, like structural damage or a brain bleed. Once you have ruled out these, seek a specialist for the remaining symptoms.

Finding The Right Specialist

This aspect of concussion recovery can often cause a lot of confusion and headache (no pun intended). Healthcare loves its specialists. This is good because it allows specific care for specific problems. With concussions, issues arise when you have multiple symptoms and see various specialists. The problem lies in the licenses of the different specialties. For example, vision issues often get deferred to eye doctors, and balance issues usually go to a physical therapist. These two separate licenses may or may need help understanding what the other is doing and may or may not be willing or have the time to communicate with one or more doctors to create a cohesive treatment strategy for each patient.

As a rule of thumb, look into a functional neurology provider if you have more than one remaining symptom. At our clinic, The Neural Connection, a majority of what we see is stubborn concussions that never healed despite seeing every specialist. The common theme in these cases is that they never taught all of the sensory systems how to work together. In other words, they never integrated their care. To save yourself time and money, multiple symptom concussions benefit from early integrated care, which is what most functional neurology clinics offer.

Conclusion:

It can be tricky to tell whether someone has a concussion. This article will help you make the right decisions early and finding the right provider. Doing so will save you time and money and the prolonged stress of unresolved symptoms. If you or someone you know is struggling with post-concussion symptoms, click here for a free 30-minute consultation with a Dr. at The Neural Connection.

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*Note: The information provided in this article is for educational purposes only and does not constitute a doctor-patient relationship. Patients are advised to consult their medical provider or primary care physician before trying any remedies or therapies at home.