Concussion in Adults: Signs, Symptoms, and Treatments
Concussions are so common that almost every American has experienced one or knows somebody who has. There is a large amount of confusion surrounding what exactly occurs in someone who has a concussion, what the symptoms of concussion are, and the best treatments for concussion. In this article we will review the signs, symptoms, and treatments of concussion.
What is a Concussion?
The term “concussion” is commonly misused by both healthcare providers and patients. A concussion is trauma to the brain that results in temporary changes in the function of the brain. Concussions do not lead to the destruction of brain tissue and do not result in permanent damage. For this reason they are commonly referred to as “mild traumatic brain injuries.” Which is a medical term that describes head injuries that lead to temporary changes in brain function without causing visible damage to the brain itself.
Many types of trauma can lead to a concussion, impacts to the head are not the only cause. Any sudden movement that causes twisting or shifting of the brain in the skull can lead to a concussion. Some of the most common causes of concussion are:
- Impacts to the head
- Car accidents, even if no head impact occurs
- Sudden impacts during sports, even with a helmet in place
- Falls from any height
- Impacts that result in the neck snapping forward or backwards (whiplash)
Any of these causes listed above can result in the brain twisting or shifting in the skull. Scientists believe that this twisting of the brain tissue changes the way that the neurons that make up the brain communicate with one another for several days to weeks after the injury. This change in communication leads to the signs and symptoms that we describe as a concussion.
What are the Signs and Symptoms of a Concussion?
Concussions are a form of mild traumatic brain injury, due to the complexity of the human brain, there are a wide variety of signs and symptoms that can develop when it is injured. The vast majority of concussion signs and symptoms are extremely mild, often only one of these signs or symptoms will be present.
Signs of Concussion in Adults
The most common signs of concussion are mild, they often require some level of formal training to effectively detect. You will most likely note that you “don’t feel right” or a loved one “doesn’t seem like themselves” shortly after sustaining a concussion, however looking for the following may be helpful.
- Loss of balance
- Loss of memory
- Loss of coordination
- A blank or vacant look
- Visible injuries to the head, face or neck
- Loss of consciousness
Only 10% of concussions present with loss of consciousness. This is a severe sign that indicates that more severe injuries may be present. If you or a loved one presents with loss of consciousness after an injury you should seek emergency medical attention.
Symptoms of Concussion in Adults
The symptoms of concussion are numerous and can be present in almost any part of the body. The presence of even a single symptom may indicate a concussion has occurred. Many of these symptoms are also present in other, more severe, medical conditions. For this reason medical evaluation is always recommended following a suspected concussion.
Some of the most common symptoms of concussion are:
- Changes in vision
- Headache
- Dizziness
- Nausea
- Vomiting
- Neck pain
- Sensitivity to light and noise
- Difficulty with concentration and memory
- Fatigue
Nausea is one of the most common symptoms following a concussion but vomiting is more rare. While vomiting immediately after a suspected concussion is not an emergency, vomiting that develops hours to days after a concussion is a sign of severe injury and should be evaluated in an emergency department.
Signs and Symptoms of Concussion in Children
Children have the same signs and symptoms of concussion as adults. Any differences in symptoms result from difficulties in communicating with a child that is injured and feels unwell. Children will often report the following symptoms after a concussion:
- Pain in the head or neck
- Bright lights in the vision
- Feeling tired
- Loss of interest in play or typical activities
Delayed Symptoms of Concussion
There are some symptoms that traditionally develop hours to days after a concussion:
- Drowsiness or difficulty falling asleep
- Irritability, sadness, or extremes of emotion
- An increase in anxiety
Concussions can worsen chronic conditions such as migraines, depression, and anxiety. In rare cases more serious injury may also be present; for this reason all delayed symptoms should be reported to your medical provider as they may be a sign of a more severe underlying condition.
Who Gets Concussions?
Concussions can occur in anyone at any age, but there are some groups that are more likely to suffer from concussions and groups that are more likely to have more severe symptoms of concussion.
Concussions in Adults
Adults that are not involved in sports or high-impact activities commonly experience concussions in combination with other injuries during a traumatic event such s a car accident, fall, or assault. Those from the age of 18 to 55 often recover quickly from concussions and have the lowest rate of complications.
Concussions in Athletes
Athletes are more likely to sustain concussions than any other group. In contact heavy sports such as football, rugby, basketball, and lacrosse young athletes may sustain multiple concussions per season.
The biggest risk in athletes is experiencing a second concussion shortly after the first. This is known as “second impact syndrome” and has been shown to slow recovery and increase the risk of severe and long-lasting injury. Due to a large amount of research in this area coaches at all levels are aware of this risk and aggressively search for signs of concussion in their players. All athletes should be evaluated by a healthcare professional before returning to play after a suspected concussion.
Concussions in Children
Children under the age of 5 have softer skulls which increases the risk that a fall or impact to the head will result in twisting of the brain tissue. Children under the age of 14 also recover more slowly from concussions compared to adults. Despite this, studies have not shown that concussions in children lead to an increased risk of brain damage, mental illness, or disability.
Concussions in the Elderly
Individuals over the age of 65 recover from concussions more slowly and are at an increased risk of severe complications as a result of head injury. An elderly individual that sustains an injury significant enough to cause any of the signs or symptoms of a concussion should generally be evaluated by a medical professional no matter how mild the symptoms may be.
How is a Concussion Diagnosed?
The diagnosis of a concussion is relatively simple if the injured individual is able to communicate their symptoms, if you or a loved one is presenting with any of the signs or symptoms listed above after a traumatic injury, fall, or other cause of sudden impact, they are likely suffering from a concussion.
This same standard is used in the emergency room and your doctor’s office to diagnose concussion. They will ask you how your injury happened, what any bystanders saw, and ask you about a long list of symptoms.
If you are injured at a sporting event a coach or athletic trainer may use a standard questionnaire known as the Sideline Concussion Assessment Tool (SCAT) to score your symptoms and determine if you need emergency treatment or more routine follow up in a doctor’s office.
An important step in the diagnosis of concussion is ruling our more severe traumatic brain injury and injury to the bones of the skull and spine. If you present to an emergency department after a concussion and have lost consciousness or experienced the more severe symptoms of a concussion your doctor will likely order tests to rule out conditions such as:
- Bleeding within or around the brain
- Physical damage to the brain tissue
- Fractures of the skull
- Fractures in the top part of the spine (cervical spine)
- Swelling of the brain tissue
These tests are not useful in diagnosing concussion, but will reveal abnormalities if a more severe injury exits. The most common tests ordered in patients with severe symptoms are:
- Computed tomography scans of the brain and neck (CT scans)
- Magnetic resonance images of the brain (MRIs)
- X-Rays of the neck and skull in children and adolescents
What is the Treatment for a Concussion?
Rest is the best treatment for a concussion. This means rest from both physical and mental activity. In the first 24 hours after a concussion it is important to avoid:
- Physical exercise
- Long periods of reading
- Schoolwork
- Video games, television, and computer use
- Work related activities such as office work, long periods of standing, and conversation.
While this list may seem restrictive, a minimization of any activities other than sleeping, resting, and eating and drinking is the only effective treatment for the immediate symptoms of a concussion.
After the first 24 hours without activity, you should gradually re-add these activities and see if they result in a sudden increase in symptoms. If so, returning to the restricted level of activity for another 24 hours is recommended. If not, continue to gradually re-add activities as tolerated over the next several days. This is especially important for athletes who should be symptom free before resuming activities that could lead to any further injury.
Monitoring for Complications of a Concussion
Another important step in the treatment of concussion is monitoring for more severe symptoms that indicate another injury is present. Symptoms that worsen or change hours after the initial concussion may indicate that a more severe condition may exist. Some of the alarm symptoms that require emergency medical attention are:
- Severe and recurrent vomiting
- Confusion
- Seizure
- Difficulty or inability to wake the injured individual from sleep
Medications for Concussion
Medications are rarely used in the treatment of concussion, medications for nausea and the treatment of headache are not recommended as they may mask the symptoms of severe complications of head injury listed above. You may be allowed to take some over the counter medications but should consult with a medical provider before doing so. Some of the medications your medical provider may recommend are:
- Ibuprofen (Motrin)
- Acetaminophen (Tyelnol)
- Naproxen (Aleve)
What Does Recovery from a Concussion Look Like?
In almost every individual that experiences a concussion, complete and total recovery is expected. This is because concussions do not involve any severe or lasting damage to the brain, this allows the brain to heal and restore itself in a relatively short period of time.
Concussion Recovery Time
The concussion recovery time in adults varies significantly based on the individual, the severity of the injury, and the ability of the injured individual to rest and recuperate.
- Significant recovery in adults is generally seen within one to two weeks, with 10 days being average for most age groups.
- Athletes, who require greater amounts of focus and physical exertion when playing sports, may not see total recovery for up to a month. However, it is safe to gradually return to activity long before complete recovery in most individuals.
- The most important indicator for time to recovery is the severity of symptoms at the time of injury.
Post Concussion Syndrome
PCS also called “post concussive syndrome,” is used to refer to concussion symptoms that persist for weeks to months after a concussion. The exact cause, treatment, and course of PCS is poorly understood and there are many other medical conditions that have similar symptoms. If you experience concussion symptoms for over two weeks you should contact your healthcare provider.
References
Tator CH. Concussions and their consequences: current diagnosis, management and prevention. CMAJ. 2013;185(11):975-979. doi:10.1503/cmaj.120039 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735746/)
Leddy JJ, Sandhu H, Sodhi V, Baker JG, Willer B. Rehabilitation of Concussion and Post-concussion Syndrome. Sports Health. 2012;4(2):147-154. doi:10.1177/1941738111433673 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435903/)
Iverson GL, Gardner AJ, Terry DP, et al. Predictors of clinical recovery from concussion: a systematic review. Br J Sports Med. 2017;51(12):941-948. doi:10.1136/bjsports-2017-097729 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466929/)
