Concussion (Mild Traumatic Brain Injury)
Concussion is caused by an injury to the brain, as a result of an impact to the head. It is also referred to as mild traumatic brain injury (MTBI). The brain, the most complicated organ in the body, is situated in the head, and is at the core of the nervous system. It is protected by the skull (a hard bony surface) and consists of soft tissue; grey and white matter, which is divided by a dark colour. The brain consists of the cerebral cortex, the cerebellum and cerebrum. The cerebral cortex is outside the cerebrum and is divided into 4 lobes (the frontal lobe, the parietal lobe, the occipital lobe and the temporal lobe). The cortex is neural tissue, which is folded to fit within the skull. It is responsible for consciousness, memory, thought, language and awareness. The brain is surrounded and protected by cerebrospinal fluid (CSF).
When concussion happens, the brain moves and knocks against the skull causing bruising to the brain, damage to the nerves and to the blood vessels. This alters the fine chemical and electrical balance in the brain which disturbs the messages sent from the brain to the rest of the body. Concussion is one of the commonest forms of injury that results in hospital treatment. Children between the ages of 5 and 14 are the most susceptible to concussion. Recovery from concussion is usually good. However, repeated incidents of concussion can lead to dementia (chronic traumatic encephalopathy).
Concussion can be caused by a fall, or by a blow to the head. There are a number of sporting activities that can result in concussion occurring, for example, boxing, horse riding (a fall from the horse), bicycling, rugby, football, cricket (hit by a cricket ball) and skiing. Car or road traffic accidents can also cause concussion. The use of helmets, for example, when riding, bicycling, motor biking can help prevent concussion occurring and limit potential brain damage.
- Disturbed eye sight (blurred or seeing stars)
If the following occur medical treatment should be sought immediately.
- Balance might be affected
- Persistent unconsciousness
- Muscle weakness/ difficulty walking
- Alternating between moments of clarity and alertness to moments of drowsiness
- Discharge (clear fluid or blood) from the ears and nose
Complications of concussion can lead to a second concussion (SIS, second impact syndrome). This could indicate brain swelling, which can be fatal. Bleeding in the brain can be a complication of concussion.
It is important to seek medical advice immediately, to rule out bleeding it to the brain, which could indicate a serious head injury. It is important to rest and monitor the patient closely, in case the symptoms worsen. This could indicate bleeding between the skull and the brain, or bleeding on the surface of the brain. The length of observation for concussion, depends on the severity of the concussion, but could range from a few days to several weeks. The first 24/48 hours are crucial. It is important that the patient is woken every 2/3 hours for the first 12-24 hours.
When moving someone with suspected concussion it is important to move them carefully and treat them as if they might have a spinal or cervical injury.
An MRI scan or a CT scan might be performed to diagnose the nature of the head injury.
During recovery from concussion, patients might find it difficult to concentrate, be irritable, and can be sensitive to noise and light. They can also get tired more easily.
Rest and avoid sport or any activity that could cause an impact to the head. For children and adults it is important to seek medical advice to find out when it is safe to resume activity. *Professional rugby players have to rest for 3 weeks before playing again.
*Detailed concussion guidelines from the IRB Player Welfare website.
Avoid driving for the first few days. (seek medical advice to find out when it is safe to resume driving.)
Painkillers (paracetamol). Seek medical advice before administering.
Aspirin and anti-inflammatories should be avoided as they cause thinning of the blood.
Sophia Cross, BA (Hons) MA