Because the definition of a concussion denotes a mechanical injury of the brain without visible structural damage on imaging studies, the physician makes the diagnosis solely on clinical criteria and the findings from the clinical presentation [1] [2] [3] [4]. Head trauma prior to the onset of symptoms is a mandatory step in the development of a concussion and headaches, often accompanied by dizziness, are described as the two most frequent findings in these individuals [1] [2] [3] Nausea, vomiting, and changes in the state of consciousness can be encountered as well [1] [2] [5]. Furthermore, a concussion is known for producing various neurological changes that are primarily related to behavior and cognition - emotional lability, depression, and irritability are main patterns of mood disorders, whereas forgetfulness, memory loss, transient amnesia, reduced reaction times, and deficits in attention might also be present [1] [2] [3] [4] [5]. Visual impairment and a sense of numbness are reported by some studies, whereas altered sleep may eventually appear in the form of insomnia [1] [2] [3] [4]. In rare cases, convulsions and significant motor deficits right after head trauma can constitute the clinical picture of a concussion [1] [2].

• Pain

  Pain relief Headaches may occur in the days or weeks after a concussion. To manage pain, ask your doctor if it's safe to take a pain reliever such as acetaminophen (Tylenol, others). [mayoclinic.org]

  Certified health and sports neuropsychologist Stoler, who is herself a brain-injured patient, and coauthor Hill thoroughly cover the treatment of PCS symptoms, including headache, fatigue, balance and coordination disturbances, chronic pain, reduced memory [amazon.com]

  Usually the patient will require no more than rest and analgesics to relieve pain. However surgery may be required in some cases where there is severe bruising or swelling in the brain. [brainfoundation.org.au]

  Avoid other pain relievers such as ibuprofen (Advil, Motrin) and aspirin, as there is a possibility these medications may increase the risk of bleeding. [mayfieldclinic.com]

• Fatigue

  Fatigue and sleep problems go hand-in-hand and tend to worsen each other. Fatigue tends to be worse in the evening and makes symptoms more noticeable. Listen to your body and rest when needed. [mayfieldclinic.com]

  At the beginning and the end of the study, both groups completed tests to measure symptoms of depression and other concussion symptoms, such as headache, fatigue and problems with sleep, memory and concentration. [sciencedaily.com]

  Certified health and sports neuropsychologist Stoler, who is herself a brain-injured patient, and coauthor Hill thoroughly cover the treatment of PCS symptoms, including headache, fatigue, balance and coordination disturbances, chronic pain, reduced memory [amazon.com]

  The physician must determine the exact events that preceded the onset of complaints and exclude their presence prior to head trauma, as the clinical presentation could be similar to exercise-induced fatigue and consequent headaches or migraines. [symptoma.com]

• Unconsciousness

  You may be knocked out (unconscious) or may just feel confused. The skull bone protects your brain. Fluid inside your skull also cushions your brain. [merckmanuals.com]

  A brief unconsciousness is often associated with this, although the latest reports tell us that unconsciousness does not always occur. The unconsciousness often takes a few minutes but never longer than fifteen minutes. [braininjury-explanation.com]

• Nausea

  The Academy recommends that athletes whose symptoms -- headaches, nausea, amnesia, blurred vision -- do not clear up within 15 minutes, or who lose consciousness even briefly, be kept out of competition until their symptoms have disappeared completely [medicinenet.com]

  Repeated vomiting or nausea, convulsions or seizures (shaking or twitching). Unusual behavior, increased confusion, restlessness, or agitation. Loss of consciousness (passed out/knocked out). [brainline.org]

  Immediately after the accident, the person may be confused, not remember what happened or have nausea, blurry vision, or dizziness. The person may appear fine at first but show symptoms hours or days later. [mayfieldclinic.com]

  Repeated vomiting or nausea. Slurred speech. Look very drowsy or cannot wake up. Have one pupil (the black part in the middle of the eye) larger than the other. Have convulsions or seizures. Cannot recognize people or places. [cdc.gov]

• Orthostatic Hypotension

  hypotension, fainting, and postural orthostatic tachycardia syndrome; neurological and sensory disturbances including muscle weakness of lower limbs, deep sensibility impairment, epileptic seizure, cognitive impairment, visual impairment, balance impairment [en.wikipedia.org]

• Blurred Vision

  The Academy recommends that athletes whose symptoms -- headaches, nausea, amnesia, blurred vision -- do not clear up within 15 minutes, or who lose consciousness even briefly, be kept out of competition until their symptoms have disappeared completely [medicinenet.com]

  Partial or total loss of vision Weakness of eye muscles and double vision (diplopia) Blurred vision Problems judging distance Involuntary eye movements (nystagmus) Intolerance of light (photophobia) Hearing: Decrease or loss of hearing Ringing in the [braininjury-explanation.com]

  In addition to loss of balance or dizziness, concussions may cause: Headache A temporary loss of consciousness Feeling as if your brain is in a fog Delayed response to questions Dizziness Ringing in your ears Nausea and vomiting Fatigue Blurred vision [healthcare.utah.edu]

  Go to a hospital emergency room for these symptoms: loss of consciousness (knocked out) severe headache, including a headache that gets worse blurred vision trouble walking confusion and saying things that don't make sense slurred speech unresponsive [kidshealth.org]

  Any of these could be a sign of traumatic brain injury: confusion or feeling dazed clumsiness slurred speech nausea or vomiting headache balance problems or dizziness blurred vision sensitivity to light sensitivity to noise sluggishness ringing in ears [webmd.com]

• Ganser Syndrome

  심인성 귀머거리(Psychogenic deafness) F44.7 혼합형 해리[전환] 장애(Mixed dissociative [conversion] disorders)(F44.0-F44.6에 분류된 장애의 복합) F44.8 기타 해리[전환]장애(Other dissociative [conversion] disorders) 간저 증후군(Ganser's syndrome) 다중 인격증(Multiple personality) 심인성 혼돈(Psychogenic [dic.impact.pe.kr]

• Headache

  For headaches, acetaminophen (Tylenol) can be taken. Postconcussive headaches often are resistant to stronger narcotic-based medications. People who suffer a head injury may suffer from side effects that persist for weeks or months. [aans.org]

  A headache, cognitive deficits, emotional instability, sleep disturbances, and an overall change in mental state after trauma are highly suggestive signs of a concussion. [symptoma.com]

  […] can vary and may feel like tension-type headaches or migraines. [mayoclinic.org]

  Sometimes symptoms such as headaches, dizziness, etc. will linger for some weeks. Recovery may take longer for those who have had a previous head injury, the elderly, and those with substance abuse problems. [brainfoundation.org.au]

  During that time, your symptoms can fluctuate in intensity: Headaches are common and can be relieved with acetaminophen (Tylenol). Patients with migraines may notice worsening. [mayfieldclinic.com]

• Confusion

  Therefore, diagnosis is based on the nature of the incident and the presence of specific symptoms, confusion being a primary one. [aans.org]

  Immediately after the accident, the person may be confused, not remember what happened or have nausea, blurry vision, or dizziness. The person may appear fine at first but show symptoms hours or days later. [mayfieldclinic.com]

  For example, in the first few minutes after the injury, someone might be just slightly confused or appear a little bit dazed. But an hour later, he or she might become confused or unable to recall what was going on before the injury. [utswmed.org]

  Unusual behavior, increased confusion, restlessness, or agitation. Loss of consciousness (passed out/knocked out). Even a brief loss of consciousness should be taken seriously. [brainline.org]

• Dizziness

  Sometimes symptoms such as headaches, dizziness, etc. will linger for some weeks. Recovery may take longer for those who have had a previous head injury, the elderly, and those with substance abuse problems. [brainfoundation.org.au]

  Initial symptoms might include dizziness, slurred speech, and amnesia. Signs of concussion may not be noticeable straight away. [medicalnewstoday.com]

  Some concussions will develop into “Post-concussion syndrome” which is a complex disorder in which a number of post-concussion symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the initial injury [nicklauschildrens.org]

  To make a diagnosis, professionals look at many variables that might indicate trauma, ranging from changes in balance to memory lapses and dizziness. [brainline.org]

  Overview Post-concussion syndrome is a complex disorder in which various symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the concussion. [mayoclinic.org]

• Irritability

  In a mild concussion may be that the person in question for some time suffer from residual symptoms such as: Fatigue Headache Dizziness Concentration problems Tinnitus Anxiousness Quickly irritated; irritability, tearfulness or feeling down Sensitive [braininjury-explanation.com]

  Signs may include: lethargy and listlessness irritability changing sleeping patterns altered appetite walking or standing unsteadily, or any signs of balance and dizziness problems Serious signs in children The following signs usually mean the child needs [medicalnewstoday.com]

  Furthermore, a concussion is known for producing various neurological changes that are primarily related to behavior and cognition - emotional lability, depression, and irritability are main patterns of mood disorders, whereas forgetfulness, memory loss [symptoma.com]

  Move slowly and constantly be aware of your surroundings Do not climb stepladders or work from heights Stress, irritability, sadness and anxiety are common and normal reactions to having to cope with your symptoms and the changes in your lifestyle Find [brainstreams.ca]

  Mood swings and irritability are common. Blurry vision or loss of smell may occur. Seizures are rare, but may occur in the first week after a brain injury. Medication may be taken for 3 to 7 days to prevent seizures. [mayfieldclinic.com]

• Amnesia

  There is often a brief period (seconds or minutes) of retrograde amnesia, meaning a loss of memory for the events immediately prior to the concussion. [weillcornellbrainandspine.org]

  A period of amnesia, or not recalling what has happened, is essential to the diagnosis of concussion. [brainfoundation.org.au]

  Grade III: loss of consciousness for more than five minutes or amnesia for more than 24 hours. [mayfieldclinic.com]

  Initial symptoms might include dizziness, slurred speech, and amnesia. Signs of concussion may not be noticeable straight away. [medicalnewstoday.com]

The diagnostic workup of cases in whom a concussion is suspected must encompass a detailed history and a thorough physical examination [1] [2] [4]. The physician must determine the exact events that preceded the onset of complaints and exclude their presence prior to head trauma, as the clinical presentation could be similar to exercise-induced fatigue and consequent headaches or migraines [1] [2]. If the initial injury occurred days or weeks ago, patients should be asked about their sleeping patterns, whether they experience memory loss, or if new-onset epilepsy may have developed [1]. The physical examination is crucial for assessing the level of consciousness and awareness of the patient, but also for evaluating the cognitive status and other neurological insults that might have occurred. Because a concussion is currently classified as a form of traumatic brain injury (although this topic has become a matter of significant discussion) [6], imaging studies need to be employed in order to rule out more serious damage. Apart from the examination of the skull, plain radiography provides little benefit in patients with a suspected concussion, which is why computed tomography (CT) is used as the cornerstone of diagnostics [1] [2] [6]. Magnetic resonance imaging (MRI) and MR spectroscopy are used as even more advanced methods to reveal pathological changes in the brain that are not visible on CT [1] [2] [5].

A specialist should direct treatment and recovery of concussion. [uofmhealth.org]

It provides information on the assessment and treatment of MTBI, literature and a continuing education course. [neuroskills.com]

Unfortunately, this creates a gap in rehabilitative services, resulting in incomplete treatment and frustration for the patient, family and treatment team. The vision care professional can play an important role in the rehabilitation effort. [braininjuries.org]

Treatment for a mild brain injury is usually rest and medication. The best treatment is time to allow the brain to heal. Get plenty of sleep. [mayfieldclinic.com]

Concussion Treatment If you suspect that you or a loved one has suffered a concussion, it’s important to seek medical treatment as soon as possible. [spinalcord.com]

Almost invariably the prognosis of brain concussion is good. [ncbi.nlm.nih.gov]

We know that you have questions about your symptoms and prognosis, and our accomplished team of highly trained specialists is here to provide you with the answers you need. [barrowneuro.org]

Prognosis Most people recover completely, with no lasting problems. Sometimes symptoms such as headaches, dizziness, etc. will linger for some weeks. [brainfoundation.org.au]

The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Biobehav Rev. 2012;36(6):1510-31. Complete Listing of References [sports-health.com]

Similarly, the etiology of post-concussion symptoms is also debatable. [frontiersin.org]

Significant controversy exists over the etiology of this condition, although it is thought to be secondary to loss of autoregulation of cerebral blood flow in an already injured brain. [emedicine.medscape.com]

The epidemiology of sport-related concussion. Clin Sports Med 2011;30:1–17, vii. Meehan WP, 3rd, d’Hemecourt P, Comstock RD. High school concussions in the 2008-2009 academic year: mechanism, symptoms, and management. [apsf.org]

Epidemiology Frequency United States The incidence of head injury varies with the sport and the age of the participants; many head injuries are likely unreported due to their supposed mild nature; mild concussions may go unnoticed by teammates, coaches [emedicine.medscape.com]

WebMD REFERENCES: Boston Children's Hospital: "Head or Brain Injury" eMedicineHealth: "Concussion" Medscape: "Classification and Complications of Traumatic Brain Injury" Medscape: "Skull Fracture" Medscape: "Traumatic Brain Injury (TBI) -- Definition, Epidemiology [onhealth.com]

Epidemiology of concussion in collegiate and high school football players. [scielo.isciii.es]

American journal of epidemiology, 137(3), 342-354 ^ Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and healthy elderly. Phys Ther. 1990;70(6):340–347. ^ Elble RJ, Thomas SS, Higgins C, Colliver J. [en.wikipedia.org]

Pathophysiology Pathophysiology explains the affects of a concussion or brain injury to the physical brain. We look at traumatic injuries from macroscopic, microscopic and molecular views. This is my particular speciality area. [xlntbrain.com]

This can be attributed to a greater understanding of the effects of both acute and chronic repeated concussion on brain pathophysiology. [apsf.org]

Pathophysiology is still being clarified, but brain dysfunction is thought to involve excitotoxicity, which is neuronal damage caused by excessive release of excitatory neurotransmitters, particularly glutamate. [merckmanuals.com]

The NCAA defines concussion or mild traumatic brain injury as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces." [aans.org]

Boston Children's Hospital: "Head or Brain Injury" eMedicineHealth: "Concussion" Medscape: "Classification and Complications of Traumatic Brain Injury" Medscape: "Skull Fracture" Medscape: "Traumatic Brain Injury (TBI) -- Definition, Epidemiology, Pathophysiology [onhealth.com]

In addition, we have led the nation in creating new and fun ways to help prevent and address concussions in high school and youth sports. [barrowneuro.org]

To learn more about concussions and how to recognize, treat, and prevent them, visit Heads Up on the Centers for Disease Control and Prevention website. [health.harvard.edu]

Molecular View Brain trauma causes changes in the neurons, preventing the brain from working normally, including: Inability to regulate electrolytes which prevents the brain cells from operating properly. [xlntbrain.com]

Centre for Disease Control and Prevention. [canchild.ca]

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2. Giza CC, Kutcher JS, Ashwal S, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;80(24):2250-2257.
3. Shaw NA. The neurophysiology of concussion. Prog Neurobiol. 2002;67(4):281-344.
4. Kutcher JS, Giza CC. Sports Concussion Diagnosis and Management. Continuum (Minneap Minn). 2014;20(6 Sports Neurology):1552-1569.
5. Signoretti S, Lazzarino G, Tavazzi B, Vagnozzi R. The pathophysiology of concussion. PM R. 2011;3(10 Suppl 2):S359-368.
6. Sharp DJ, Jenkins PO. Concussion is confusing us all. Pract Neurol. 2015;15(3):172-186.