What is concussion?
Concussion is the most common form of injury to the brain. The labels ‘concussion’ and ‘head injury’ are often used interchangeably. Most people fully recover from a concussion relatively quickly, but some can suffer ongoing persistent symptoms (this is usually called post-concussion syndrome).
Concussion may be caused by a direct bump or blow to the head, for example, a collision during sport or road traffic accident. There need not be a direct blow to the head; a sudden jolt or violent shaking of the head can have the same effect of causing the brain to bounce, shake and twist within the skull.
Through either a direct blow or a jolt, these forces can stretch nerve fibres and can create chemical changes which can damage brain cells.
What are the symptoms of concussion?
It is common to associate concussion with being ‘knocked out,’ or the loss of consciousness. In fact, loss of consciousness only occurs in about ten per cent of concussions and is not required for a diagnosis. The symptoms of concussion frequently include headache, dizziness and difficulties balancing. There may also be difficulties with speech and memory.
When there has been a blow to the head which causes evident symptoms, the likelihood of concussion is clear. However, in many cases, this may be less evident: during fast-moving contact sport, a blow to the head may not be seen. Concussion can occur from an incident which may not appear serious, such as slipping over and a bump to the head upon falling. Therefore, even if the cause of the injury seems mild or is unclear, it is very important to pay attention to possible symptoms of concussion. Symptoms usually occur within 24 to 48 hours of the injury.
Should you go to hospital?
Yes: any suspected cases of concussion should be seen and assessed by a doctor, even if symptoms seem to be mild or the person seems to be recovering. The Accident and Emergency department is best because of the access to CT and MRI scanning equipment.
The current recommendations (particularly from world of concussion in sport) is that all concussions should be taken seriously.
A concussion is unlikely to be seen on a regular CT or MRI scan. This is because the changes are extremely small and will not appear in standard imaging technology. You may have a CT or MRI scan, but these are primarily to check for any signs of swelling (edema), bleeding (hemorrhage), bruising (hematoma) or fluid in the brain which may need monitoring or treatment. If anything is seen on a scan, then the diagnosis is usually not a concussion or mild traumatic brain injury: it is usually classed as a moderate or even a severe brain injury.
The medical definition of concussion
A concussion (sometimes referred to as a head injury) or mild traumatic brain injury is usually defined in situations when a person has suffered a:
- A blow or jolt (shaking) to the head that causes a change in brain function and mental state including feeling dazed, disorientated or confused or any loss of memory.
And where none of the following indicators are exceeded:
- No loss of consciousness or loss of consciousness under 30 minutes
- Glasgow Coma Scale (GCS) of 13 – 15
- Post-traumatic amnesia (memory loss) less than 24 hours
- A clear CT or MRI scan (no bleed or bruising evident)
Many patients are told no damage is evident and are sent home, advised to rest, to avoid alcohol and driving until symptoms improve. This is because the majority of people recover relatively quickly.
What if symptoms of concussion don’t improve?
In adults, symptoms would normally be expected to improve within 10 to 14 days of the injury occurring. In children and adolescents, who are recognised as being more susceptible to concussion, symptoms may take up to four weeks to improve.
If you or your family member are experiencing these symptoms, it is important to urgently go back to hospital:
- Loss of consciousness
- New deafness in one or both ears
- Loss of balance or problems walking
- Any weakness in one or both arms or legs
- Any vomiting
- Clear fluid coming out of your ears or nose
- Drowsiness when you would normally be wide awake
- Increasing disorientation
- Problems understanding or speaking
- Blurred or double vision
- Severe headache not relieved by painkillers such as paracetamol
- Bleeding from one or both ears
- Any fits (collapsing or passing out suddenly)
- Inability to be woken
We know from studies that a significant majority do not recover quickly and suffer ongoing persistent symptoms. These symptoms may be obviously linked with the original concussion, although sometimes, people find they are struggling in a number of ways, but it may not be immediately clear that this is due to concussion. Post-concussion syndrome is a recognised diagnosis of symptoms associated with concussion for those that do not recover within these time frames. This diagnosis is commonly given at around three months, but may be given sooner. We consider post-concussion syndrome in more detail here.
Why is concussion often missed?
Concussion can be easy to miss because there may be no external sign of injury, no loss of consciousness or there may be other more immediately serious injuries that are focussed on. All patients are advised they are likely to recover from concussion quickly and this is the case for the majority of people. However, when this is not the case, there may be difficulties recognising the problems an individual continues to experience are due to the original concussion.
In our experience those with persistent symptoms may have difficulty explaining this to employers, family and doctors as they think they should have recovered by now. Also, the symptoms can be confused and overlap with other conditions such as depression or as a consequence of the traumatic event (such as Post Traumatic Stress Disorder).
This can mean that the concussion or persisting symptoms can be missed and people can have difficulties getting access to the treatment, rehabilitation, education and support systems that they need. We understand the difficulty that this can cause, and we specialise exclusively in concussion and brain injury cases.
Sometimes it is the family member equally as much as the injured person that notices and feels that “they are simply just not right”. We work closely with those who we believe are the best concussion and brain injury specialists around the country and will make it a priority that you get access to the treatment, rehabilitation and support you need. We take over cases from other solicitors where the client or family members feels that they need advice from a specialist in concussion and brain injury claims.
If you would like some further advice or just someone to talk to then please do not hesitate to get in contact with us. All initial advice is in absolute confidence at no charge and without any commitment.