Bumps to the head: minor concussion and post concussive symptoms

Recently I have seen a few patients in my office with minor concussions. They all pressented with post concussive symptoms and hence that shall be the focus of my post on this gorgeous June day.  So what is a concussion and what is a “minor” concussion? Concussion is usually a closed head injury with temporary loss of brain function or rather loss of consciousness. By closed head injury, I mean that nothing penetrated the brain. Example of a penetrating head injury shall be a gun shot wound to the head.  Do not get me wrong here-obviously a penetrating head injury shall likely result in loss of consciousness and temporary or permanent loss of some brain function.

That said the word concussion is more commonly used for closed head injuries. Let me give you a few prime examples of concussion.  I am a big fan of boxing and the UFC. Anyone who watches these sports has seen a concussion. Boxer A walks into a stiff jab thrown by Boxer B. Down he goes and is out for the count. The ringside doctor jumps into the ring to examine him. Flips his eyes open and flashes a light into both of them.  After a momentary loss of consciousness, our fallen boxer comes to. Open his eyes but has a dazed look. He is able to answer the ringside doctors questions (show me two fingers with your left hand). He struggles to his feet but his legs are wobbly.  The referee consults the doctor and decides to halt the fight.  So what happened to our boxer? He just sustained a concussion.

Concussions can be graded into mild, moderate and severe. This is quite arbitrary. If the loss of consciousness is more than half an hour the concussion is graded as severe. Minor concussions, which shall be the focus of our talk henceforth, are usually associated with either no or momentary loss of consciousness.  Let me give you a few examples of minor concussions. Walking into a door, bumping your head against a low lying ceiling or a car door are all examples of minor closed head injury with or without concussion.  Majority of patients walk away from such an injury and never seek any medical attention because they experience no ill-effects. A few though  are not so lucky and post the head injury are plagued by headache (post concussive headache), problems with memory and concentration (especially when they are multi-tasking) and a myriad of other complaints such as subjectively feeling off balance, difficulty with sleeping and mood changes such as irritability. All these symptoms after a closed head injury/ concussion are included under the umbrella of post concussive symptoms.

In my next post, I  shall discuss post concussive syndrome and its treatment.

Nitin Sethi, MD

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