Diagnosis and management of concussion

Abstract

Cerebral concussion is a minute and diffuse injury to the brain caused by direct or indirect violence. A diagnostic symptom is loss of consciousness of momentary to prolonged degree. There is often an associated transient or permanent loss of memory for detail preceding the accident for a short time. Symptoms of dizziness or headache may persist for some time, and are known as the post-concussion syndrome with no objective neurological evidence of damage found. The post-concussion syndrome of cognitive, emotional and physical complaints typically resolves in a matter of weeks, but in some cases persists for months after the injury. Research has supported the hypothesis that in some patients with mild brain injury persistent symptoms are tied to neurologic changes that are not difficult to find on CT or MRI Litigation is a major factor in the persistence of the post-concussion syndrome, less frequently because of malingering and more often because those with chronic problems related to their injury are most likely to sue, and the litigation process requires constant attention to and reminders of the consequences of the injury. Patients and their families benefit significantly from education and reassurance regarding the nature of concussion related problems, and strategies for minimizing secondary disturbance and stress.