Concussion

HOW ARE SPORTS RELATED CONCUSSIONS DIAGNOSED AND TREATED?

 
concussion evaluationMany patients will initially be evaluated on the sideline by a coach or athletic trainer who will perform a baseline assessment which may include the following:

 

MENTAL STATUS TESTING:
Orientation Time, place, person, and situation (circumstances of injury)
Concentration Digits backward (e.g., 3-1-7, 4-6-8-2, 5-3-0-7-4);
Months of the year in reverse order
Memory Names of teams in prior contest;
Recall of 3 words and 3 objects at 0 and 5 minutes;
Recent newsworthy events;
Details of the contest (plays, moves, strategies, etc.)

 

EXTERNAL PROVOCATIVE TESTS:
40-yard sprint;
5 push ups;
5 sit ups;
5 knee bends;
(any appearance of associated symptoms is abnormal,
e.g. headaches, dizziness, nausea, unsteadiness,
photophobia, blurred or double vision, emotional
lability, or mental status changes)

 

NEUROLOGIGAL TESTS:
Pupils Symmetry and reaction
Smooth pursuits
Coordination Finger-nose-finger
Timed tandem gait and task switching
Sensation Finger-nose (eyes closed) and Sway on Romberg

 

Some institutions and professional sports organizations also use a standardized test SCAT3 (see our concussion toolbox) which is usually given before the start of the season and again if the athlete is suspected to have suffered a concussion. The testing involves many of the items listed above, however is somewhat controversial as many athletes do not take the initial testing very serious and have actually performed better after a concussion. Therefore the test is not intended to act as a stand alone evaluation or a substitute for more formal neuropsychological testing.  Athlete should be evaluated by a physician specializing in the diagnosis and treatment of concussion.

 

MOST IMPORTANT!!!

Any athlete with a suspected concussion should be REMOVED FROM PLAY, medically assessed, monitored for deterioration (i.e., should not be left alone)

 

athletic trainer baselineDepending on the severity of the concussion the athlete may be taken to a local emergency room for further evaluation and diagnostic imaging (as a rule any loss of consciousness, seizure, prolonged amnesia and focal neurological findings on examination warrant imaging with MRI preferable to CT if available). If the player is sent home then it is recommended that they be closely monitored for the first 24 hours for changes in their neurological status as the appearance of symptoms may be delayed for hours.

 

During the first week the athlete should be evaluated by a physician preferably a neurologist or neurosurgeon, and if available one specializing in the diagnosis and treatment of sports related concussion. The physician may recommend more detailed imaging studies including the latest technique, Diffusion Tensor MRI. This test is used to look for changes in the brains white matter, i.e. its wiring, which can be damaged by the force or a concussive injury. These changes can be temporary theoretically representing transient swelling or inflammation of the white matter or more permanent injury i.e. shearing of the white matter. Some patients, especially professional athletes and those with prolonged cognitive symptoms may also undergo formal neuropsychological testing. The doctor may also prescribe medications to treat the associated symptoms such as headache, nausea, depression, anxiety and trouble sleeping. At no time should narcotic pain medications, barbiturates or benzodiazepine medications and sleeping pills be used in treatment as they have the potential to worsen the cognitive and physical symptoms, increase underlying depression, have dependency issues, and can trigger medication overuse headaches. In fact most of the symptoms of the concussion will gradually resolve on their own and do not require treatment.