A concussion is a mild traumatic brain injury in which a blow or jolt to the head briefly disturbs brain function. Standard scans are usually normal, and most people recover within days to a few weeks.
Key symptoms
- Headache, dizziness, nausea
- Confusion, feeling foggy or slowed down
- Memory gap around the event; loss of consciousness is not required
- Sensitivity to light and noise, blurred vision
- Sleep changes, irritability, trouble concentrating
What you find on exam
- Glasgow Coma Scale and orientation
- Full neurological exam, pupils and balance
- Look for signs of skull fracture and check the neck
- Sideline tools such as the SCAT for athletes
Tests
- Head CT only when a decision rule shows risk (Canadian CT Head Rule; PECARN in children)
- Reasons to scan: repeated vomiting, age 65 or older, anticoagulants, skull fracture signs, GCS below 15
- No lab test confirms a concussion
Treatment basics
- Remove from play the same day; no return until cleared
- Relative rest for 24 to 48 hours, then a gradual return to light activity
- Stepwise return to school first, then to sport
- Acetaminophen for headache; limit screens early if they worsen symptoms
- Symptoms beyond 4 weeks: refer to a concussion specialist
Red flags
- Worsening headache, repeated vomiting or a seizure
- Increasing drowsiness, confusion or one pupil larger than the other
- Weakness, numbness or slurred speech
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.