What happens during a concussion
The brain lies inside the skull, surrounded by fluid that dampens shocks. During a sudden impact or, equally important, during sudden acceleration and deceleration of the head - as in a whiplash injury in a car - the brain is displaced inside the skull, nerve fibers are stretched, and a cascade of biochemical changes is triggered in the cells. Sodium and calcium ions rush into the cells, potassium comes out, the brain's need for energy increases sharply, and blood flow decreases. A kind of energy crisis arises, which lasts from several days to several weeks. It is he who explains the headache, the fog in the head, and the inability to concentrate, although everything is fine in the pictures.
- Falling from one's own height is the most common cause in children and the elderly
- Sports injury: martial arts, football, cycling, skiing
- Road traffic accident, including without direct impact to the head
- Domestic injury, hitting a low ceiling, falling on a slippery floor
- A blow to the head in conflict
Symptoms: immediately and then
Manifestations of concussion are divided into several groups, and not all of them appear in the first minutes. Some symptoms occur within a few hours or the next day - this is typical and does not mean worsening. Loss of consciousness, contrary to popular belief, occurs only in a minority of victims and usually lasts seconds or minutes; its absence does not exclude anything.
There is also a downside to this problem. Since a person looks healthy outwardly and his tomography tests are in order, those around him often stop taking his complaints seriously. Meanwhile, the feeling of fog in the head and the inability to keep attention on a working document is not suspiciousness, but a direct consequence of the energy crisis in the brain cells. For a driver, machine operator, surgeon or student taking an exam, this condition is dangerous, and recognizing it is as important as applying a bandage to a visible wound.
- Physical: headache, dizziness, nausea, vomiting, tinnitus, photophobia, sensitivity to loud noises
- Cognitive: Sluggishness, brain fog, difficulty concentrating, slow responses, loss of memory of the time of injury
- Emotional: irritability, tearfulness, anxiety, unusual temperament
- Sleep-related: drowsiness, insomnia, light sleep
- Brief loss of consciousness - in a minority of victims
- Short-term amnesia for events before or after the injury
In young children, the picture is different: they cannot describe the headache, and unusual tearfulness, refusal to eat, loss of interest in favorite toys, changes in gait, and sleep disturbances come to the fore. In older people, symptoms are often blurred and attributed to age, and the risk of intracranial hemorrhage is higher - especially in those taking blood thinners.
Who needs a computed tomography scan?
The doctor’s task in case of a head injury is not to confirm a concussion, but to exclude what is dangerous: intracranial hematoma, brain contusion, skull fracture. CT scan shows exactly this. It is neither necessary nor harmless to do it to everyone, so there are criteria by which they decide who really needs the research.
It is worth immediately removing the opposite expectation. A clean tomogram does not cancel the diagnosis: in case of a concussion, it should be normal, because the function is damaged, not the structure. The phrase “CT scan is good, it means there is nothing” is incorrect - it only means that there is no hemorrhage and fracture, that is, life-threatening is excluded, but the concussion itself does not go away and requires a recovery regime. The confusion between these two things is the reason why many return to work and sports too early.
- Loss of consciousness or amnesia for events surrounding the injury
- Repeated vomiting - two episodes or more
- Increasing or severe headache
- Age 65 and older
- Taking anticoagulants or bleeding disorders
- Signs of a skull fracture: discharge from the nose or ear, bruising around the eyes or behind the ear
- Seizures, focal neurological disorders, confusion
- Severe mechanism of injury: traffic accident, fall from a height, ejection from a vehicle
If none of these signs are present, and the person is clearly conscious and his condition is not worsening, the doctor can get by with observation. Magnetic resonance imaging is usually not needed in the acute period: it sees fresh blood worse and is not faster. MRI is appropriate later, for prolonged complaints. X-ray of the skull as an independent method for head trauma is practically not used today: it shows the bone, but says nothing about what is happening inside.
Light period: why you can’t relax
There is a peculiarity due to which a head injury cannot be assessed by how you feel in the first hour. With an epidural hematoma - bleeding between the skull and the dura mater - a person may lose consciousness for a short time, then come to, feel almost normal, talk and even go home. This period is called the light interval, it lasts from several tens of minutes to several hours. During this time, the hematoma increases, and then the condition worsens sharply: the headache increases, vomiting appears, the person becomes lethargic and loses consciousness.
- В первые 24–48 часов пострадавший не должен оставаться один — рядом нужен взрослый, способный заметить ухудшение.
- Наблюдать нужно за уровнем сознания, головной болью, рвотой, речью и силой в конечностях.
- При появлении любого of тревожных признаков — немедленно вызывать скорую помощь, а не ждать утра.
- Спать можно и нужно: сон не маскирует ухудшение, если человек нормально пробуждается при обращении к нему.
- Алкоголь в первые сутки исключён полностью — он и маскирует симптомы, и увеличивает риск кровотечения.
- Обезболивающие принимать только те, что разрешил врач: некоторые препараты влияют на свёртываемость крови.
Treatment and return to normal life
Until recently, the standard was strict bed rest for a week or two in a darkened room. It is now known that this is rather harmful: prolonged isolation slows down recovery, increases anxiety and prolongs the period of complaints. The modern approach is relative rest for the first 24–48 hours, followed by a gradual, measured return to activity, guided by worsening symptoms.
- Первые 1–2 суток: физический и умственный покой, ограничение экранов, громких звуков и яркого света, достаточный сон.
- Next — лёгкая активность, не усиливающая симптомы: спокойная ходьба, короткие бытовые дела.
- Постепенное увеличение умственной нагрузки: чтение, работа, учёба сначала короткими интервалами с перерывами.
- Затем — аэробная нагрузка лёгкой и умеренной интенсивности, которая, по современным данным, ускоряет восстановление.
- Возвращение к работе или учёбе с сокращённой нагрузкой, если полная вызывает головную боль или трудности с концентрацией.
- Последний этап — спорт, сначала без контакта, затем контактный, и только с разрешения врача.
Medicines play a supporting role: painkillers for headaches approved by the doctor, anti-nausea medications, sleep correction. No drugs speed up brain recovery after a concussion, and promises to the contrary should be taken critically. The main treatment factors are sleep, gradual exercise, avoidance of alcohol and patience.
If symptoms do not go away
In most adults, complaints disappear completely within 2–4 weeks; in children and adolescents, sometimes longer. If headaches, dizziness, irritability, sleep disturbances and difficulties with concentration persist for more than a month, they speak of post-concussion syndrome. This is not a “weakness of character” or a fiction: the condition is real, but it is not treated with rest, but with active work - dosed aerobic exercise, vestibular rehabilitation, normalization of sleep and, if necessary, help with anxiety.
- Headache that lasts longer than a month
- Persistent dizziness and unsteadiness when walking
- Difficulty with concentration and memory that interferes with work or study
- Irritability, anxiety, depression
- Persistent sleep disturbances
- Poor tolerance to noise, light and screens
Prolonged concussions are more common in those who have had concussions before, in people with migraines, anxiety disorders, and sleep disorders before the injury, and in teenagers. Expectation plays a special role: if a person is convinced that a concussion inevitably leaves lifelong consequences, recovery is worse - this is a confirmed pattern, not reasoning. Therefore, an explanation of what is happening to the brain and what to expect in terms of timing is itself included in the treatment and significantly improves the outcome.