What is a concussion?
A change in mental status or cognitive function as a result of trauma; a mild traumatic brain injury (TBI).
What are the typical symptoms of a concussion?
Concussion typically causes a rapid onset of short-lived neurologic impairment, which usually resolves spontaneously. Symptoms generally resolve with rest/observation within 7-10 days, but postconcussive symptoms can become chronic.
What are common causes of concussion?
Concussion can result from direct trauma, blast, or coup-contrecoup injury.
What changes occur in the brain during a concussion?
Changes in white matter occur, likely due to sudden release of excitatory neurotransmitters, quick release of potassium into the extracellular space, calcium entrance into the cells, and decreased cerebral blood flow.
What are the leading causes of concussion?
Falls, motor vehicle accidents, and sports injuries.
How many sports-related concussions occur annually?
Estimated 1.6-3.8 million sports- and recreation-related concussions per year; underreporting is prevalent.
What are risk factors for concussion?
Sports participation, especially contact sports; fall risk due to age; women have a higher incidence than men; postconcussive syndrome is more common in women and those with severe initial injury, previous head injuries, and comorbid psychiatric illness.
What are assessment findings for concussion?
Observed or self-reported loss of consciousness lasting <30 minutes, posttraumatic amnesia <24 hours, GCS score ≥13, confusion, delayed responses, pain/dizziness/headache, visual disturbances, irritability, and changes in sleep patterns.
What physical findings may indicate a concussion?
Physical exam is often normal; however, injuries/fractures involving the head or neck, persistent rhinorrhea or otorrhea, and abnormalities in visual field exam may indicate concussion.
What are differential diagnoses for concussion?
Severe TBI, subdural or subarachnoid hemorrhage, seizure disorder.
What diagnostic studies are used for concussion?
Neurocognitive sideline testing, Acute Concussion Evaluation (ACE) tool, and CT scan if certain criteria are met.
What are prevention strategies for concussion?
Use of helmets in sports, seatbelts, proper child restraints, baseline neurocognitive tests, and safety measures to prevent falls.
What is the primary treatment for concussion?
Physical and cognitive rest for 24-48 hours; early return to nonstrenuous, noncontact activity can accelerate recovery.
What accommodations may be recommended for concussion recovery?
Frequent rest breaks, no standardized testing, and less computer work.
What additional support may be beneficial for concussion patients?
Physical therapy for persistent head or neck pain, vocational rehabilitation for returning to work, and education to reduce symptom duration and severity.
What is the focus of pharmacologic management for concussion?
Symptom management only; no medications have an FDA indication for the treatment of concussion.
What may help speed recovery after a concussion?
Omega-3 fatty acids may help due to possible reduction in DHA in the brain after TBI.
What should be considered for short-term insomnia management in concussion patients?
Melatonin, tricyclic antidepressants; avoid benzodiazepines due to negative effects on arousal and cognition.
What is recommended for headache management in concussion patients?
Acetaminophen and/or NSAIDs; if ineffective, consider agents used to treat migraines, pain syndromes, tension-type headaches.
What should drug therapy target in concussion management?
Specific emotional symptoms; for depression use SSRIs, for anxiety use buspirone.
What medication may enhance cognitive processing after a concussion?
Amantadine.
What is the mechanism of action for nonbenzodiazepine, benzodiazepine receptor agonists?
They interact with GABA-benzodiazepine receptor complexes.
What is the FDA indication for zolpidem?
Treatment of insomnia.
What is the half-life of zolpidem?
2.5-3.1 hours.
