The Center for Neuropsychology and Counseling

“Seeing stars,” “a bruise on the brain,” or just a good ol’ fashioned bonk to the head? This can be hard to sort out, especially with how this condition tends to be portrayed by the media. Surprisingly, not all concussions look like someone passing out, waking up in a daze with an open wound on their forehead and a little trickle of blood, being shaken and told they have to stay awake.

By definition, a concussion happens when some sort of force or impact occurs, and the brain is injured. Concussions happen as a result of many different situations: falls, contact sports, car accidents, and more. Our brains are suspended in fluid to help protect it from damage, but any sudden jolt with enough force may jostle the brain and cause it to twist or hit up against the skull, resulting in an injury to the brain tissue.

But not all bonks to the head will automatically lead to a concussion. So how do we know if we should be concerned? Here are some common symptoms to look out for immediately following the event (first 24 hours):

• Loss of consciousness (LOC) – fainting or passing out after impact
  • Note: this can be very brief and be over by the time someone walks over to check
• Posttraumatic Amnesia (PTA) – blacking out or being unable to recall what happened immediately prior to or following the impact
  • For more significant concussions, this may last for a few hours
• Vomiting
• Confusion – repeating themselves, forgetting information that was just told to them,
  • Disorientation – being confused about the time (when?) and place (where?), personal information (who?), or the situation (what?)

The initial symptoms immediately following the accident tell us a lot about how severe a concussion is, so pay attention if you can! If you personally have experienced a concussion, be sure to ask any witnesses or medical providers for information for your records. If you witness a concussion, make note of how long a person may have been unconscious for, or what their behavior was like right after they hit their head.

For less severe concussions, some of these more significant symptoms may not have been observed right away. That doesn’t necessarily mean that there was no injury! Here are some common symptoms that may emerge after the initial event, usually within the next few days:

• Physical symptoms
  • Headaches
  • Dizziness or nausea
  • Light or sound sensitivity
  • Fatigue
  • Vision changes – blurry vision, double vision
  • Balance problems
  • Sleep changes – sleeping more or less, fitful or disrupted sleep
• Cognitive
  • Confusion or “fogginess”
  • Attention problems – distractibility or difficulty concentrating
  • Memory problems – forgetfulness or difficulty remembering things
  • Impulsivity – doing things without thinking
• Emotional
  • Anxiety
  • Irritability
  • Mood changes – being more emotional or tearful than usual
    • This is especially noteworthy if the concussion was the result of a serious accident or assault

All in all, it’s important to know about the different ways concussions may show up and what to do. Let’s say you were at your child’s soccer game, and just watched them collide head-on with another athlete after a gnarly header. Maybe it’s not clear if they lost consciousness during the scuffle of teammates, coaches, and trainers making their way onto the field, but they finally stand up and are shaky on their feet, confused, and pale. Here are some options for what to do if you have concerns that you or a loved one has suffered a concussion:

• Immediately remove yourself or your loved one from the impact zone to avoid further injury
• Seek medical attention at an urgent care, emergency room, or primary care physician depending on the severity of symptoms and any other injuries
  • For example, if there was no apparent loss of consciousness, your child was able to independently get up and walk over to the bench, and they talked about their symptoms with clarity, you may take your child home to rest before calling the pediatrician
  • Conversely, if there was an observed or likely loss of consciousness, your child is very confused and repeating themselves or vomits, then you may insist that your child be transported via ambulance to the emergency department immediately
    • If you have serious concerns about a severe head injury, be very wary about transporting a child independently
    • Once you arrive at the ED,  there will likely be an examination, some testing, and regular monitoring of symptoms
      • This may include brain imaging, such as a CT scan, to make sure there is not significant bleeding or damage to the brain
• Keep track of any concerning symptoms that are seen
• Prioritize rest and limiting stimulation on the brain
• Seek support for how to best manage concussion recovery (That includes us!)

Here at The Center, we have qualified clinicians who specialize in brain injuries and concussion care. We are happy to personally evaluate and monitor concussion recovery, as well as provide education about concussions and strategies for optimal recovery. Please don’t hesitate to contact our office at 215-491-1119 or info@thecenterinpa.com. And please stay tuned for more information to come regarding general concussion and recovery information.

Casey Terzian, PsyD, Clinical Neuropsychologist