One of the pathological conditions that often occurs in medicine is a concussion. It does not cause obvious pathological changes in the tissues of the brain, but a person develops complaints, and some signs and symptoms that indicate functional disorders in the medulla. How to recognize a concussion?
The cause of a concussion of the brain substance can be trauma, shock, falling, and even too sudden movement. Often, concussion occurs in car accidents, even when there is no direct impact (impact) in the head area, when falling on the tailbone. It is believed that at this moment microscopic changes occur that cause symptoms of a concussion and a worsening of the patient's condition.
Concussion occurs after impacts and falls, as well as in road accidents
The degree of the disease
This type of injury can cause unconsciousness, but this does not always happen. For example, in young children, concussion is rarely accompanied by loss of consciousness, while older people, on the contrary, may not recover for a long time. Loss of consciousness is the main symptom of a third-degree concussion.
How do you know if you or your loved one has a concussion? There are a number of signs and complaints that allow you to determine it, they will be described below. It should be borne in mind that in young children, symptoms may not appear immediately, therefore, after an injury, you need to consult a doctor so that he can check reflexes and conduct additional research, if necessary.
If the concussion proceeds without loss of consciousness, then in the first minutes after the injury, the patient is stunned, he cannot understand where he is, answer the questions of others, sometimes memory loss (amnesia) is observed, which is a symptom of a second-degree concussion. The first degree of concussion, or mild concussion, is characterized only by temporary disorientation in space (stunnedness) and neurological symptoms that can be detected later.
| Signs | Concussion degrees | ||
| Lung | Medium severity | Heavy | |
| Deafening | immediately after injury, usually at least 15 minutes | can be observed for several hours | after loss of consciousness, with any other symptomatology |
| Amnesia | absent | retrograde or antegrade amnesia | after loss of consciousness, retrograde or antegrade amnesia occurs |
| Loss of consciousness | absent | absent | there is a loss of consciousness, short-term or long-term. |
Clinical picture
Immediately after the injury, a state of stunnedness (stupor) occurs, if the patient has lost consciousness, then the stupor is observed when he comes to his senses. The patient complains of weakness, dizziness, nausea, single vomiting is possible. The face is pale, the pulse is fast. The patient is unable to quickly answer questions, in some cases does not remember what happened to him (amnesia). There is a lack of coordination, it is difficult for the patient to stand on his feet.
Dizziness may occur immediately after injury
Later, other signs of concussion develop - lethargy, drowsiness, sleep disturbance. Sometimes there are flushes of blood to the face, dizziness, tinnitus. Often there are intolerance to noise, light (photophobia) and severe headaches. It is difficult for a person to concentrate, there is depression, irritability. This condition can last from 2-3 days to several weeks, which is more common in the elderly. It depends on the severity of the concussion and the treatment given.
When after an injury there are no symptoms inherent in a concussion, that is, the symptoms could not be determined, there was no loss of consciousness, or the person believes that everything is in order with him and does not complain about anything, in the first hours he should remain under observation, since many signs may appear later.
Symptoms and Signs
How to identify a concussion? The fact is that the symptoms of a concussion in adults differ little from those in a child or adolescent, but a child cannot always explain correctly, tell what he is feeling. Some symptoms are often associated with the patient's complaints, others can be identified on examination. Consider the most common manifestations of concussion.
| Patient complaints | Causes of occurrence |
| Headache | More often it is pulsating or bursting, it can be localized at the place of impact (counterstroke) or be widespread. Not removed when taking analgesics. May increase with noise, bright light. It occurs due to irritation of certain parts of the brain or an increase in intracranial pressure. |
| Nausea, vomiting | Vomiting usually occurs immediately after injury, is associated with irritation of the cells of the vomiting center, which is located at the bottom of the fourth ventricle, due to a sharp movement of the cerebrospinal fluid in this area or disruption of cell connections. The nausea may last longer. |
| Dizziness | A common sign of concussion, caused by disturbances in the vestibular apparatus and cerebellar tissues. It is often accompanied by impaired coordination, unsteadiness of gait, slowness of movement, which can be seen in a child if he cannot explain his condition. |
| Coordination disorders | Sometimes it is difficult for the patient to immediately perform even the usual actions, he seems to be inhibited, this is due to a violation of the conduction of impulses from brain cells to muscles. Often there is a tremor of the small muscles of the upper extremities. |
| Noise in ears | Caused by changes in the area of the auditory nerve, more often when it is compressed, during an increase in intracranial pressure. |
| Pain in the eyes | May occur when reading, watching television, or working with a computer. It is often accompanied by a headache. Children who liked to watch TV or play often become lethargic and do not even want to watch their favorite programs. There is a twitching or tremor of the eye muscles when looking to the side. |
| Pallor, skin redness, sweating | Caused by changes in the autonomic nervous system, loss of communication between cells, increased intracranial pressure. They can also be accompanied by an increase or slowdown in the pulse rate, a slow reaction of the pupils to light, which causes photophobia. |
| Irritability, depression | They arise when cells responsible for emotions are irritated. The mood often changes, the patient becomes moody. |
| Inability to concentrate | The patient does not want to do anything, it is difficult for him to concentrate on work, even to do what he loves. It is associated with a violation of the connections between the cells of the trunk and subcortical structures. |
| Sleep problems | Most often associated with a decrease in the nutrition of brain cells, due to increased intracranial pressure, are late signs with a concussion. |
| Amnesia | It can be overt or implicit. Sometimes the patient does not remember what happened, this is retrograde amnesia. Antegrade can be determined by asking you to repeat a series of several words after you, the patient does this with difficulty. |
In addition, there are neurological symptoms, which are determined by the doctor. It is not at all necessary for the patient to have all these complaints and symptoms. The diagnosis is based on a combination of some signs.
Diagnostics
When making a diagnosis, the doctor takes into account the history data (how the injury occurred, whether there was a loss of consciousness), the patient's complaints, conducts a survey to determine the concentration of attention, and detect signs of amnesia. He may ask questions about what preceded the injury, what day it is, what month it is, or ask them to do some simple tests. For example, say several numbers in reverse order, repeat a series of words. Such tests allow you to determine the impairment of memory, concentration and help to identify a concussion and orient your further actions (calling an ambulance) at home.
After this, a neurological examination of the patient is carried out. Symptoms that may indicate a concussion are as follows:
| Symptom | How to determine |
| Pupil reaction to light | The pupils can be slightly narrowed, dilated, and the reaction to light is sluggish. Usually they are symmetrical, if there is unevenness, then this indicates more serious damage, bruise, hematoma. |
| Nystagmus | Usually horizontal when looking to the side. A person cannot see an object without turning his head in his direction. |
| Asymmetry of tendon, skin reflexes | Usually this is determined by a neuropathologist, for example, knee reflexes of both lower extremities should be equally pronounced, different reflexes, or pathological, indicate a violation. |
| Oculostatic phenomenon of Gurevich | If you ask the patient to look up, then he deviates and begins to fall back, if you look down, then forward. |
| Romberg's symptom | In a standing state with shifted soles, closed eyes and arms extended forward, tremor of fingers, tremor of eyelids is observed. |
| Signs of a violation of the autonomic nervous system | Changes in heart rate, instability in blood pressure, blanching or redness of the skin. |
| Asymmetrical movements of the muscles of the face | If you ask the patient to smile, the levels of the corners of the mouth may be asymmetrically located. |
| Palmar-chin reflex | When stroking the palm of the hand in the area of the base of the thumb, contraction of the chin muscles is observed. |
| Symptoms of irritation of the lining of the brain | Rigidity of the occipital muscles, it is usually mild and passes quickly. |
| Divergence of eyeballs | When trying to concentrate, for example, to closely follow the finger of the hand with a gaze, divergence of the eyeballs is observed, and nystagmus is also determined. |
2-3 symptoms and anamnesis data are enough to make a diagnosis, but first you need to make sure that there are no more serious brain damage (bruises, fractures, hemorrhages, etc.). For this, various additional studies are used: X-rays, computed or magnetic resonance imaging, encephalography, spinal puncture.
For many people, the concussion goes away without treatment, but at home after an injury, it is necessary to provide the patient with peace, and if his condition worsens, it is imperative to consult a doctor.
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