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Learn the six types of concussions that clinicians use to classify brain injuries based on their symptoms.
A concussion is a form of traumatic brain injury caused by a hard bump, blow, or jolt to the head. It may be seen in the case of falls, road traffic accidents, and sports injuries, or due to something falling on the head.
Although most concussions are mild and do not have any long-lasting complications, every concussion must be evaluated by a doctor. This is especially important in children and cases of sports injuries.
Most doctors classify concussions into three types depending on their parameters called Glasgow Coma Scale (GCS).
- Mild concussion: Scores of 13 to 15 on GCS and no loss of consciousness
- Moderate concussion: Scores of 9 to 12 on GCS and loss of consciousness less than 15 minutes or no loss of consciousness
- Severe concussion: Scores of 3 to 8 on GCS and loss of consciousness for 15 or more minutes
GCS is based on three responses, namely, eye-opening response (spontaneous, on calling out, to pain stimuli, nil), verbal response (oriented, confused, inappropriate answer, incomprehensible answer, no answer), and motor response (obeys a command, only pain elicits movement, moves away from a painful stimulus, no movement). Each response is graded based on full, partial, or no response to stimuli.
Some clinicians prefer to classify concussions into six types based on symptomatology, which include:
- Physical (somatic) type concussion: Symptoms include pain, nausea, vomiting, and loss of consciousness after the head trauma
- Cognitive type concussion: Symptoms include temporary or permanent memory loss, reduced ability to concentrate, trouble multitasking and retaining new information, convulsions, irritability, and slurred speech
- Emotional (affective) type concussion: Mood swings, personality change, and newfound anxiety or phobias.
- The concussion that affects sleep: Presents as insomnia (lack of sleep), heightened sensitivity to sounds and lights, and poor sleep quality
- Vestibular type concussion: Symptoms include giddiness, vertigo, loss of coordination, and nystagmus (abnormal eye movements)
- Ocular type concussion: Symptoms include the inability to read out long passages in a book or work on screens due to lowered color/light sensitivity, poor night vision, altered depth perception, blurred vision and seeing stars before their eyes (phosphenes), or photopsia (flashes of lights before the eyes)
How to test for a concussion
Every concussion, however minor, needs evaluation. The doctor will assess your symptoms based on a checklist that you have to fill out yourself or by the person accompanying you.
The doctor will then perform a clinical examination for balance testing, vision, coordination, memory, and speech disturbances. They will order a brain computed tomography or magnetic resonance imaging scan to rule out cranial fractures and hematomas (collection of blood around the brain tissue).
In case of moderate or severe concussions, they may perform an electroencephalogram to check your brainwaves, a videonystagmography to examine inner ear/balance function, and a transcranial doppler ultrasound to evaluate blood flow in the brain.
What happens if a concussion goes untreated?
An untreated concussion can have acute and long-term sequelae, especially in case of moderate or severe concussion, which include:
- Coma or death: Severe brain injury causes the brain to swell due to edema. Because the cranium is a closed space, edema causes pressure buildup over respiratory and cardiovascular centers (areas in the brain that control breathing, heartbeat, and blood pressure), depressing them, and causing the person to slip into a coma or die.
- Post-concussion migraine: Many individuals complain of crippling migraine attacks after concussion episodes, especially if the injury was left unattended.
- Post-traumatic epilepsy: The injured part of the brain may change, causing seizures or epilepsy.
- Post-concussion syndrome: Some individuals complain of headaches, dizziness, and problems with concentration and memory weeks after the concussion. Some develop anxiety and phobias, irritability, mood swings, and increased sensitivity to lights and sounds. Symptoms occur within the first 7 to 10 days and go away within three months. Sometimes, they can persist for a year or more.
- Dementia: Loss of higher functions such as comprehension, memory, and ability to multitask may often be lost or compromised after a head injury.
Which medicines should you not take with a concussion?
The most important thing to do post a concussion is rest for the first 24 hours and ensure adequate hydration. Any visible wound over the head should be cleaned and dressed.
You must avoid the following medications, especially during the first 24 hours:
- Aspirin, Naprosyn, and Aleve (naproxen sodium), and Advil (ibuprofen); may mask trauma symptoms and increase bleeding risk
- Opiate-containing painkillers (these can depress brain functions further)
- Alcohol
- Caffeine-containing beverages
Have someone stay with you for 12 to 24 hours to watch for any new symptoms. They should call the doctor or nurse right away if they have any trouble waking you up or observing new symptoms.
When should you go to the emergency room for a concussion?
Here are 15 red flags in case you have a suspected concussion:
- Bleeding from the nose and ears or bruising around eyeballs after the blow
- Loss of consciousness
- Bump (the size of an egg or bigger)
- Laceration or bleeding over the scalp
- Feeling drowsy or disoriented
- Severe headache or a headache that gets worse
- Vomiting after sustaining the trauma
- Seizure or abnormal body movements
- Seeing flashes of light or floaters before the eyes
- Trouble walking or standing
- Slurred speech
- Weakness or numbness in any part of the body
- Loss of bladder or bowel control
- Head trauma in a child (however mild) needs evaluation
- Head trauma over the temple (thinnest part of the cranium)
