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Mild Traumatic Brain Injury/Concussion

Concussion

Concussion is a commonly used term meaning a mild traumatic injury to the brain. Given this, many doctors (myself included) prefer to use the term “mild traumatic brain injury” (TBI). This has the advantage of stating explicitly what the issue is - the brain has been injured - an important and significant event.

Some researchers have proposed that the term “concussion” should be retired. I would agree.

Mild Traumatic Brain Injury

Mild TBI is usually defined as TBI with one or more of the following features:

  • loss of consciousness
  • loss of memory for events immediately before or after the accident
  • alternation in mental state at the time of the incident (e.g. feeling dazed, disorientated, or confused),
  • focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does not exceed any of the following:
    • loss of consciousness of approximately 30 minutes or less;
    • after 30 minutes, initial Glasgow Coma Scale (GCS) of 13-15;
    • post-traumatic amnesia not greater than 24 hours.

Moderate and Severe Traumatic Brain Injury

Where any of the three severity markers (see below) are present, TBI is graded as being moderate or severe in its extent:

  • loss of consciousness of approximately 30 minutes or less;
  • after 30 minutes, initial Glasgow Coma Scale (GCS) of 13-15;
  • post-traumatic amnesia not greater than 24 hours.

Moderate and severe TBI are not discussed further here.

Symptoms in Mild Traumatic Brain Injury

Common symptoms after mild TBI include:

  • headache and dizziness;
  • fatigue and poor sleep;
  • altered cognition: memory impairment, reduced concentration;
  • changes in mood: irritability, anxiety and depression;
  • sensory sensitivity: commonly to light and noise;

Symptoms resolve in two thirds of mild TBI by 3 months. The remainder have more persistent symptoms, with the potential to improve.

Management of Symptoms After Mild Traumatic Brain Injury

Neuropsychological support is a major domain of symptom management after mild TBI. This can be self-directed, or supported by a neuropsychologist. The patient is helped to develop cognitive and behavioural strategies to reduce the effects on day-to-day life, noting the natural tendency for the burden of symptoms to slowly reduce over time.

Symptomatic recovery usually involves a combination of:

  • for headache and sensory sensitivity: avoid overuse of simple pain killers, consider atypical pain medication where appropriate;
  • for dizziness: diagnose and treat vestibular disorders, where present(e.g. benign paroxysmal positional vertigo [BPPV], or persistent postural-perceptual disorder [PPPD]);
  • for fatigue: gradually building up activities, avoiding excess alcohol;
  • for poor sleep: good sleep hygiene and being aware that too much sleep does not help;
  • for altered cognition: brain training, and keeping the mind active;
  • for changes in mood: relaxation, and where appropriate considering anti-anxiety and anti-depressant medication;

Resources

https://headinjurysymptoms.org/ is excellent.