A concussion is a mild traumatic brain injury that results from a bump, blow, or jolt to the head, or a hit to the body that causes the brain to move rapidly back and forth. This movement can stretch and damage brain cells and create chemical changes. Seeking prompt medical evaluation from a doctor after a suspected head injury is important.
Initial Symptom Assessment
A doctor’s initial step in evaluating a potential concussion involves a thorough discussion with the patient, or a witness if the patient is unable to provide details, about the injury event and any symptoms experienced. The doctor will ask how the injury occurred, including the force of impact and if there was any loss of consciousness. They will also inquire about any immediate symptoms, such as headache, dizziness, nausea, confusion, or sensitivity to light or sound.
The assessment includes symptoms that may develop hours or days after the injury, as concussion symptoms often do not appear immediately. The doctor will ask about physical symptoms like neck pain, blurred vision, or ringing in the ears. Cognitive changes such as difficulty concentrating, memory problems, or feeling “foggy” are important to report. Emotional symptoms, including irritability, anxiety, or sadness, and sleep disturbances like insomnia or excessive sleepiness, are also reviewed.
Neurological and Physical Examination
Following the symptom assessment, a doctor performs a general physical and neurological examination. This begins with checking vital signs like blood pressure and heart rate. The doctor will visually inspect the head and neck for any signs of external injury, such as cuts, bruises, or swelling, and may gently palpate the skull for tenderness or deformity.
The neurological exam assesses brain functions. The doctor checks pupillary response, observing if pupils react appropriately to light, which can indicate issues with cranial nerves. Eye movements are also evaluated, as the doctor asks the patient to follow a finger or object. Facial symmetry is observed, and the patient may be asked to smile or frown to assess facial nerve function. Muscle strength and reflexes in the limbs are also tested.
Cognitive and Balance Testing
Doctors perform specific tests to evaluate cognitive functions and balance. Cognitive assessments include evaluating memory by asking the patient to recall a short list of words or a series of numbers. Concentration is tested by having the patient repeat numbers backward or perform simple mental calculations. Processing speed might be assessed through rapid naming tasks or by asking the patient to respond quickly to a series of questions.
Orientation is also checked, where the patient is asked about the current date, time, location, and their own name. Balance assessments are a key part of the examination. The doctor might ask the patient to stand on one leg or perform a tandem gait, walking heel-to-toe in a straight line. Standardized tools, such as the Sport Concussion Assessment Tool (SCAT5), are often utilized for evaluation.
When Imaging is Necessary
Medical imaging, such as CT scans or MRIs, plays a specific but limited role in concussion diagnosis. These scans are not typically used to diagnose a concussion itself, because concussions are primarily functional injuries that do not usually show visible structural changes on standard imaging. Instead, imaging is primarily employed to rule out more serious, underlying structural brain injuries. These include conditions like bleeding within the brain, skull fractures, or significant brain swelling.
A doctor might order imaging in specific situations, even though it does not diagnose a concussion. This includes instances where symptoms are severe or rapidly worsening, if there was a prolonged loss of consciousness, or if the patient experiences persistent vomiting. Imaging is also considered when specific neurological deficits are identified during the physical examination, such as weakness on one side of the body or unequal pupil size. These scenarios indicate a need to exclude a more critical injury.