A concussion is a traumatic brain injury resulting from a blow or jolt to the head or body, causing the brain to move rapidly inside the skull. This movement initiates chemical and metabolic changes that temporarily disrupt normal brain function. While concussions are common, the vast majority of cases resolve spontaneously within a few weeks with rest. For a significant minority, however, symptoms can linger or worsen, indicating a need for specialized medical attention. Knowing when to escalate care to a neurologist is important for recovery.
Immediate Care: When to Seek Emergency or Primary Care
The first 24 to 48 hours following a head injury carry the highest risk of serious complications, making immediate triage necessary. Certain severe warning signs, often called “red flags,” necessitate an immediate visit to the Emergency Room (ER) for stabilization and imaging. These signs point toward potentially dangerous internal bleeding or swelling within the skull.
An ER visit is warranted for any person experiencing repeated vomiting, a seizure, slurred speech, or a headache that progressively worsens. Other concerning symptoms include weakness or numbness on one side of the body, difficulty waking up, or if one pupil appears significantly larger than the other. Loss of consciousness for more than a brief period also requires immediate emergency evaluation to rule out a severe intracranial injury.
If no “red flag” symptoms are present, initial assessment can be handled by a primary care physician or urgent care center. Common, non-emergency symptoms include mild dizziness, a temporary feeling of fogginess, sensitivity to light or noise, or a minor headache. A medical provider will perform a basic neurological exam and provide guidance on cognitive and physical rest. A diagnosis of a mild concussion is often made at this stage, with the expectation that symptoms will clear up within one to two weeks.
Indicators Requiring Neurologist Consultation
When recovery deviates from the expected timeline, a referral to a neurologist becomes necessary for specialized management. The primary indicator for consultation is symptom persistence, especially if symptoms fail to resolve within the typical recovery window of 7 to 14 days for adults. This extended duration is often defined as Post-Concussion Syndrome (PCS), which requires targeted intervention.
A worsening or complex presentation of symptoms also elevates the need for specialist input. This includes severe or persistent balance issues that continue past the initial injury phase, suggesting a possible issue with the vestibular system. Similarly, new or worsening focal neurological signs, such as changes in coordination or unusual muscle weakness, require a neurologist’s expertise.
Significant cognitive impairment, such as difficulty with concentration, memory retrieval, or executive function that interferes with school or work, is another trigger for referral. Sleep disturbances, including chronic insomnia or excessive daytime sleepiness, are complex symptoms a neurologist can address through specialized diagnostic testing and pharmacological plans. These persistent issues indicate an ongoing disruption to the brain’s regulatory networks that requires advanced care.
A patient’s medical history can also lower the threshold for early neurological consultation, even with mild symptoms. Individuals who have experienced multiple concussions, particularly in quick succession, are at higher risk for prolonged recovery and should be managed by a specialist. Pre-existing conditions, such as a history of migraines, anxiety, depression, or ADHD, are known to complicate recovery, making early specialized oversight beneficial.
Specialized Neurological Evaluation and Treatment Planning
Once referred, the neurologist conducts a comprehensive assessment aimed at pinpointing the specific physiological systems affected. The diagnostic process often involves specialized neurocognitive assessments to objectively measure deficits in reaction time, processing speed, and memory. These tests provide a measurable baseline and track improvements or declines over time, guiding the individualized treatment plan.
Advanced diagnostic tools evaluate specific neurological subsystems that may be damaged. For example, a Videonystagmography (VNG) or Vestibular-Ocular Reflex (VOR) test may be performed to assess the eye movement and inner ear systems responsible for balance and gaze stability. Computerized Dynamic Posturography is used to quantify balance deficits by measuring how the patient uses visual, vestibular, and somatosensory information to maintain equilibrium.
While initial CT or MRI scans rule out acute structural injury like a hemorrhage, the neurologist may order advanced imaging like functional MRI (fMRI) or Diffusion Tensor Imaging (DTI) to look for subtle changes. These techniques can reveal metabolic dysfunction or microstructural damage in the white matter tracts of the brain not visible on standard scans. This detailed system analysis allows the neurologist to create a precise, targeted treatment protocol.
Treatment planning focuses on rehabilitation and symptom management, moving toward active recovery. Targeted cognitive rehabilitation is prescribed to help patients relearn or compensate for specific cognitive deficits identified in the assessments. If the vestibular system is implicated, the patient will be referred for Vestibular Rehabilitation Therapy (VRT) to address dizziness and balance problems. The neurologist also manages pharmacological treatments, including medications for post-traumatic migraines, severe sleep disorders, or mood disturbances that often accompany prolonged recovery.