What is a concussion?

The definition of concussion is evolving thanks to an increase in awareness, funding and  research into concussion diagnosis and rehabilitation.

In the UK In 2016-17, there were 155,919 admissions for head injury. That equates to 427 every day, or one every three minutes.

Men are 1.5 times more likely than women to be admitted for head injury. However, female head injury admissions have risen 23% since 2005-6.

http://www.headway.org.uk

The current concussion definition comes from the Berlin Consensus Guidelines in 2016. The Concussion in Sport Guidelines (CISG)* also summarises each topic and recommendations in the context of all five CISG meetings (that is, 2001, 2004, 2008, 2012 as well as 2016). Approximately 60 000 published articles were screened by the expert panels for the Berlin meeting.

Concussion is a traumatic brain injury induced by biomechanical forces. Several common features that may be utilised in clinically defining the nature of a concussive head injury include:

1, Caused either by direct blow to the head, face, neck or elsewhere on the body with an ‘impulsive’ force transmitted to the head.

2, Typically results in the rapid onset of short lived impairment of neurological function that resolves spontaneously.

3, It may result in neuropathological changes but the acute clinical symptoms largely reflect a functional disturbance rather than structural abnormality.

4, There are a set of clinical symptoms, which resolve in a sequential course, however in some cases may be prolonged.

This awareness and level of research into sport related concussions has enabled the development of multidisciplinary concussion assessments and improved our management and guidelines. It may be surprising to know that this is not the only type of patients we see and in the clinical setting we are seeing more and more concussion injuries from other causes, such as motor vehicle accidents, home and work based injuries. Some have started as a simple ‘I bumped my head on cupboard door’ or ‘the dog ran into me and knocked me down’ and so it pays to be vigilant to the signs and symptoms of a concussion after any type of accident, even if there is no obvious direct impact to the head. We will explore ‘the signs and symptoms of a concussion’ in the next blog.

* https://bjsm.bmj.com/content/bjsports/early/2017/04/28/bjsports-2017-097699.full.pdf

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