Medical Follow-Up: Concussion

200-jorgeExperts: Dr. Jorge Gomez, sports medicine specialist at Texas Children’s Hospital West Campus, along with Dr. Kristin Ernest, answer some questions about concussions.


Q: My child received a blow to the head during a game. When should he see a physician?

An athlete who suffers a blow to the head should be evaluated by a physician within 48 hours if the athlete has any of the following symptoms: headache, dizziness, blurred vision, disorientation, slowed speech or thinking, difficulty concentrating or remembering, excessive fatigue or drowsiness. These may be symptoms of a serious head injury, such as bleeding in the skull or brain. The primary care or emergency room physician will look for factors that increase the likelihood of bleeding in the head, including loss of consciousness longer than one minute, worsening of symptoms as opposed to gradual improvement of symptoms, which is a hallmark of a concussion, and focal neurological findings such as abnormalities of strength, sensation or reflexes on one side of the body but not the other side.

Any of these findings may warrant imaging of the head – a computerized tomography (CT) scan if less than 48 hours after the head injury or a magnetic resonance imaging (MRI) if more than 48

Texas Children’s Hospital West Campus. Photo by A. Kramer.

Texas Children’s Hospital West Campus. Photo by A. Kramer.

hours after the injury. If the young athlete’s head injury symptoms are improving, he has not suffered prolonged loss of consciousness and has a non-focal (symmetrical) neurological examination, it is very likely he has a concussion and does not require imaging. If the physician decides to order a CT or MRI and the results are normal, the physician will likewise conclude that the athlete has a concussion.

Q: The physician has determined my child has a concussion. How does my athlete recover?

The athlete should not participate in athletic activity or exercise besides normal walking, use of electronics should be minimal, and school modifications should be taken to minimize symptoms and reduce the amount of mental work the athlete has to do. The athlete should get a good night’s sleep.

The athlete should be encouraged to return to school as soon as possible with the above modifications and should be seen weekly until completely recovered. At these weekly visits, the health care provider should ask about symptoms and administer tests of orientation, concentration, memory and balance.

Computerized neuropsychological testing such as ImPACT, BrainCheck and Cogsport rarely adds any useful information while the athlete still has symptoms of a concussion. These tests are most useful when the athlete is no longer reporting symptoms and the physician seeks additional information to determine that the athlete has completely recovered.

For more information about sports medicine care at Texas Children’s Hospital West Campus, call 832-227-1000 or visit westcampus.texaschildrens.org.


References:

McCrory P, Meeuwisse WH, Aubry M, et al.  Consensus statement on concussion in sport: the 4th international conference on concussion in sport held in Zurich, November 2012. British Journal of Sports Medicine 2013; 47: 250-258.

Giza CC, Kutcher JS, Ashwal S, et al.  Summery of evidence-based guideline update: evaluation and management of concussion in sports: report of the guideline development subcommittee of the American Academy of Neurology. Neurology 2013; 80: 2250-2257.