What Happens In A Concussion Diagnosis

As an athlete, you're likely to hear the word "concussion" pretty often. A concussion is a brain injury caused by a blow to the head or a force to the body that causes the brain to rattle within your skull. These sudden movements and physical contacts happen constantly in some sports, which is why concussions are most common among athletes.

According to the Centers for Disease Control and Prevention, the nearly 3.8 million concussions happening each year are related to sports. Even so, non-sports-related concussions also can happen, often caused by falls and accidents.

"It's important to note that while wearing a helmet is important for serious head injury prevention, it will not prevent concussion," said Joshua Scheidler, MD, board-certified physical medicine and rehabilitation doctor with the Franciscan Physician Network in Crown Point. “A concussion is caused by movement of the brain within the skull from acceleration-deceleration injuries caused by things like whiplash, tackling, and blast injuries in addition to direct impacts to the skull.”

While it's crucial to visit a doctor for an injury to your head or a brain-rattling blow to your body, it's also important to understand the process of a concussion diagnosis. Dr. Scheidler explains how you can be prepared for the testing process if you think you or someone you know may have a concussion.

What Type Of Doctor Diagnoses A Concussion?

Many types of doctors can diagnose a concussion or treat concussion patients. These include:

• Emergency medicine
• Pediatrics
• Family medicine
• Internal medicine
• Sports medicine and orthopedics
• Neurology
• Neurosurgery
• Physical medicine
• Rehabilitation
• Physical medicine and rehabilitation
• Physiatry

What Should Patients Expect From The Concussion Diagnosis Process?

The process of a concussion diagnosis can be very in-depth as providers need to review your mind and how well it controls your body.

"The key components of a concussion test include a detailed medical history review and a physical exam, which include a full cognitive, neurologic, and balance test," Dr. Scheidler said.

Dr. Scheidler explains that commonly utilized forms include:

• Standardized Assessment of Concussion (SAC)
• Acute Concussion Evaluation (ACE)
• Sport Concussion Assessment Tool 5th Edition (SCAT5)

"Fairly often, the questionnaires and standardized forms that cover a person's orientation, mental status, balance, and symptom self-report checklists are also used for screening in the sports setting or before seeing a physician in the office or ER,” he said.

What Questions Should Patients Be Prepared To Answer During A Concussion Test?

"The most important questions for concussion diagnosis are the ones that get the details of the injury from the patient or witnesses," Dr. Scheidler said. "These Important details include the cause of the injury such as a motor vehicle accident, fall, collision with another person or object, speed and the patient's memories of the injury, including any surrounding events."

Dr. Scheidler explains that while many concussion-related symptoms can be recognized at home, associated new symptoms will be reviewed by your provider. These symptoms can include:

• Loss of consciousness
• Changes in thinking, such as confusion or slowed thinking
• Trouble with memory and concentration
• Headaches
• Neck pain,
• Vision changes
• Nausea and vomiting
• Balance problems
• Light and sound sensitivity
• Change in emotions such as irritability, nervousness and sadness
• Drowsiness

"Finally, the physician will want to rule out other conditions that would cause such symptoms, including alcohol or drug intoxication, post-traumatic stress disorder, or other injuries," Dr. Scheidler said. 

Are Concussion Symptoms Immediate Or Delayed?

"Concussion symptoms are usually immediate, but some can progress or worsen over time," Dr. Scheidler said.

Due to the possibility of symptoms worsening, staying in the hospital for observation is often crucial in more severe cases of concussion or when a responsible adult cannot watch the patient for some time after the injury, Dr. Scheidler said.

High-risk conditions for worsening symptoms include:

• A seizure associated with the injury
• The patient is on anticoagulation or has a history of bleeding disorder
• When a significant abnormality is noted on imaging
• When the patient has a depressed level of consciousness or more severe disorientation 

"Coaches and school athletic departments should be trained in recognizing a concussion and must be supportive of athletes being removed from play at least for the duration of the game when a concussion is suspected," Dr. Scheidler said.

How Long Does A Mild Concussion Last?

While a normal recovery highly depends on your symptoms and their severity, a typical duration for symptoms is one to two weeks for adults and two to four weeks for children and adolescents, Dr. Scheidler said.

"80 to 90% of athletes, for example, will have a resolution of their concussion symptoms within seven to 10 days," Dr. Scheidler said. "Patients with more persistent symptoms, spanning four to six weeks, may have post-concussion syndrome and should see a concussion and traumatic brain injury specialist, such as a neurologist or physical medicine and rehabilitation physician."

Still, in most cases, the patient's primary care physician will be able to manage most cases of concussion, Dr. Scheidler said.

What Happens If A Concussion Goes Untreated?

Even though many athletes will have a support system under their school to respond to injuries, a concussion that occurs at home has a higher chance of being left untreated. Still, what happens if a concussion is left alone or the symptoms aren't recognized?

"Most concussions will heal on their own without specific treatment. Still, if a patient does not allow the concussion to heal before returning to high-risk activities and then suffers another concussion before full recovery, they can risk serious neurological injury or death," Dr. Scheidler said. "Patients who do not fully recover in the expected time period yet do not receive treatment may be impacted in their everyday function if their post-concussive syndrome is not addressed."

What Tests Can Detect A Concussion?

"A concussion is a clinical diagnosis, meaning a clinician must diagnose the condition based on a history and physical exam," Dr. Scheidler said.

CT and occasionally MRI imaging can be required due to the following:

• Risk of more serious head or brain trauma
• Difficulty speaking
• Facial weakness
• More serious or progressive mental status change
• Age 60 years old or older
• Two or more episodes of vomiting
• Patients taking blood thinners or with a history of bleeding condition
• Seizures associated with the injury
• Very high-impact trauma
• Signs of skull fracture
• Lack of memory 30 minutes or more before the injury

"While there is active and promising research into diagnostic tests for concussion, including blood laboratory studies, currently none are validated for everyday use," Dr. Scheidler said.

How Long Do Concussion Tests Usually Take?

As complex as concussion tests may seem, the time it takes for a complete test is usually brief, depending on the circumstances.

"Typical testing for a simple concussion may take only five to 10 minutes but can take longer if more testing is needed," Dr. Scheidler said.

What Are The Main Components Of A Follow-Up Concussion Test?

Follow-up concussion tests are done to check for symptom improvements or persistence. Dr. Scheidler explains that these follow-up tests will involve elements of the tests from your previous visit.

"Usually, a self-report symptom questionnaire will be administered to assess for ongoing symptoms," Dr. Scheidler said. "Rarely, more extensive neuropsychological testing may be needed, usually if cognitive symptoms are persisting for more than 30 days after the injury."

What Should A Patient With A Concussion Do To Recover Following A Doctor Visit?

While the process of a concussion test and diagnosis can be concerning to many, the recovery stage is usually straightforward, gradually returning athletes back to their sport.

Dr. Scheidler said that the outcome following a concussion diagnosis is usually good, with notable recovery.

"The most important element of recovery is mental and physical relative rest for one to three days after the injury followed by a gradual return to activity," Dr. Scheidler said. "Not only can patients resume low-impact, low-intensity aerobic activity such as stationary cycling or walking, but this type of early return to light activity may improve recovery times."

Dr. Scheidler suggests "sub-threshold activity" for recovering patients, which means you'll be able to do activities that don't threaten your health, worsen the symptoms you're currently facing or produce new symptoms. As your symptoms continue to improve, you can begin to increase your activities as long as they don't significantly worsen your symptoms.

"Athletes will have a more structured return to play program that involves a step-wise return to more vigorous activities and eventually return to play," Dr. Scheidler said. "It's important to avoid high-risk activities during the recovery period, such as contact sports, high-speed activities, or activities that could result in a fall. A second injury while still recovering from the first can result in a more serious injury."

A healthy diet, adequate sleep and avoiding alcohol, drugs, tobacco, or excessive caffeine can help maximize recovery.