Probably the most commonly known traumatic brain injury is a concussion. This usually means to most people that someone has been hit in the head, may have lost consciousness temporarily and may have a headache and be somewhat confused afterwards. In sports, a player can be hit on the head and it is said he had his “bell rung.” In fact, there is a spectrum of injuries that could be called concussions, and each of them needs to be taken seriously.

The term concussion may be used for mild TBI, but there are still differences in severity regardless of what the injury is called. Concussion is usually the term used by athletes, including students playing sports as well as adults, whether they are participating for fun or are professional athletes.

There is a system to grade concussions. This system, from the American Academy of Neurology, is used for sports injuries, but could be applied to any other cause of head trauma. A Grade 1 concussion can include transient confusion, but no loss of consciousness. The duration of mental status abnormalities on examination resolve in less than 15 minutes. A Grade 2 concussion also can include transient confusion but no loss of consciousness. However, concussion symptoms or mental status abnormalities on examination can last more than 15 minutes. A Grade 3 Concussion includes any loss of consciousness, either brief (seconds) or prolonged (minutes).

Most of the time, people with mild concussions do not have a lot to be seen on the outside. Anyone who has hit their head, or been hit in the head by another person or object, and has symptoms, has a concussion. Symptoms include headache, confusion, grogginess, dizziness, nausea and vomiting. Memory loss may include forgetting the accident and events immediately before or afterwards. If the person has lost consciousness for any amount of time, the injury is more serious. The longer the person is unconscious, the more serious the injury. Usually someone who is still unconscious will get medical attention, probably at the scene, with ambulance transport to a hospital.

But those that are briefly unconscious may not receive medical attention promptly, or even at all. It is common practice that athletes who get hit in the head go right back into the game if they seem okay. They just try to shake off the injury. Not only may they have a brain injury already, they are more likely to get injured again because of even minor impairment from the first injury.

Anyone suffering a blow to the head with any symptoms needs to be evaluated by a physician. If the symptoms are mild, they do not need to be taken immediately to an emergency room but can be driven by automobile to a doctor’s office. If there has been loss of consciousness or the symptoms are more severe, they need to get to an emergency room. The same is true if the symptoms don’t seem to be serious, but get worse over time.

Difficulties after a concussion have been called postconcussion syndrome. These can occur even after a minor brain injury, can persist for some time, and can even appear days to weeks after a concussion. As with concussion itself, there is debate, not just about the terminology, but about exactly what kind of brain injury concussion represents. However, it is clear that some patients have symptoms and deficits after concussions.

Some of the symptoms of postconcussion syndrome include headache, fatigue, dizziness, light-headedness, drowsiness, nausea and vomiting, blurred vision, problems with memory, problems with concentration and attention, depression, anxiety, irritability, insomnia, complaints about other physical symptoms, intolerance to noise, light and alcohol.

As many as 50% of patients with concussion have some degree of post-concussion syndrome. Most of these problems will resolve, but a minority, perhaps 15%, will have ongoing difficulties, including problems with information processing, attention, and concentration, can be a cause of disability preventing a return to work. Their physical symptoms can also be a cause of disability.

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