Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The signs and symptoms of concussion may be obvious or subtle. Much of the
experience in caring for mild head injuries comes from the treatment of sports
injuries. Football, hockey, and soccer have high potential for head injury, and
player research has given insight into what symptoms may occur.
While dramatic, loss of consciousness or
seizure are not common in concussion
and do not predict severity. More common are mild
confusion and disorientation.
Symptoms tend not to be objective and may be hard to describe. As well, they may
be delayed for many hours after injury, and sometimes the initial injury may
have been forgotten or discounted.
Since, by definition, concussion does not damage the structure of the brain,
the physical examination should be normal. More subtle findings may include:
Slow to answer questions or follow directions
Poor concentration
Emotional lability (emotional changes or instability)
Slurred speech
Personality changes
How is concussion diagnosed?
Physical Examination and Testing
History and physical examination are crucial to making the diagnosis of
concussion.
Understanding the mechanism of injuries allows the healthcare provider to
decide if further radiologic testing is required. A normal neurologic
examination is somewhat reassuring that no major structural injuries to the
brain have occurred.
Glasgow Coma Score (GCS)
The GCS was developed to quickly assess a patient's neurologic status based
on speech, eye opening, and movement. The scale is used as part of the initial
evaluation of a patient. Since it "scores" the level of
coma, the GCS can be
used by healthcare providers with different skill levels to assess changes in
patient status.
Glasgow Coma Scale
Eye Opening
Spontaneous
4
To loud voice
3
To pain
2
None
1
Verbal Response
Oriented
5
Confused, Disoriented
4
Inappropriate words
3
Incomprehensible words
2
None
1
Motor Response
Obeys commands
6
Localizes pain
5
Withdraws from pain
4
Abnormal flexion posturing
3
Extensor posturing
2
None
1
Computerized Tomography (CT scan)
Not everyone who has sustained a blow to the head needs a
CT scan. The
Canadian Head CT Rules were developed to minimize the number of brain scans that
were done with little chance of finding bleeding in the brain and requiring an
operation. There is no need for CT scanning if none of the following high or medium
risk criteria are met.
Any sign of basal skull fracture [blood behind the eardrum, "raccoon eyes" or
bruising around the eyes, cerebrospinal fluid leaking from the nose or ears,
or Battle's sign (bruising behind the ear)]
Amnesia before impact >30 minutes - This refers to loss of memory prior
to the trauma (retrograde amnesia).
Amnesia can be retrograde (loss of memory of events prior to
the injury) and antegrade (where the person cannot remember
events that have occurred after he injury). Antegrade amnesia is common
and not an indicator of significant brain trauma. Retrograde amnesia of
more than 30 minutes is a risk for brain bleeding.
Dangerous mechanism of injury (pedestrian struck by motor vehicle, occupant
ejected from motor vehicle, fall from height >3 feet or five stairs)
These indications are valid for those patients aged 2 to 65.
X-rays of the skull are not indicated in minor head trauma, since normal
x-rays do not correspond to a normal brain.
Since concussion is defined as a temporary change in brain function, it is
important to examine the patient on more than one occasion. Brain function may
or may not correlate with the resolution of symptoms. Neuropsychologic testing
can be used to assess brain function to decide when to allow a patient to return
to full activity.
Headaches can be divided into two categories: primary headaches and secondary headaches. Migraine headaches, tension headaches, and cluster headaches are considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Hydrocephalus is an abnormal buildup of cerebrospinal fluid (CSF) in the ventricles of the brain. The fluid is often under increased pressure and can compress and damage the brain. Symptoms of hydrocephalus vary with age, progression of the disease, and individual tolerance to the condition. Hydrocephalus is most often treated by surgery in which a shunt system is inserted.
Hypothermia is having a body core temperature of less than 35 C or 95 F. Most causes of hypothermia are preventable. Risk factors for hypothermia include age, mental status, medical conditions, and medications. Symptoms of hypothermia generally depend upon the severity of the condition. Treatment depends upon the severity of hypothermia. If not treated early, hypothermia can lead to cardiac arrest, coma, or death.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
In the United States, head injuries are one of the most common causes of death and disability. Head injuries due to bleeding are generally classified by the location of the blood within the scull, these include: epidural hematoma, subdural hematoma, subarachnoid bleed, intracranial bleed, sheer injury, edema, and skull fracture. Some common symptoms of a head injury include: vomiting, bleeding from the ear, speech difficulties, paralysis, difficulty swallowing, and body numbness. Treatment of a head injury depends on the type and severity of the injury.
Brain lesions (lesions on the brain) are caused by trauma, inflammation, autoimmune diseases, cancers, other diseases, stroke, bleeding, pituitary adenomas, and cerebral palsy. Symptoms of brain lesions include headache, nausea, fever, neck pain and stiffness, affected vision and speech, weakness or paralysis to one side of the body. Diagnosis of brain lesions is generally with imaging studies like CT or MRI scans. Treatment and prognosis of brain lesions depends on the cause of the lesion.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
First aid is a complicated subject and it is situation-specific. First aid is the help and medical assistance that someone gives, not only to an injured person, but to a person who is sick. Preparedness is a key element of first aid, like having basic medical emergency kits in your home, car, boat, or RV. Cuts, puncture wounds, sprains, strains, nosebleeds are one type of injury that may require first aid; heart attacks, strokes, seizures, and heat stroke are examples of more critical first aid emergencies.
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