Concussion

Last reviewed: 9 Nov 2022
Last updated: 18 Nov 2022

Summary

Definition

History and exam

Key diagnostic factors

  • direct blow to the head or deceleration of the head from an impulsive force
  • previous brain trauma or alcohol misuse
More key diagnostic factors

Other diagnostic factors

  • headache
  • feeling foggy/slow
  • dizziness/balance problems
  • memory difficulties
  • vomiting/nausea
  • normal physical neurologic exam
  • abnormalities on neuropsychological testing
Other diagnostic factors

Risk factors

  • previous brain trauma
  • alcohol and drug misuse
  • poor neck strength
More risk factors

Diagnostic investigations

1st investigations to order

  • CT head
More 1st investigations to order

Investigations to consider

  • MRI head
  • functional MRI (fMRI)
More investigations to consider

Emerging tests

  • PET, single-photon emission CT (SPECT) of head
  • alternative imaging techniques
  • anatomic brain imaging techniques

Treatment algorithm

ACUTE

all patients

Contributors

Authors

Luke C. Henry, PhD
Luke C. Henry

Assistant Professor

Department of Neurological Surgery

Senior Clinical Neuropsychologist

University of Pittsburgh

Pittsburgh

PA

Disclosures

LCH declares that he has no competing interests.

Maria Twichell, MD

Assistant Clinical Professor

Director

General Rehabilitation Unit

UPMC Physical Medicine and Rehabilitation

University of Pittsburgh Medical Center

Pittsburgh

PA

Disclosures

MT declares that she has no competing interests.

Acknowledgements

Dr Luke C. Henry and Dr Maria Twichell would like to gratefully acknowledge Dr Jeffrey Bazarian and Dr Maryse Lassonde, previous contributors to this topic.

Disclosures

JB has been reimbursed by Roche, the manufacturer of an automated assay for serum S-100B, to attend a conference, and has been reimbursed by Banyan Biomarkers and Neuren Pharmaceuticals to help develop their research protocols. JB is also an author of a reference cited in this topic. ML is an author of several references cited in this topic.

Peer reviewers

Eirik Helseth, MD, PhD

Professor and Consultant

Department of Neurosurgery

Ulleval University Hospital

Oslo

Norway

Disclosures

EH declares that he has no competing interests.

Margot Putukian, MD

Director of Athletic Medicine

Princeton University

Princeton

NJ

Disclosures

MP is an author of a reference cited in this topic.

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