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| {{Concussion}} | | {{Concussion}} |
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| ==Diagnosis== | | ==[[Concussion overview|Overview]]== |
| Diagnosis of MTBI is based on physical and neurological exams, duration of unconsciousness (usually less than 30 minutes) and post-traumatic amnesia (PTA; usually less than 24 hours), and the Glasgow Coma Scale (MTBI sufferers have scores of 13 to 15).<ref name="BorgHolm04"/> [[Neuropsychological test]]s exist to measure cognitive function.<ref name="Rees03"/> The tests may be administered hours, days, or weeks after the injury, or at different times to determine whether there is a trend in the patient's condition.<ref name=moser>
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| | ==[[Concussion historical perspective|Historical Perspective]]== |
| cite journal|author=Moser RS, Iverson GL, Echemendia RJ, Lovell MR, Schatz P, Webbe FM ''et al.'' |date=2007 |title=Neuropsychological evaluation in the diagnosis and management of sports-related concussion |journal=Archives of Clinical Neuropsychology |volume=22 |issue=8 |pages=909–916 |pmid=17988831
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| | ==[[Concussion classification|Classification]]== |
| </ref> Athletes may be tested before a sports season begins to provide a baseline comparison in the event of an injury.<ref name="pmid10981754">
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| | ==[[Concussion pathophysiology|Pathophysiology]]== |
| cite journal |author=Maroon JC, Lovell MR, Norwig J, Podell K, Powell JW, Hartl R |title=Cerebral concussion in athletes: Evaluation and neuropsychological testing |journal=Neurosurgery |volume=47 |issue=3 |pages=659–669; discussion 669–672 |year=2000 |pmid=10981754 |doi= |url=
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| | ==[[Concussion causes|Causes]]== |
| </ref>
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| | ==[[Concussion differential diagnosis|Differentiating Concussion from other Diseases]]== |
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| [[Image:Anizokoria.JPG|left|thumb|230px|Unequal pupil size is a sign of a brain injury more serious than concussion.]]
| | ==[[Concussion epidemiology and demographics|Epidemiology and Demographics]]== |
| Health care providers examine head trauma survivors to ensure that the injury is not a more severe [[medical emergency]] such as an intracranial hemorrhage. Indications that screening for more serious injury is needed include worsening of symptoms such as headache, persistent vomiting,<ref name="CookSchweer">
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| cite journal |author=Cook RS, Schweer L, Shebesta KF, Hartjes K, Falcone RA |title=Mild traumatic brain injury in children: Just another bump on the head? |journal=Journal of Trauma Nursing |volume=13 |issue=2 |pages=58–65 |year=2006 |pmid=16884134 |doi=
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| </ref> increasing disorientation or a deteriorating level of consciousness,<ref name="Kayteasdale">
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| cite journal |author=Kay A, Teasdale G |title=Head injury in the United Kingdom |journal=World Journal of Surgery |volume=25 |issue=9 |pages=1210–1220 |year=2001 |pmid=11571960 |doi=10.1007/s00268-001-0084-6 |url=
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| </ref> [[post-traumatic seizure|seizure]]s, and [[anisocoria|unequal pupil size]].<ref name="cdcfacts">
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| cite web|publisher=Centers for Disease Control and Prevention |date=2006 |url=http://www.cdc.gov/ncipc/tbi/contents.htm |title=Facts About Concussion and Brain Injury |accessdate=2008-01-13
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| </ref> Patients with such symptoms, or who are at higher risk for a more serious brain injury, are given [[Magnetic resonance imaging|MRI]]s or [[CT scan]]s to detect brain lesions and are observed by medical staff.
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| Health care providers make the decision about whether to give a CT scan using the Glasgow Coma Scale.<ref name="pmid17215534">
| | ==[[Concussion risk factors|Risk Factors]]== |
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| cite journal |author=Ropper AH, Gorson KC |title=Clinical practice. Concussion |journal=New England Journal of Medicine |volume=356 |issue=2 |pages=166–172 |year=2007|url=http://content.nejm.org/cgi/content/full/356/2/166 |pmid=17215534 |doi=10.1056/NEJMcp064645 |pmid=17215534
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| </ref> In addition, they may be more likely to perform a CT scan on people who would be difficult to observe after discharge or those who are [[intoxication|intoxicated]], at risk for bleeding, older than 60,<ref name="pmid17215534"/> or younger than 16. Most concussions cannot be detected with MRI or CT scans.<ref name="Poirier">
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| cite journal |author=Poirier MP |year=2003 |url= |title=Concussions: Assessment, management, and recommendations for return to activity ([http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75BD-49H1C2F-7&_user=3356446&_origUdi=B6VDJ-44KHFBN-8&_fmt=high&_coverDate=09%2F30%2F2003&_rdoc=1&_orig=article&_acct=C000060332&_version=1&_urlVersion=0&_userid=3356446&md5=9c2a61c0c62684c26cf317a8ea637458 abstract]) |journal=Clinical Pediatric Emergency Medicine |volume=4 |issue=3 |pages=179–185 |doi=10.1016/S1522-8401(03)00061-2
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| <!--abstract linked with url because doi doesn't take you right to it. no PMID found--></ref> However, changes have been reported to show up on MRI and SPECT imaging in concussed people with normal CT scans, and [[post-concussion syndrome]] may be associated with abnormalities visible on [[single photon emission computed tomography|SPECT]] and [[Positron emission tomography|PET scan]]s.<ref name="Iverson2005"/> Mild head injury may or may not produce abnormal [[Electroencephalography|EEG]] readings.<ref name="Binder86">
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| cite journal |author=Binder LM |title=Persisting symptoms after mild head injury: A review of the postconcussive syndrome |journal=Journal of Clinical and Experimental Neuropsychology|volume=8 |issue=4 |pages=323–346 |year=1986 |pmid=3091631 |doi=10.1080/01688638608401325
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| </ref>
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| Concussion may be under-diagnosed. The lack of the highly noticeable signs and symptoms that are frequently present in other forms of head injury could lead [[clinician]]s to miss the injury, and athletes may cover up their injuries in order to be allowed to remain in the competition.<ref name="BarthVarney99"/> A retrospective survey in 2005 found that more than 88% of concussions go unrecognized.<ref name="Delaney">
| | ==[[Concussion natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| cite journal |author=Delaney JS, Abuzeyad F, Correa JA, Foxford R |title=Recognition and characteristics of concussions in the emergency department population |journal=Journal of Emergency Medicine |volume=29 |issue=2 |pages=189–197 |year=2005 |pmid=16029831 |doi=10.1016/j.jemermed.2005.01.020
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| </ref>
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| Diagnosis of concussion can be complicated because it shares symptoms with other conditions. For example, post-concussion symptoms such as cognitive problems may be misattributed to brain injury when they are in fact due to [[post-traumatic stress disorder]] (PTSD).<ref name="Bryant08"/> | | ==Diagnosis== |
| | [[Concussion diagnostic criteria|Diagnostic Criteria]] | [[Concussion history and symptoms|History and Symptoms]] | [[Concussion physical examination|Physical Examination]] | [[Concussion CT|CT]] | [[Concussion MRI|MRI]] | [[Concussion other imaging findings|Other Imaging Findings]] | [[Concussion other diagnostic studies|Other Diagnostic Studies]] |
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| ==Dementia pugilistica== | | ==Treatment== |
| | [[Concussion medical therapy|Medical Therapy]] | [[Concussion primary prevention|Primary Prevention]] | [[Concussion secondary prevention|Secondary Prevention]] | [[Concussion cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Concussion future or investigational therapies|Future or Investigational Therapies]] |
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| {{main|Dementia pugilistica}}
| | ==Case Studies== |
| Chronic [[encephalopathy]] is an example of the cumulative damage that can occur as the result of multiple concussions or less severe blows to the head. The condition called [[dementia pugilistica]], or "punch drunk" syndrome, which is associated with boxers, can result in cognitive and physical deficits such as [[parkinsonism]], speech and memory problems, slowed mental processing, tremor, and inappropriate behavior.<ref name="Mendez">
| | [[Concussion case study one|Case #1]] |
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| cite journal |author=Mendez MF |title=The neuropsychiatric aspects of boxing |journal=International Journal of Psychiatry in Medicine |volume=25 |issue=3 |pages=249–262 |year=1995 |pmid=8567192 |doi=
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| </ref> It shares features with Alzheimer's disease.<ref name="Jordan00">
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| cite journal |author=Jordan BD |title=Chronic traumatic brain injury associated with boxing |journal=Seminars in Neurology |volume=20 |issue=2 |pages=179–85 |year=2000 |pmid=10946737 |doi=10.1055/s-2000-9826
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| </ref>
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| ===Second-impact syndrome===
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| {{main|Second-impact syndrome}}
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| Second-impact syndrome, in which the brain swells dangerously after a minor blow, may occur in very rare cases. The condition may develop in people who receive a second blow days or weeks after an initial concussion, before its symptoms have gone away.<ref name="Bowen03"/> No one is certain of the cause of this often fatal complication, but it is commonly thought that the swelling occurs because the brain's [[arteriole]]s lose the ability to regulate their diameter, causing a loss of control over cerebral blood flow.<ref name=moser/> As the brain [[swelling|swells]], intracranial pressure rapidly rises.<ref name="CookSchweer"/> The brain can [[brain herniation|herniate]], and the brain stem can fail within five minutes.<ref name="Bowen03"/> Except in boxing, all cases have occurred in athletes under age 20.<ref name="Team"/> Due to the very small number of documented cases, the diagnosis is controversial, and doubt exists about its validity.<ref name=McCroryP01>
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| cite journal|author=McCrory P |date=2001 |title=Does second impact syndrome exist? |journal=Clinical Journal of Sport Medicine |volume=11 |issue=3 |pages=144–149 |pmid=11495318
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| </ref>
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| ==Related Chapters== | | ==Related Chapters== |
| *[[Post-concussion syndrome]] | | *[[Post-concussion syndrome]] |
| | *[[Second-impact syndrome]] |
| | *[[Dementia pugilistica]] |
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| == References ==
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| {{Reflist|2}}
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| {{Injuries, other than fractures, dislocations, sprains and strains}} | | {{Injuries, other than fractures, dislocations, sprains and strains}} |