Guidelines to follow up patient with concussion

Concussion (commotio cerebri) is a temporary symptom of the brain caused by a trauma to a head, without permanent tissue damage. Concussion may be a result of a fall, slip, trauma/impact or blow to a head.

Symptoms

Impact or trauma to a head may cause decreased level of consciousness which lasts from few minutes to half an hour. It might also cause sleepiness and temporary memory loss. Other symptoms may include problems with balance, problems with vision, headache and tiredness. Patient can also have severe vomiting but the symptoms usually get easier in a few hours. Problems with memory and concentration may occur. It is also possible that there are light headache, dizziness, and nausea for a week. Concussion usually does not cause problems with brain function afterwards.

Treatment

The most important issue when treating a patient with concussion is to follow up the level of consciousness and coherency of speech. Also the patient should be oriented to place an time and the reaction of pupils and mobility of the limbs should be normal. Also the level of headache and nausea should be monitored. Patient with mild symptoms of a concussion does not necessarily need doctor check up, but the level of consciousness and the condition as a hole should be monitored at home, day and night. Every three- to-four-hour patient should be talked to, also during the night, in order to detect possible changes in the level of consciousness. Observe how the patient reacts and for example how the patient wakes up and does the patient answer coherently to questions. If patient is vomiting, small portions can be eaten, preferably liquid type of food. Bed rest is advised only in the beginning.

Children

A child with concussion is usually sleepy/drowsy in the beginning. The child should be awaken in every three hours during the first night. Also the child should answer coherently to questions. Bed rest, lifting up the head-end of the bed and painkillers should be remembered. Guidelines concerning painkillers should be followed according to the doctor’s prescription. If the symptoms are very mild or there are almost no symptoms of the concussion, there is no need for bed rest. Child can move around and be mobile according to the symptoms, as soon as she/he can. If there are no symptoms on the following morning the child is able to attend school or kindergarten. If the child has symptoms, he/she should be taken to doctor.

If a patient suffering from concussion is elderly or under an influence of alcohol the follow up has to be more careful. After concussion the person should avoid physical exercise, driving a car, avoid too much computer games and enjoying alcohol or other intoxicating substances.

When to a doctor

Patient has to be taken to a doctor if the symptoms get worse or the following symptoms occur: The level of consciousness decreases remarkably or the patient is unconscious. Other symptoms include: Confusion/incoherent behaviour, abnormal sleepiness, strong headache, abnormal speech, symptoms of a stroke, asymmetric pupils, abnormal mobility and movement, persistent vomiting and dizziness. The patient might also feel difficult to wake up. If the symptoms come back in weeks or months, the patient should meet a doctor.

The emergency number is 112.

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